PURPOSE: Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. METHODS: We conducted a prospective cohort study to examine the association of lifestyle factors, focusing on physical activity, with risk of incident major osteoporotic fracture and osteoporosis in 2152 HR+ BC patients diagnosed from 2006 to 2013 at Kaiser Permanente Northern California and who received AIs. Patients self-reported lifestyle factors at study entry and at 6-month follow-up. Fracture and osteoporosis outcomes were prospectively ascertained by physician-adjudication and bone mineral density (BMD) values, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable proportional hazards regression. Models were adjusted for age, menopausal status, race/ethnicity, body mass index (BMI), AJCC stage, breast cancer treatment, prior osteoporosis, and prior major fracture. RESULTS: Over a median 6.1 years of follow-up after AI initiation, 165 women experienced an incident osteoporotic fracture and 243 women had osteoporosis. No associations were found between overall moderate-vigorous physical activity and fracture risk, although < 150 min/week of aerobic exercise in the 6 months after BC diagnosis was associated with increased fracture risk (HR=2.42; 95% CI: 1.34, 4.37) compared with ≥ 150 min/week (meeting physical activity guidelines). Risk was also higher for never or infrequently engaging in aerobic exercise (HR=1.90; 95% CI: 1.05, 3.44). None or infrequent overall moderate-vigorous physical activity in the 6 months before BC diagnosis was associated with increased risk of osteoporosis (HR=1.94; 95% CI: 1.11; 3.37). CONCLUSIONS: Moderate-vigorous physical activity during the immediate period after BC diagnosis, particularly aerobic exercise, was associated with lower risk of major osteoporotic fractures in women on AI therapy. IMPLICATIONS FOR CANCER SURVIVORS: Findings may inform fracture prevention in women on AI therapy through non-pharmacologic lifestyle-based strategies.
PURPOSE: Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. METHODS: We conducted a prospective cohort study to examine the association of lifestyle factors, focusing on physical activity, with risk of incident major osteoporotic fracture and osteoporosis in 2152 HR+ BC patients diagnosed from 2006 to 2013 at Kaiser Permanente Northern California and who received AIs. Patients self-reported lifestyle factors at study entry and at 6-month follow-up. Fracture and osteoporosis outcomes were prospectively ascertained by physician-adjudication and bone mineral density (BMD) values, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable proportional hazards regression. Models were adjusted for age, menopausal status, race/ethnicity, body mass index (BMI), AJCC stage, breast cancer treatment, prior osteoporosis, and prior major fracture. RESULTS: Over a median 6.1 years of follow-up after AI initiation, 165 women experienced an incident osteoporotic fracture and 243 women had osteoporosis. No associations were found between overall moderate-vigorous physical activity and fracture risk, although < 150 min/week of aerobic exercise in the 6 months after BC diagnosis was associated with increased fracture risk (HR=2.42; 95% CI: 1.34, 4.37) compared with ≥ 150 min/week (meeting physical activity guidelines). Risk was also higher for never or infrequently engaging in aerobic exercise (HR=1.90; 95% CI: 1.05, 3.44). None or infrequent overall moderate-vigorous physical activity in the 6 months before BC diagnosis was associated with increased risk of osteoporosis (HR=1.94; 95% CI: 1.11; 3.37). CONCLUSIONS: Moderate-vigorous physical activity during the immediate period after BC diagnosis, particularly aerobic exercise, was associated with lower risk of major osteoporotic fractures in women on AI therapy. IMPLICATIONS FOR CANCER SURVIVORS: Findings may inform fracture prevention in women on AI therapy through non-pharmacologic lifestyle-based strategies.
Entities:
Keywords:
Aerobic exercise; Alcohol; Aromatase inhibitor; Bone; Bone mineral density; Breast cancer; Diet; Endocrine therapy; Fragility fracture; Hormone therapy; Major osteoporotic fracture; Osteoporosis; Physical activity; Smoking; Vitamin supplements
Authors: Miranda E G Armstrong; Elizabeth A Spencer; Benjamin J Cairns; Emily Banks; Kirstin Pirie; Jane Green; F Lucy Wright; Gillian K Reeves; Valerie Beral Journal: J Bone Miner Res Date: 2011-06 Impact factor: 6.741
Authors: Bernhard Haring; Carolyn J Crandall; Chunyuan Wu; Erin S LeBlanc; James M Shikany; Laura Carbone; Tonya Orchard; Fridtjof Thomas; Jean Wactawaski-Wende; Wenjun Li; Jane A Cauley; Sylvia Wassertheil-Smoller Journal: JAMA Intern Med Date: 2016-05-01 Impact factor: 21.873
Authors: Lisa Langsetmo; David A Hanley; Jerilynn C Prior; Susan I Barr; Tassos Anastassiades; Tanveer Towheed; David Goltzman; Suzanne Morin; Suzette Poliquin; Nancy Kreiger Journal: Am J Clin Nutr Date: 2010-11-10 Impact factor: 7.045
Authors: Song Yao; Yali Zhang; Li Tang; Janise M Roh; Cecile A Laurent; Chi-Chen Hong; Theresa Hahn; Joan C Lo; Christine B Ambrosone; Lawrence H Kushi; Marilyn L Kwan Journal: Breast Cancer Res Treat Date: 2016-12-03 Impact factor: 4.872
Authors: Rebecca D Jackson; Andrea Z LaCroix; Margery Gass; Robert B Wallace; John Robbins; Cora E Lewis; Tamsen Bassford; Shirley A A Beresford; Henry R Black; Patricia Blanchette; Denise E Bonds; Robert L Brunner; Robert G Brzyski; Bette Caan; Jane A Cauley; Rowan T Chlebowski; Steven R Cummings; Iris Granek; Jennifer Hays; Gerardo Heiss; Susan L Hendrix; Barbara V Howard; Judith Hsia; F Allan Hubbell; Karen C Johnson; Howard Judd; Jane Morley Kotchen; Lewis H Kuller; Robert D Langer; Norman L Lasser; Marian C Limacher; Shari Ludlam; JoAnn E Manson; Karen L Margolis; Joan McGowan; Judith K Ockene; Mary Jo O'Sullivan; Lawrence Phillips; Ross L Prentice; Gloria E Sarto; Marcia L Stefanick; Linda Van Horn; Jean Wactawski-Wende; Evelyn Whitlock; Garnet L Anderson; Annlouise R Assaf; David Barad Journal: N Engl J Med Date: 2006-02-16 Impact factor: 91.245
Authors: Paul E Goss; James N Ingle; Kathleen I Pritchard; Nicholas J Robert; Hyman Muss; Julie Gralow; Karen Gelmon; Tim Whelan; Kathrin Strasser-Weippl; Sheldon Rubin; Keren Sturtz; Antonio C Wolff; Eric Winer; Clifford Hudis; Alison Stopeck; J Thaddeus Beck; Judith S Kaur; Kate Whelan; Dongsheng Tu; Wendy R Parulekar Journal: N Engl J Med Date: 2016-06-05 Impact factor: 91.245
Authors: Marilyn L Kwan; Joan C Lo; Li Tang; Cecile A Laurent; Janise M Roh; Malini Chandra; Theresa E Hahn; Chi-Chen Hong; Lara Sucheston-Campbell; Dawn L Hershman; Charles P Quesenberry; Christine B Ambrosone; Lawrence H Kushi; Song Yao Journal: PLoS One Date: 2014-10-29 Impact factor: 3.240