Originally published as JCO Early Release 10.1200/JCO.2008.17.7451 on October 27 2008

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Prevalence of Secondary Causes of Bone Loss Among Breast Cancer Patients With Osteopenia and Osteoporosis

Pauline M. Camacho, Amit S. Dayal, Josefina L. Diaz, Fadi A. Nabhan, Monica Agarwal, John G. Norton, Patricia A. Robinson, Kathy S. Albain

From the Divisions of Endocrinology and Metabolism, Hematology/Oncology Institute, and Department of Medicine, Loyola University Medical Center, Maywood, IL

Corresponding author: Pauline M. Camacho, MD, FACE, Loyola University Medical Center, 2160 S First Ave, Bldg 54, Maywood, IL 60153; e-mail: pcamach{at}lumc.edu

Purpose To determine the prevalence of secondary causes of bone loss among patients with breast cancer with osteopenia and osteoporosis.

Patients and Methods All women referred to a bone health clinic over a 6-year period for bone evaluation were included in this retrospective study and stratified based on presence or absence of a breast cancer history. The prevalence of secondary causes of bone loss in the two groups was compared.

Results Of the 238 women identified, 64 women had breast cancer. The non–breast cancer group (n = 174) was significantly older (P = .015), had a lower mean weight (P = .019), lower 25 hydroxy-vitamin D level (P = .019), and greater degree of bone loss in both the spine and hip (P < .001 and 0.004, respectively). The presence of at least one secondary cause of bone loss, excluding cancer-related therapies, was seen in 78% of the breast cancer patient group and in 77% of the non–breast cancer group (P = not significant). Newly diagnosed metabolic bone disorders were seen in 58% of the breast cancer population. The most common was vitamin D deficiency, seen in 38% of patients in the breast cancer group and 51% of patients in the non–breast cancer group. Idiopathic hypercalciuria was diagnosed in 15.6%, primary hyperparathyroidism in 1.6%, and normocalcemic hyperparathyroidism in 3.1% of the breast cancer population.

Conclusion A high prevalence of secondary causes of bone loss among patients with breast cancer supports a comprehensive evaluation in these patients, particularly those considering therapy with an aromatase inhibitor.

published online ahead of print at www.jco.org on October 27, 2008

Supported by an investigator-initiated grant from Procter and Gamble.

Presented in part at the 2007 Annual Meeting of the American Society of Bone and Mineral Research in Honolulu, HI, September 16-19, 2007.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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