Oncology Medical News about breast cancer;low bone mass

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Secondary causes of low bone mass in patients with breast cancer: a need for greater vigilance
Journal of Clinical Oncology, 06/25/09

Mann GB et al. - In a study to assess the prevalence of secondary causes of low bone density in pts with breast cancer, it was shown that secondary causes of low bone mineral density (BMD) are common in postmenopausal women. Identification and management of secondary causes should be included in bone health management algorithms.

Methods

Female pts within 5 yrs of breast cancer diagnosis and age older than 50 yrs at diagnosis were recruited.
Consenting pts completed a questionnaire and had blood taken for serum calcium, vitamin D, parathyroid hormone (PTH), and thyroid function testing.
BMD was assessed; abnormalities were additionally investigated and treated.

Results

200 pts were recruited; median age at diagnosis was 62 yrs.
169 pts had hormone receptor (HR) –positive cancer.
Vitamin D and thyroid function were assessed in 200 pts; PTH was assessed in 197 pts; and BMD was assessed in 187 pts.
87 pts (46.5%) had osteopenia, and 24 pts (12.8%) had osteoporosis.
Vitamin D levels were insufficient (ie, 50 to 75 nmol/L) in 74 pts (37%) and were deficient (ie, <50 nmol/L) in 54 pts (27%).
Only 24 of 65 pts taking vitamin D supplements were replete (ie, >75 nmol/L).
39 (21%) of 197 pts had PTH concentrations greater than the normal range.
6 had primary hyperparathyroidism (PHPT), and 2 more had recent surgery for PHPT.
27 had secondary hyperparathyroidism (HPT) from vitamin D deficiency and 6 had normocalcemic HPT.
Of 90 pts with low BMD and HR-positive cancer, 8% (7 of 90 pts) had new or recent PHPT, and 63% (57 of 90 pts) had insufficient or deficient vitamin D.
More pts with HR-positive cancer than with HR-negative cancer had elevated PTH (38 of 167 v 3 of 30 pts, respectively).