Disentangling the body weight-bone mineral density association among breast cancer survivors: an examination of the independent roles of lean mass and fat mass

BMC Cancer

Stephanie M George⁵  Anne McTiernan⁷  Adriana Villaseñor³  Catherine M Alfano⁶  Melinda L Irwin¹  Marian L Neuhouser⁷  Richard N Baumgartner⁴  Kathy B Baumgartner⁴  Leslie Bernstein²  Ashley W Smith⁵  Rachel Ballard-Barbash⁵ 

[1] Division of Chronic Disease Epidemiology, MD Yale School of Public Health, New Haven CT, USA

[2] Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte CA, USA

[3] Moores UCSD Cancer Center, Cancer Prevention and Control Program, University of California, San Diego CA, USA

[4] Department of Epidemiology and Population Health, University of Louisville, Louisville KY, USA

[5] Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA

[6] Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda MD, USA

[7] Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA

关键词: Bone loss;    Epidemiology;    Breast cancer survivor;    Bone mineral density;    Body composition;   

Others  :  1079497
DOI  :  10.1186/1471-2407-13-497

 received in 2013-02-01, accepted in 2013-09-19,  发布年份 2013

【 摘 要 】

Background

Bone mineral density (BMD) and lean mass (LM) may both decrease in breast cancer survivors, thereby increasing risk of falls and fractures. Research is needed to determine whether lean mass (LM) and fat mass (FM) independently relate to BMD in this patient group.

Methods

The Health, Eating, Activity, and Lifestyle Study participants included 599 women, ages 29–87 years, diagnosed from 1995–1999 with stage 0-IIIA breast cancer, who underwent dual-energy X-ray absorptiometry scans approximately 6-months postdiagnosis. We calculated adjusted geometric means of total body BMD within quartiles (Q) of LM and FM. We also stratified LM-BMD associations by a fat mass index threshold that tracks with obesity (lower body fat: ≤12.9 kg/m²; higher body fat: >12.9 kg/m²) and stratified FM-BMD associations by appendicular lean mass index level corresponding with sarcopenia (non-sarcopenic: ≥ 5.45 kg/m² and sarcopenic: < 5.45 kg/m²).

Results

Higher LM (Q4 vs. Q1) was associated with higher total body BMD overall (1.12 g/cm² vs. 1.07 g/cm², p-trend < 0.0001), and among survivors with lower body fat (1.13 g/cm² vs. 1.07 g/cm², p-trend < 0.0001) and higher body fat (1.15 g/cm² vs. 1.08 g/cm², p-trend = 0.004). Higher FM (Q4 vs. Q1) was associated with higher total body BMD overall (1.12 g/cm² vs. 1.07 g/cm², p-trend < 0.0001) and among non-sarcopenic survivors (1.15 g/cm² vs. 1.08 g/cm², p < 0.0001), but the association was not significant among sarcopenic survivors (1.09 g/cm² vs. 1.04 g/cm², p-trend = 0.18).

Conclusion

Among breast cancer survivors, higher LM and FM were independently related to higher total body BMD. Future exercise interventions to prevent bone loss among survivors should consider the potential relevance of increasing and preserving LM.

【 授权许可】

   
2013 George et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Altekruse S, Kosary C, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, et al.: (eds.): SEER Cancer Statistics Review, 1975–2007. National Cancer Institute: Bethesda, MD; 2010.
• [2]American Cancer Society: Breast Cancer Facts and Figures. Atlanta, GA; 2009.
• [3]Saad F, Adachi JD, Brown JP, Canning LA, Gelmon KA, Josse RG, Pritchard KI: Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol 2008, 26(33):5465-5476.
• [4]Winters-Stone KM, Schwartz AL, Hayes SC, Fabian CJ, Campbell KL: A prospective model of care for breast cancer rehabilitation: bone health and arthralgias. Cancer 2012, 118(8 Suppl):2288-2299.
• [5]Edwards BJ, Raisch DW, Shankaran V, McKoy JM, Gradishar W, Bunta AD, Samaras AT, Boyle SN, Bennett CL, West DP, et al.: Cancer therapy associated bone loss: implications for hip fractures in mid-life women with breast cancer. Clin Cancer Res 2011, 17(3):560-568.
• [6]Chen Z, Maricic M, Aragaki A, Mouton C, Arendell L, Lopez A, Bassford T, Chlebowski R: Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women’s Health Initiative. Osteoporos Int 2009, 20(4):527-536.
• [7]Body JJ: Increased fracture rate in women with breast cancer: a review of the hidden risk. BMC Cancer 2011, 11:384. BioMed Central Full Text
• [8]Hannan MT, Felson DT, Anderson JJ: Bone mineral density in elderly men and women: results from the Framingham osteoporosis study. J Bone Miner Res 1992, 7(5):547-553.
• [9]Rubin CT, Lanyon LE: Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 1985, 37(4):411-417.
• [10]Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone A-M, Pan L, Anderson RN, Fulton JE, Kohler BA, et al.: Annual Report to the Nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012, 118(9):2338-2366.
• [11]Demark-Wahnefried W, Platz EA, Ligibel JA, Blair CK, Courneya KS, Meyerhardt J, Ganz PA, Rock CL, Schmitz KH, Wadden T, et al.: The Role of Obesity in Cancer Survival and Recurrence. Cancer Epidemiology Biomarkers Prev 2012, 21(8):1244-1259.
• [12]Finkelstein EA, Chen H, Prabhu M, Trogdon JG, Corso PS: The relationship between obesity and injuries among U.S. adults. Am J Health Promot 2007, 21(5):460-468.
• [13]Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, Pfeilschifter J, Silverman S, Díez-Pérez A, Lindsay R, et al.: Obesity Is Not Protective against Fracture in Postmenopausal Women: GLOW. Am J Med 2011, 124(11):1043-1050.
• [14]Mignardot JB, Olivier I, Promayon E, Nougier V: Obesity impact on the attentional cost for controlling posture. PLoS One 2010, 5(12):e14387.
• [15]Faje A, Klibanski A: Body composition and skeletal health: too heavy? too thin? Curr Osteoporos Rep 2012, 10(3):208-216.
• [16]Campbell KL, Lane K, Martin AD, Gelmon KA, McKenzie DC: Resting energy expenditure and body mass changes in women during adjuvant chemotherapy for breast cancer. Cancer Nurs 2007, 30(2):95-100.
• [17]Cheney CL, Mahloch J, Freeny P: Computerized tomography assessment of women with weight changes associated with adjuvant treatment for breast cancer. Am J Clin Nutr 1997, 66(1):141-146.
• [18]Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, McElveen G, Winer EP: Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr 1997, 65(5):1495-1501.
• [19]Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK: Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 2001, 19(9):2381-2389.
• [20]Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, Sebring N, Reynolds JC, Yanovski JA: Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab 2004, 89(5):2248-2253.
• [21]Gordon AM, Hurwitz S, Shapiro CL, LeBoff MS: Premature ovarian failure and body composition changes with adjuvant chemotherapy for breast cancer. Menopause 2011, 18(11):1244-1248.
• [22]Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, Ballard-Barbash R: Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 2005, 23(4):774-782.
• [23]Kutynec CL, McCargar L, Barr SI, Hislop TG: Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc 1999, 99(10):1222-1227.
• [24]Nissen MJ, Shapiro A, Swenson KK: Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer 2011, 11(1):52-60.
• [25]Winters-Stone KM, Nail L, Bennett JA, Schwartz A: Bone Health and Falls: Fracture Risk in Breast Cancer Survivors With Chemotherapy-Induced Amenorrhea. Oncol Nurs Forum 2009, 36(3):315-325.
• [26]Sheean PM, Hoskins K, Stolley M: Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat 2012, 135(3):663-680.
• [27]Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, Schwartz A: Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat 2011, 127(2):447-456.
• [28]Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L: Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring) 2009, 17(8):1534-1541.
• [29]Winters-Stone KM, Schwartz A, Nail LM: A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Surviv 2010, 4(3):187-201.
• [30]Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, Ballard-Barbash R: Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 2004, 36(9):1484-1491.
• [31]McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, Gilliland F, Stanczyk FZ, Yasui Y, Ballard-Barbash R: Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 2003, 21(10):1961-1966.
• [32]Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R: Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat 2006, 96(3):227-232.
• [33]Baumgartner RN: Body composition in healthy aging. Ann N Y Acad Sci 2000, 904:437-448.
• [34]Kiebzak GM, Leamy LJ, Pierson LM, Nord RH, Zhang ZY: Measurement precision of body composition variables using the lunar DPX-L densitometer. J Clin Densitom 2000, 3(1):35-41.
• [35]Link J, Glazer C, Torres F, Chin K: International Classification of Diseases coding changes lead to profound declines in reported idiopathic pulmonary arterial hypertension mortality and hospitalizations: implications for database studies. Chest 2011, 139(3):497-504.
• [36]Kelly TL, Wilson KE, Heymsfield SB: Dual energy X-Ray absorptiometry body composition reference values from NHANES. PLoS ONE 2009, 4(9):e7038.
• [37]Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD: Epidemiology of Sarcopenia among the Elderly in New Mexico. Am J Epidemiol 1998, 147(8):755-763.
• [38]Villaseñor A, Ballard-Barbash R, Baumgartner K, Baumgartner R, Bernstein L, McTiernan A, Neuhouser ML: Prevalence and prognostic effect of sarcopenia in breast cancer survivors; the HEAL Study. J Cancer SurvivIn press
• [39]Lanyon LE, Rubin CT: Static vs dynamic loads as an influence on bone remodelling. J Biomech 1984, 17(12):897-905.
• [40]Liskova M, Hert J: Reaction of bone to mechanical stimuli. 2. Periosteal and endosteal reaction of tibial diaphysis in rabbit to intermittent loading. Folia Morphol (Praha) 1971, 19(3):301-317.
• [41]Riggs BL, Khosla S, Melton LJ 3rd: Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev 2002, 23(3):279-302.
• [42]Waltman NL, Twiss JJ, Ott CD, Gross GJ, Lindsey AM, Moore TE, Berg K, Kupzyk K: The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporos Int 2010, 21(8):1361-1369.