Tamoxifen use reduces the risk of osteoporotic fractures in women with breast cancer in Asia: a nationwide population-based cohort study

BMC Musculoskeletal Disorders

Chun-Hao Tsai¹  Horng-Chang Hsu¹  Wen-Li Hwang²  Hsien-Te Chen³  Chih-Hsin Muo⁴  Huey-En Tzeng⁵ 

[1] Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan;Division of Hematology/Oncology, Taichung Veterans General Hospital, Taichung, Taiwan;School of Chinese Medicine, China Medical University, Taichung, Taiwan;Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan;School of Medicine, China Medical University, Taichung, Taiwan

关键词: Population-based cohort study;    Tamoxifen;    Risk;    Fracture;    Breast cancer;   

Others  :  1227772
DOI  :  10.1186/s12891-015-0580-8

 received in 2015-02-03, accepted in 2015-05-12,  发布年份 2015

【 摘 要 】

Purpose

Bone mineral density changes with tamoxifen treatment have been reported in pre- and post-menopausal women with breast cancer. However, there remains controversy as to whether tamoxifen significantly reduces fracture rates in different age groups. Breast cancer occurs at 10-20 years younger in Asian women compared with Western women. Therefore we conducted this population-based case-control study to determine whether or not tamoxifen use is associated with osteoporotic fractures.

Patients and methods

We selected 75488 women with breast cancer with no prior history of fractures from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in 2000-2011. They were followed from the date of the diagnosis of breast cancer to the date a hip, vertebral or wrist fracture occurred. Because the use of tamoxifen was a time-dependent variable, we used a Cox proportional hazard model with time-dependent exposure covariates to estimate the risk of a fracture.

Results

There were 50257 and 25231 women with breast cancer who did and did not receive tamoxifen treatment, respectively. The tamoxifen users had lower risks for overall fractures with hazard ratios (HRs) of 0.52 and 0.59 in the crude and adjusted models (95 % CI = 0.45-0.61 and 0.51-0.69), respectively. They also had lower risks for hip (HR = 0.55, 95 % CI = 0.45-0.67) and vertebral (HR = 0.64, 95 % CI = 0.50-0.82) fractures in the adjusted model. The risk of fractures decreased with an increasing dosage of tamoxifen. Regardless of the age group, the tamoxifen users had a lower risk of fractures than the non-users.

Conclusion

In this Asian population-based case-control study, tamoxifen use was associated with a reduction in osteoporotic fractures, especially in hip fractures.

【 授权许可】

   
2015 Tzeng et al.; licensee BioMed Central.

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