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

Huey En Tzeng, Chih Hsin Muo, Hsien Te Chen, Wen Li Hwang, Horng Chang Hsu, Chun Hao Tsai

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number123
JournalBMC Musculoskeletal Disorders
Volume16
Issue number1
DOIs
Publication statusPublished - May 20 2015
Externally publishedYes

Fingerprint

Osteoporotic Fractures
Tamoxifen
Cohort Studies
Breast Neoplasms
Population
Case-Control Studies
Hip
Catastrophic Illness
Age Groups
Hip Fractures
Health Insurance
Wrist
Proportional Hazards Models
Bone Density
Databases

Keywords

  • Breast cancer
  • Fracture
  • Population-based cohort study
  • Risk
  • Tamoxifen

ASJC Scopus subject areas

  • Rheumatology
  • Orthopedics and Sports Medicine

Cite this

Tamoxifen use reduces the risk of osteoporotic fractures in women with breast cancer in Asia : A nationwide population-based cohort study. / Tzeng, Huey En; Muo, Chih Hsin; Chen, Hsien Te; Hwang, Wen Li; Hsu, Horng Chang; Tsai, Chun Hao.

In: BMC Musculoskeletal Disorders, Vol. 16, No. 1, 123, 20.05.2015.

Research output: Contribution to journalArticle

Tzeng, Huey En ; Muo, Chih Hsin ; Chen, Hsien Te ; Hwang, Wen Li ; Hsu, Horng Chang ; Tsai, Chun Hao. / Tamoxifen use reduces the risk of osteoporotic fractures in women with breast cancer in Asia : A nationwide population-based cohort study. In: BMC Musculoskeletal Disorders. 2015 ; Vol. 16, No. 1.
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abstract = "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.",
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AU - Muo, Chih Hsin

AU - Chen, Hsien Te

AU - Hwang, Wen Li

AU - Hsu, Horng Chang

AU - Tsai, Chun Hao

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AB - 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.

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KW - Risk

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