Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study

Rebecca Pedersini; Deborah Cosentini; Luca Rinaudo; Manuel Zamparini; Fabio Massimo Ulivieri; Pierluigi di Mauro; Filippo Maffezzoni; Sara Monteverdi; Walter Vena; Lara Laini; Vito Amoroso; Edda Lucia Simoncini; Davide Farina; Gherardo Mazziotti; Alfredo Berruti

doi:10.1016/j.bonr.2023.101654

Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study

Bone Rep. 2023 Jan 11:18:101654. doi: 10.1016/j.bonr.2023.101654. eCollection 2023 Jun.

Authors

Rebecca Pedersini^{1

2}, Deborah Cosentini^{1

2}, Luca Rinaudo³, Manuel Zamparini¹, Fabio Massimo Ulivieri⁴, Pierluigi di Mauro¹, Filippo Maffezzoni², Sara Monteverdi⁵, Walter Vena⁶, Lara Laini¹, Vito Amoroso¹, Edda Lucia Simoncini², Davide Farina⁷, Gherardo Mazziotti^{8

6}, Alfredo Berruti¹

Affiliations

¹ Medical Oncology, ASST Spedali Civili, Brescia, Italy.
² Breast Unit, ASST Spedali Civili, Brescia, Italy.
³ Tecnologie Avanzate Srl, Turin, Italy.
⁴ Casa di Cura la Madonnina, Milano, Italy.
⁵ Santa Chiara Hospital, Trento, Italy.
⁶ Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
⁷ Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy.
⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.

Abstract

Background: Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed.

Methods: Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab.

Results: A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups.

Conclusions: Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.

Keywords: AI, aromatase inhibitor; AIDen+, aromatase inhibitor with denosumab; AIDen-, aromatase inhibitor without denosumab; Aromatase inhibitors; BMD, bone mineral density; BMI, body-mass index; BR, buckling ratio; BSI, bone strain index; Bone strain index; CSA, cross-sectional area; CSMI, cross-sectional moment of inertia; DXA, dual-energy X-ray absorptiometry; Dual-energy X-ray absorptiometry; EBC, early breast cancer; FS, femoral shaft; HAL, hip axis length; HR, hormone receptor; HSA, Hip Structure Analysis; IT, intertrochanteric; NN, narrow neck; NSA, neck shaft angle; PS, propensity score; ROC, receiver operator characteristic; TBS, trabecular bone score; VF, vertebral fracture; Vertebral fractures; Z, modulus.