Researchers at the University of Nebraska Medical Center College of
Nursing are involved in a study to evaluate a new approach in preventing
and treating osteoporosis in breast cancer survivors.
As a result of chemotherapy, at least 50 percent of women who are diagnosed
with breast cancer under age 50 experience premature ovarian failure that
leads to early menopause. Because estrogen influences growth of breast
cancer in women with estrogen receptor positive cancers, women with a history
of breast cancer are often not candidates for hormone replacement therapy,
the most effective preventive treatment for osteoporosis.
Osteoporosis causes deterioration of bone tissue, which leads to bone
fragility and an increased susceptibility to fractures of the hip, spine
and wrist, according to the National Osteoporosis Foundation. The disease
is a major public health threat for more than 28 million Americans, 80
percent of whom are women. An average of 24 percent of hip fracture patients
age 50 and over die in the year following their fracture. Caucasian and
Asian women are at increased risk for osteoporosis.
This is a really significant problem. The good news is that more
women are surviving breast cancer than ever before, said Nancy Waltman,
Ph.D., associate professor of nursing, UNMC College of Nursing Lincoln
Division and principal investigator of the study. Unfortunately, they
have another concern — they may be at greater risk of osteoporosis than
healthy women, and the onset of osteoporosis may occur at an earlier age.
The purpose of the one-year study is to evaluate the feasibility and
effectiveness of a multi-component intervention in post-menopausal women
between the ages of 40 and 65 years, who have completed treatment for early
stage breast cancer and who cannot receive hormone replacement therapy
(HRT). Specific objectives of the pilot study are to determine adherence
of the intervention, and to look at differences between the groups such
as quality of life and vigor, and outcomes such as bone mineral density,
muscle strength and activity level.
Women in Omaha, Kearney and Scottsbluff will participate in the study.
The study is funded by the Regional West Foundation of Scottsbluff,
Neb., and national organizations: Oncology Nursing Foundation; Sigma Theta
Tau International Honor Society of Nursing; and the American Nurses Foundation.
The study will evaluate a group of 30 women who will taking calcium
with vitamin D, and Fosamax®, a drug shown to rebuild bone mass. Women
also participate in strength and weight training exercises and receive
education on osteoporosis as well as strategies to promote adherence to
the intervention. A control group of seven to 12 women will follow the
same protocol but without strength and weight training.
Eligible study participants will receive evaluations, including muscle
strength and balance tests and bone mineral density screenings using Dual-Energy
X-ray Absorptiometry (DEXA). DEXA screening is painless, takes less than
15 minutes and doesnt require clothes removal. Women will be evaluated
at various intervals during the study.
Researchers say the study is unique because it combines exercise with
other components used in the fight against osteoporosis — calcium, vitamin
D and drugs that build bone mass.
We want to know how much exercise improves on the effects of the medication,
said Janice Twiss, Ph.D., UNMC associate professor of nursing and womens
health nurse practitioner and co-principal investigator of the study. Dr.
Twiss said a strength-weight training program will be used to strengthen
muscle and bone mass in the hip, spine and wrist.
After age 65, women who arent on HRT are at great risk for osteoporotic
fractures, said Twiss said. Women whove had breast cancer and have gone
through chemotherapy have a longer period of time where bone is lost.
She said there is a growing concern in regards to osteoporosis as people
live longer. The estimated annual cost of osteoporosis is $15 to 20 million
annually.
Its a more expensive chronic illness than congestive heart failure
and asthma, Dr. Twiss said. Women can live a long time, but theyre disabled.
They end up in a nursing home.
She said women get fractures in their spine simply by reaching up to
get something, sneezing or walking down steps. Most often, hip fractures
usually occur with a fall.
An important part of the study evaluates study participants adherence
with components of the study. Weve recognized that adherence not only
to exercise, but to medications, is a problem. So weve included strategies
to improve adherence, Dr. Waltman said.
Information gathered from this study will be used for a larger study.
In June, Drs. Waltman and Twiss published baseline results of bone mineral
density in postmenopausal breast cancer survivors in the Journal of the
American Academy of Nurse Practitioners. They were surprised to find 80
percent of the women had signs of osteopenia or osteoporosis and about
45 percent were not aware they had a problem because theyd never been
told.
Very few women had bone mineral density measurements before the study,
Dr. Waltman said. Many of these women didnt even realize that osteoporosis
was something they should be concerned about it. The findings suggest the
need for health care providers to educate breast cancer survivors or women
not on hormone replacement therapy that they are at risk for osteoporosis
and they should be screened.
Other researchers participating in the study are: Carol Ott, Ph.D.,
UNMC College of Nursing Kearney Division; Gloria Gross, Ph.D., UNMC College
of Nursing West Nebraska Division; Ada Lindsey, Ph.D., UNMC College of
Nursing, Omaha; and Timothy Moore, M.D., UNMC College of Medicine, Omaha.