Evidence map›Paper›PMID 34728119›Full record

ArticleBreast (Edinburgh, Scotland)2021

The association between endocrine therapy use and osteoporotic fracture among post-menopausal women treated for early-stage breast cancer in Ontario, Canada.

Phillip S Blanchette, Melody Lam, Britney Le, Lucie Richard, Salimah Z Shariff, Alexandra M Ouédraogo, Kathleen I Pritchard, Jacques Raphael, Ted Vandenberg, Ricardo Fernandes and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast (Edinburgh, Scotland), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.3field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Comparative analysis of osteoporotic versus pathologic fracture in metastatic colorectal cancer patients.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 1 country.

Phillip S BlanchetteDivision of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada; ICES Western, London, Ontario, Canada. Electronic address: phillip.blanchette@lhsc.on.ca.
Melody LamICES Western, London, Ontario, Canada.
Britney LeICES Western, London, Ontario, Canada.
Lucie RichardICES Western, London, Ontario, Canada.
Salimah Z ShariffICES Western, London, Ontario, Canada.
Alexandra M OuédraogoICES Western, London, Ontario, Canada.
Kathleen I PritchardDivision of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Jacques RaphaelDivision of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada; ICES Western, London, Ontario, Canada.
Ted VandenbergDivision of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Ricardo FernandesDivision of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Danielle N DesautelsCancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada.
Kelvin K W ChanDivision of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
Craig C EarleDivision of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; ICES, University of Toronto, Toronto, Ontario, Canada.
Western University · CASunnybrook Health Science Centre · CACancerCare Manitoba · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of endocrine therapy for early-stage breast cancer, particularly aromatase inhibitor therapy has been associated with an increased risk of osteoporosis and fracture in clinical trials. We sought to validate this observation in real-world practice.

methodsWe used health administrative data collected from post-menopausal women (aged ≥66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2012. Patients were classified by use of either an aromatase inhibitor or tamoxifen and followed until 2017 for a new diagnosis of an osteoporotic fracture. A multivariable analysis using a Cox proportional hazards model was adjusting for age, medical co-morbidities, medication use and duration of endocrine therapy.

resultsWe identified 12,077 patients of whom 73% were treated with an aromatase inhibitor as compared to 27% with tamoxifen. Our multivariable analysis did not demonstrate any significant difference in the rate of osteoporotic fracture between patients treated with an aromatase inhibitor when compared with tamoxifen [Hazard ratio (HR) = 1.09; 95% confidence interval (CI) = 0.96-1.23, p-value = 0.18]. The 5-year rate of osteoporotic fracture for patients treated with either an aromatase inhibitor or tamoxifen was 7.5% and 6.9%, respectively. A completed sensitivity analysis did observe a decreased risk of fracture associated with tamoxifen usage over time.

conclusionWe could not detect a significant difference in the rate of osteoporotic fracture among patients treated with an aromatase inhibitor versus tamoxifen. Nonetheless, the risk with tamoxifen was numerically lower and significantly decreased when accounting for total duration of endocrine therapy.

Indexed as

Breast NeoplasmsOsteoporotic FracturesAntineoplastic Agents, HormonalAromatase InhibitorsChemotherapy, AdjuvantFemaleHumansOntarioPostmenopauseTamoxifenAntineoplastic Agents, HormonalAromatase InhibitorsTamoxifenBreast cancerEndocrine therapyFractureOsteoporosis

Identifiers

PMID34728119
PMCPMC8714501
OpenAlexW3209188040

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.