Trabecular Bone Score is inversely associated with C-reactive protein levels in women with breast cancer
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.216913Keywords:
Bone microarchitecture, Bone health, Menopause, Inflammation, CancerAbstract
Objective: To investigate the association of body composition and biochemical and functional variables with bone microarchitecture in women with breast can-cer. Methods: Observational cross-sectional study carried out with women diag-nosed with Luminal-subtype breast cancer, aged between 40 and 80 years, from January 2021 to January 2022. Anthropometric, biochemical, muscle strength, and physical performance variables were obtained. Body composition and bone mineral density (BMD) were analyzed by dual-energy X-ray absorptiometry (DXA) and bone microarchitecture by Trabecular Bone Score (TBS). We applied multi-variate linear regression analysis with adjusted models to verify the influence of independent variables on bone microarchitecture (dependent variable). The sig-nificance level adopted was 5% for all tests. Results: Forty-three women with a mean age of 57.9 ± 11.2 years were evaluated. There was a predominance of women with diagnosis time <6 months (83.7%), tumor stage II (48.8%), without previous treatment (37.2%), and post-menopausal (81.4%). There was a signifi-cant difference between mean TBS values according to age group (p= 0.003), menopausal status (p= 0.043), physical performance (p= 0.033), and BMD (p= 0.009). A moderate and inverse correlation was observed between TBS and se-rum levels of C-reactive protein (CRP) (p= 0.006). After multivariate linear regres-sion analysis, serum CRP remained associated with TBS (p= 0.001). Conclusion: High serum CRP levels were associated with worse bone microarchitecture in women with breast cancer.
Downloads
References
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Esti-mates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209–249.
Iwase T, Wang X, Shrimanker TV, et al. Body composition and breast cancer risk and treatment: mechanisms and impact. Breast Cancer Res Treat 2021; 186: 273–283.
World Health Organization. WHO Scientific Group on the Assessment of Osteoporosis At Primary Health. World Heal Summ Meet Rep Brussels 2004; 1–13.
Aziziyeh R, Amin M, Habib M, et al. The burden of osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. J Med Econ 2019; 22: 638–644.
Kanis J A. Assessment of osteoporosis at the primary health care level. World Health 2007; 339.
Rajan R, Cherian K, Kapoor N, et al. Trabecular bone score—An emerging tool in the management of osteoporosis. Indian J Endocrinol Metab 2020; 24: 237.
Kong SH, Hong N, Kim J-W, et al. Application of the Trabecular Bone Score in Clinical Practice. J Bone Metab 2021; 28: 101–113.
de Almeida Marques Bernabé R, de Souza Vieira M, Felício de Souza V, et al. Muscle strength is associated with fracture risk obtained by fracture risk assessment tool (FRAX) in women with breast cancer. BMC Cancer 2022; 22: 1115.
Wu D, Cline-Smith A, Shashkova E, et al. T-Cell Mediated Inflammation in Postmenopausal Osteoporosis. Front Immunol; 12. Epub ahead of print 30 June 2021. DOI: 10.3389/fimmu.2021.687551.
Hong C, Choi S, Park M, et al. Body composition and osteoporotic fracture using anthropometric prediction equations to assess muscle and fat masses. J Cachexia Sarcopenia Muscle 2021; 12: 2247–2258.
Ahmadi-Abhari S, Luben RN, Wareham NJ, et al. C-reactive protein and fracture risk: European Prospective Investigation into Cancer Norfolk Study. Bone 2013; 56: 67–72.
Wang Y, Wang S, Chen Z, et al. The Relationship between Body Composition and Bone Mineral Density of Female Workers in A Unit of Tai’an. Comput Math Methods Med 2022; 2022: 1–6.
Waqas K, Lima Ferreira J, Tsourdi E, et al. Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer. J Bone Oncol 2021; 28: 100355.
Silva BC, Leslie WD, Resch H, et al. Trabecular Bone Score: A Noninvasive Analytical Method Based Upon the DXA Image. Journal of Bone and Mineral Research 2014; 29: 518–530.
ISCD. Official Positions Adult ISCD 2019. Psychol Appl to Work An Introd to Ind Organ Psychol Tenth Ed Paul 2019; 1–34.
WHO. Obesity: Preventing and managing the global epidemic. 2000.
OPAS. XXXI Meeting of the Health Research Advisory Committee. Pan American Journal of Public Health 2001; 119: 538–46.
Kelly O, Gilman J, Boschiero D, et al. Osteosarcopenic Obesity: Current Knowledge, Revised Identification Criteria and Treatment Principles. Nutrients 2019; 11: 747.
Chaves LGC de M, Gonçalves TJM, Bitencourt AGV, et al. Assessment of body com-position by whole-body densitometry: what radiologists need to know. Radiol Bras 2022; 55: 305–311.
Coin A, Sarti S, Ruggiero E, et al. Prevalence of Sarcopenia Based on Different Diagnostic Criteria Using DEXA and Appendicular Skeletal Muscle Mass Reference Values in an Italian Population Aged 20 to 80. J Am Med Dir Assoc 2013; 14: 507–512.
MacDermid J, Solomon G, Valdes K. Therapists AS of Clinical assessment recom-mendations. American Society of Hand Therapists.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16–31.
Podsiadlo D, Richardson S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J Am Geriatr Soc 1991; 39: 142–148.
IBGE. Self-identification, ethnic-racial identity and heteroclassification. Self-identification, ethnic-racial identity and heteroclassification. [s.l: s.n.]. 2013
Matsudo S, Araújo T, Marsudo V, et al. International physical activity questionnaire (IPAQ): validity and reproducibility study in Brazil. Rev Bras Physical Activity and Health 2001; 6: 5–18.
WHO. WHO Guidelines on physical activity and sedentary behaviour 2020.
WILLETT Walter. Nutritional epidemiology. 2nd ed. 1998.
Fischer J, Hans D, Lamy O, et al. “Inflammaging” and bone in the OsteoLaus cohort. Immunity & Ageing 2020; 17: 5.
Mun H, Liu B, Pham THA, et al. C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches. Osteoporosis International 2021; 32: 425–435.
Buyuksimsek M, Ogul A, Mirilli C, et al. Inflammatory Markers Predicting Pathological Complete Response in Cases with Breast Cancer Treated by Neoadjuvant Chemotherapy. Eur J Breast Health 2020; 16: 229–234.
Maharjan CK, Mo J, Wang L, et al. Natural and Synthetic Estrogens in Chronic Inflammation and Breast Cancer. Cancers (Basel) 2021; 14: 206.
Bower JE, Ganz PA, Irwin MR, et al. Acute and Chronic Effects of Adjuvant Therapy on Inflammatory Markers in Breast Cancer Patients. JNCI Cancer Spectr; 6. Epub ahead of print 1 July 2022. DOI: 10.1093/jncics/pkac052.
Shapiro CL. Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments. Cancers (Basel) 2020; 12: 3094.
Body J-J. Increased fracture rate in women with breast cancer: a review of the hidden risk. BMC Cancer 2011; 11: 384.
Erbağ G, Uygun K, Binnetoğlu E, et al. Aromatase inhibitor treatment for breast cancer: short-term effect on bone health. Współczesna Onkologia 2015; 5: 374–377.
Boutroy S, Hans D, Sornay-Rendu E, et al. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study. Osteoporosis International 2013; 24: 77–85.
Iki M, Tamaki J, Kadowaki E, et al. Trabecular Bone Score (TBS) Predicts Vertebral Fractures in Japanese Women Over 10 Years Independently of Bone Density and Prevalent Vertebral Deformity: The Japanese Population-Based Osteoporosis (JPOS) Cohort Study. Journal of Bone and Mineral Research 2014; 29: 399–407.
Silva BC, Broy SB, Boutroy S, et al. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score. Journal of Clinical Densitometry 2015; 18: 309–330.
Mariotti V, Page DB, Davydov O, et al. Assessing fracture risk in early stage breast cancer patients treated with aromatase-inhibitors: An enhanced screening approach incorporating trabecular bone score. J Bone Oncol 2017; 7: 32–37.
Qi H, Sheng Y, Chen S, et al. Bone mineral density and trabecular bone score in Chinese subjects with sarcopenia. Aging Clin Exp Res 2019; 31: 1549–1556.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Rayne de Almeida Marques Bernabé, Larissa Leopoldino da Silva, Mariana de Souza Vieira, Vanusa Felício de Souza Mamede, Thalita Gonçalves Santos , Luana Gomes Fontana, Ben-Hur Albergaria, Janine Martins Machado , José Luiz Marques-Rocha , Valdete Regina Guandalini
This work is licensed under a Creative Commons Attribution 4.0 International License.
