Bone Health in Breast Cancer Patients: Comparative Evaluation Using Dual Energy X-Ray Absorptiometry Scan and High-Resolution Peripheral Quantitative Computed Tomography.

BACKGROUND

Osteoporosis is highly prevalent among Indian women and is further exacerbated by cancer-directed therapies such as chemotherapy, hormonal therapy, and radiotherapy. Patients with breast cancer are particularly susceptible to bone loss. While dual energy X-ray absorptiometry (DXA) remains the gold standard, it does not assess bone microarchitecture. High-resolution peripheral quantitative computed tomography (HR-pQCT) may provide additional insights.

METHODS

This cross-sectional pilot study was conducted between May and December 2024 at a tertiary care center and included 54 women with breast cancer without bone metastases. Demographic, clinical, and treatment data were recorded. All patients underwent DXA and HR-pQCT scans to assess bone density and microarchitecture. Statistical analysis included subgroup comparisons and concordance testing.

RESULTS

Mean age was 55.8±11 years, and 65% were postmenopausal. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 positivity rates were 76%, 57%, and 28%, respectively. Osteoporosis was found in 38.2% and osteopenia in 61.8% by DXA. HR-pQCT revealed lower volumetric bone density (0.59±0.07 g/cm³) compared to DXA (0.84±0.16 g/cm³, P<0.01). Microarchitectural deficits were significant in postmenopausal women, chemotherapy recipients, and those on letrozole. Lin's concordance correlation indicated poor agreement between HR-pQCT and DXA (<0.9).

CONCLUSIONS

HR-pQCT was superior to DXA in detecting microarchitectural deterioration in women with breast cancer. This pilot study emphasizes the need for larger prospective studies in Indian cohorts.