BMD, TBS, and osteoporosis in women with breast cancer vs. healthy controls: An age-stratified retrospective analysis.

OBJECTIVE

The aim of this study is to compare bone mineral density (BMD), trabecular bone score (TBS), and prevalence of osteoporosis between women with breast cancer and controls across different age groups.

METHODS

Dual-energy X-ray absorptiometry data (lumbar spine BMD, hip region BMD, and lumbar spine TBS) from 578 women with breast cancer and 2,312 controls (October 2022-May 2024) were retrospectively analyzed. Differences in BMD, TBS, and osteoporosis prevalence between women with breast cancer and controls across different age groups were compared. The correlations of TBS and BMD with age and body mass index (BMI) were calculated. Multivariate logistic regression analysis was performed to identify factors independently associated with degraded microarchitecture.

RESULTS

Compared with controls, women with breast cancer aged < 60 years had lower lumbar spine BMD, whereas those ≥ 60 years had higher lumbar spine BMD. In the hip region, women aged < 50 years had lower BMD compared with controls, whereas those ≥ 50 years had higher hip BMD. The prevalence of osteoporosis in women with breast cancer increased progressively with age. Across all age strata, the prevalence of degraded microarchitecture increased with age and was consistently higher in women with breast cancer (P < 0.05). Among the subgroups categorized by BMD status (osteoporosis, osteopenia, and normal), the proportion of degraded microarchitecture was significantly higher in women with breast cancer than in controls. BMI correlated positively with BMD and TBS, whereas age correlated negatively. Multivariate logistic regression analysis identified age and lumbar spine BMD as the independent predictors of degraded microarchitecture (P < 0.001).

CONCLUSIONS

Relying solely on BMD may underestimate the osteoporosis risk in women with breast cancer. Concurrent assessment of TBS provides complementary information on bone microarchitecture, which is particularly valuable for refining fracture risk stratification in younger patients and may help guide early bone-protective interventions.