Relação entre fenótipos da sarcopenia e risco de fratura em mulheres com câncer de mama

Abstract

Women with breast cancer are a risk group for development of sarcopenia and increased risk fractures. This study investigated the association between sarcopenia phenotypes and fracture risk in women with breast cancer and the relationship between fracture risk and nutritional status and their clinical variables. Cross-sectional study, carried out from January 2021 to May 2022, performed in a mastology clinic of a public hospital in Vitória-ES. It included women aged between 40 and 80 years, diagnosed with Luminal subtype breast cancer, with time of diagnosis ≤12 months, who had not started endocrine therapy, did not have metastasis, had not been treated for another malignancy and had no recurrences. The sarcopenia phenotypes were investigated by handgrip strength (HGS), appendicular skeletal muscle mass index (ASMI) and Timed-Up and Go test (TUGT). The fracture risk by Fracture Risk Assessment Tool (FRAX®). As variables of nutritional status, anthropometric, body composition and biochemical measurements were collected. Menopausal status, time of menopause, diagnosis time, clinical staging, histological subtype and type of treatment were considered as clinical variables. Multiple linear regression models were conducted to verify the association between exposure variables and sarcopenia phenotypes, and binary logistic regression models to assess the influence of exposure variables on fracture risk. A significance level of p<0.05 was adopted for all tests using the SPPS 25.0 program. Sixty-two women were evaluated, which 11.3%, 5.5% and 3.2% had compromised HGS, ASMI and TUGT, respectively. 14.5% of participants had a high risk of hip fractures and 17.7% had a high risk of major fractures, according to FRAX®. After adjusted models, HGS remained associated with FRAX® Hip fracture (p= 0.007) and FRAX® major fractures (p= 0.007), while ASMI was associated with body mass (p<0.001). Obesity, defined by body mass index (BMI) (p= 0.022) and serum vitamin D (p= 0.021) were associated with the FRAX® Hip fracture categories, while only serum vitamin D was associated with FRAX® Major fractures categories (p=0.008). It was concluded that muscle strength, obesity, defined by BMI, and serum vitamin D were inversely associated with fracture risk. In this way, simple tools suitable to be part of the clinical routine can contribute to the screening of women with breast cancer at risk of fractures.