Abstract
PURPOSE: Worsening bone mineral density (BMD)-and the corresponding increase in osteoporotic fractures-is an important and well-established source of morbidity and mortality in women receiving treatment of breast cancer, as well as those living with HIV. However, there are comparatively few reports on pretreatment bone health in women newly diagnosed with breast cancer, especially in predominantly Black populations, across sub-Saharan Africa (SSA), and among individuals living with HIV. Therefore, we sought to characterize bone health in a cohort of Black South African women with and without HIV before the initiation of systemic breast cancer therapy, in particular chemotherapy and/or aromatase inhibitors. METHODS: Building on the South African Breast Cancer and HIV Outcomes study, we recruited consecutive women newly diagnosed with stage I-III breast cancer who were to start systemic cancer therapy at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, between June 2021 and August 2024. In addition to collecting extensive demographic and clinical information, we conducted dual energy X-ray absorptiometry (DXA) scans on each patient to measure BMD of the lumbar spine, femoral neck, and total hip. RESULTS: We enrolled a total of 378 women, 32.3% of whom (n = 122) were living with HIV. Among women aged 50 years and older (n = 156), 64.1% had osteopenia or osteoporosis; HIV infection and vitamin D insufficiency/deficiency-but no breast cancer characteristics-were associated with a higher risk of osteoporosis. By contrast, 3.6% of women younger than 50 years had BMD below the expected range for age. CONCLUSION: Especially in low-resource clinical settings, such as public hospitals in SSA, understanding which women are at highest risk of osteoporosis and fragility fracture before the initiation of breast cancer systemic therapy is critical. Our study provides a foundation for identifying relevant risk factors and ultimately designing interventional studies that target high-risk women for intensified osteoporosis screening and management.