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Published in: Cancer Causes & Control 4/2015

01-04-2015 | Original paper

Soy isoflavone intake and bone mineral density in breast cancer survivors

Authors: Michelle L. Baglia, Kai Gu, Xianglan Zhang, Ying Zheng, Peng Peng, Hui Cai, Ping-Ping Bao, Wei Zheng, Wei Lu, Xiao-Ou Shu

Published in: Cancer Causes & Control | Issue 4/2015

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Abstract

Purpose

Low bone mineral density (BMD) is common among breast cancer survivors due to acute estrogen deprivation. Soy food is a rich source of phytoestrogens, namely isoflavones, known to have both estrogenic and anti-estrogenic effects. The objective of the study was to assess the association between soy consumption and BMD in breast cancer survivors, which has not previously been evaluated.

Methods

Forearm BMD was evaluated using dual-energy X-ray absorptiometry at 60 months post-diagnosis for 1,587 participants of the Shanghai Breast Cancer Survival Study. Soy intakes collected at 6, 18, and 36 months post-diagnosis were averaged, and the association with BMD, osteopenia, and osteoporosis was evaluated using linear and logistic regression.

Results

The mean (standard deviation) intake of isoflavones was 48.1 (28.0) mg/day. Soy intake was inversely associated with BMD and positively associated with osteoporosis. Compared with the lowest quartile, the highest quartile of soy isoflavone intake, ≥ 62.64 mg/day, was associated with a reduction of BMD by 1.95 % [95 % confidence interval (CI) −3.54, −0.36 %] and an increased odds ratio of 1.69 for osteoporosis (95 % CI 1.09, 2.61). The inverse association was predominantly seen among women who recently entered menopause (≤5 years).

Conclusion

In contrast to observations from general populations, high soy intake (≥62.64 mg of soy isoflavone/day) was associated with lower proximal forearm BMD among breast cancer survivors, particularly during the early years of menopause. Our finding needs to be replicated, particularly in studies with more comprehensive bone density evaluation.
Literature
1.
go back to reference Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefPubMed Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefPubMed
2.
go back to reference Jatoi I, Chen BE, Anderson WF, Rosenberg PS (2007) Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 25:1683–1690CrossRefPubMed Jatoi I, Chen BE, Anderson WF, Rosenberg PS (2007) Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 25:1683–1690CrossRefPubMed
3.
go back to reference De Angelis R, Tavilla A, Verdecchia A, Scoppa S, Hachey M, Feuer EJ, Mariotto AB (2009) Breast cancer survivors in the United States: geographic variability and time trends, 2005–2015. Cancer 115:1954–1966CrossRefPubMed De Angelis R, Tavilla A, Verdecchia A, Scoppa S, Hachey M, Feuer EJ, Mariotto AB (2009) Breast cancer survivors in the United States: geographic variability and time trends, 2005–2015. Cancer 115:1954–1966CrossRefPubMed
4.
go back to reference Bray F, Ren JS, Masuyer E, Ferlay J (2013) Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 132:1133–1145CrossRefPubMed Bray F, Ren JS, Masuyer E, Ferlay J (2013) Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 132:1133–1145CrossRefPubMed
5.
go back to reference Chen Z, Maricic M, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS, Bassford TL (2005) Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer 104:1520–1530CrossRefPubMed Chen Z, Maricic M, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS, Bassford TL (2005) Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer 104:1520–1530CrossRefPubMed
6.
go back to reference Abdel-Razeq H, Awidi A (2011) Bone health in breast cancer survivors. J Cancer Res Ther 7:256–263CrossRefPubMed Abdel-Razeq H, Awidi A (2011) Bone health in breast cancer survivors. J Cancer Res Ther 7:256–263CrossRefPubMed
7.
go back to reference Hadji P, Bundred N (2007) Reducing the risk of cancer treatment-associated bone loss in patients with breast cancer. Semin Oncol 34:S4–S10CrossRefPubMed Hadji P, Bundred N (2007) Reducing the risk of cancer treatment-associated bone loss in patients with breast cancer. Semin Oncol 34:S4–S10CrossRefPubMed
8.
go back to reference Conde DM, Costa-Paiva L, Martinez EZ, Pinto-Neto AM (2012) Low bone mineral density in middle-aged breast cancer survivors: prevalence and associated factors. Breast Care (Basel) 7:121–125CrossRef Conde DM, Costa-Paiva L, Martinez EZ, Pinto-Neto AM (2012) Low bone mineral density in middle-aged breast cancer survivors: prevalence and associated factors. Breast Care (Basel) 7:121–125CrossRef
9.
go back to reference Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS (2005) Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 165:552–558CrossRefPubMed Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS (2005) Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 165:552–558CrossRefPubMed
10.
go back to reference Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, LeBoff M, Lewis CE, McGowan J, Neuner J, Pettinger M, Stefanick ML, Wactawski-Wende J, Watts NB (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 290:1729–1738CrossRefPubMed Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, LeBoff M, Lewis CE, McGowan J, Neuner J, Pettinger M, Stefanick ML, Wactawski-Wende J, Watts NB (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 290:1729–1738CrossRefPubMed
11.
go back to reference Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O’Connell D, Cranney A (2002) Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 23:529–539CrossRefPubMed Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O’Connell D, Cranney A (2002) Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 23:529–539CrossRefPubMed
12.
go back to reference Ramaswamy B, Shapiro CL (2003) Osteopenia and osteoporosis in women with breast cancer. Semin Oncol 30:763–775CrossRefPubMed Ramaswamy B, Shapiro CL (2003) Osteopenia and osteoporosis in women with breast cancer. Semin Oncol 30:763–775CrossRefPubMed
13.
go back to reference Eastell R (2007) Breast cancer and the risk of osteoporotic fracture: a paradox. J Clin Endocrinol Metab 92:42–43CrossRefPubMed Eastell R (2007) Breast cancer and the risk of osteoporotic fracture: a paradox. J Clin Endocrinol Metab 92:42–43CrossRefPubMed
14.
15.
go back to reference Taylor CK, Levy RM, Elliott JC, Burnett BP (2009) The effect of genistein aglycone on cancer and cancer risk: a review of in vitro, preclinical, and clinical studies. Nutr Rev 67:398–415CrossRefPubMed Taylor CK, Levy RM, Elliott JC, Burnett BP (2009) The effect of genistein aglycone on cancer and cancer risk: a review of in vitro, preclinical, and clinical studies. Nutr Rev 67:398–415CrossRefPubMed
16.
go back to reference Zhang Y, Chen WF, Lai WP, Wong MS (2008) Soy isoflavones and their bone protective effects. Inflammopharmacology 16:213–215CrossRefPubMed Zhang Y, Chen WF, Lai WP, Wong MS (2008) Soy isoflavones and their bone protective effects. Inflammopharmacology 16:213–215CrossRefPubMed
17.
go back to reference Ho SC, Woo J, Lam S, Chen Y, Sham A, Lau J (2003) Soy protein consumption and bone mass in early postmenopausal Chinese women. Osteoporos Int 14:835–842CrossRefPubMed Ho SC, Woo J, Lam S, Chen Y, Sham A, Lau J (2003) Soy protein consumption and bone mass in early postmenopausal Chinese women. Osteoporos Int 14:835–842CrossRefPubMed
18.
go back to reference Mei J, Yeung SS, Kung AW (2001) High dietary phytoestrogen intake is associated with higher bone mineral density in postmenopausal but not premenopausal women. J Clin Endocrinol Metab 86:5217–5221CrossRefPubMed Mei J, Yeung SS, Kung AW (2001) High dietary phytoestrogen intake is associated with higher bone mineral density in postmenopausal but not premenopausal women. J Clin Endocrinol Metab 86:5217–5221CrossRefPubMed
19.
go back to reference Somekawa Y, Chiguchi M, Ishibashi T, Aso T (2001) Soy intake related to menopausal symptoms, serum lipids, and bone mineral density in postmenopausal Japanese women. Obstet Gynecol 97:109–115CrossRefPubMed Somekawa Y, Chiguchi M, Ishibashi T, Aso T (2001) Soy intake related to menopausal symptoms, serum lipids, and bone mineral density in postmenopausal Japanese women. Obstet Gynecol 97:109–115CrossRefPubMed
20.
go back to reference Horiuchi T, Onouchi T, Takahashi M, Ito H, Orimo H (2000) Effect of soy protein on bone metabolism in postmenopausal Japanese women. Osteoporos Int 11:721–724CrossRefPubMed Horiuchi T, Onouchi T, Takahashi M, Ito H, Orimo H (2000) Effect of soy protein on bone metabolism in postmenopausal Japanese women. Osteoporos Int 11:721–724CrossRefPubMed
21.
go back to reference Ikeda Y, Iki M, Morita A, Kajita E, Kagamimori S, Kagawa Y, Yoneshima H (2006) Intake of fermented soybeans, natto, is associated with reduced bone loss in postmenopausal women: Japanese population-based osteoporosis (JPOS) Study. J Nutr 136:1323–1328PubMed Ikeda Y, Iki M, Morita A, Kajita E, Kagamimori S, Kagawa Y, Yoneshima H (2006) Intake of fermented soybeans, natto, is associated with reduced bone loss in postmenopausal women: Japanese population-based osteoporosis (JPOS) Study. J Nutr 136:1323–1328PubMed
22.
go back to reference Zhang X, Shu XO, Li H, Yang G, Li Q, Gao YT, Zheng W (2005) Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med 165:1890–1895CrossRefPubMed Zhang X, Shu XO, Li H, Yang G, Li Q, Gao YT, Zheng W (2005) Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med 165:1890–1895CrossRefPubMed
23.
go back to reference Nagata C, Shimizu H, Takami R, Hayashi M, Takeda N, Yasuda K (2002) Soy product intake and serum isoflavonoid and estradiol concentrations in relation to bone mineral density in postmenopausal Japanese women. Osteoporos Int 13:200–204CrossRefPubMed Nagata C, Shimizu H, Takami R, Hayashi M, Takeda N, Yasuda K (2002) Soy product intake and serum isoflavonoid and estradiol concentrations in relation to bone mineral density in postmenopausal Japanese women. Osteoporos Int 13:200–204CrossRefPubMed
24.
go back to reference Hsu CS, Shen WW, Hsueh YM, Yeh SL (2001) Soy isoflavone supplementation in postmenopausal women. Effects on plasma lipids, antioxidant enzyme activities and bone density. J Reprod Med 46:221–226PubMed Hsu CS, Shen WW, Hsueh YM, Yeh SL (2001) Soy isoflavone supplementation in postmenopausal women. Effects on plasma lipids, antioxidant enzyme activities and bone density. J Reprod Med 46:221–226PubMed
26.
go back to reference Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, Gao YT, Zheng W (2004) Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women’s Health Study. Eur J Clin Nutr 58:17–23CrossRefPubMed Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, Gao YT, Zheng W (2004) Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women’s Health Study. Eur J Clin Nutr 58:17–23CrossRefPubMed
27.
go back to reference Yang Y, Wang GY, Pan XC (2002) Chinese food composition tables 2002. Beijing University Medical Press Yang Y, Wang GY, Pan XC (2002) Chinese food composition tables 2002. Beijing University Medical Press
28.
go back to reference World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. Technical report series 843: 1–129 World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. Technical report series 843: 1–129
29.
go back to reference Recker R, Lappe J, Davies K, Heaney R (2000) Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 15:1965–1973CrossRefPubMed Recker R, Lappe J, Davies K, Heaney R (2000) Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 15:1965–1973CrossRefPubMed
31.
go back to reference Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333CrossRefPubMed Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333CrossRefPubMed
32.
go back to reference Penttinen-Damdimopoulou PE, Power KA, Hurmerinta TT, Nurmi T, van der Saag PT, Makela SI (2009) Dietary sources of lignans and isoflavones modulate responses to estradiol in estrogen reporter mice. Mol Nutr Food Res 53:996–1006CrossRefPubMed Penttinen-Damdimopoulou PE, Power KA, Hurmerinta TT, Nurmi T, van der Saag PT, Makela SI (2009) Dietary sources of lignans and isoflavones modulate responses to estradiol in estrogen reporter mice. Mol Nutr Food Res 53:996–1006CrossRefPubMed
33.
go back to reference Xu X, Duncan AM, Merz BE, Kurzer MS (1998) Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women. Cancer Epidemiol Biomarkers Prev 7:1101–1108PubMed Xu X, Duncan AM, Merz BE, Kurzer MS (1998) Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women. Cancer Epidemiol Biomarkers Prev 7:1101–1108PubMed
34.
go back to reference Weaver CM, Cheong JM (2005) Soy isoflavones and bone health: the relationship is still unclear. J Nutr 135:1243–1247PubMed Weaver CM, Cheong JM (2005) Soy isoflavones and bone health: the relationship is still unclear. J Nutr 135:1243–1247PubMed
35.
go back to reference Messina M, Ho S, Alekel DL (2004) Skeletal benefits of soy isoflavones: a review of the clinical trial and epidemiologic data. Curr Opin Clin Nutr Metab Care 7:649–658CrossRefPubMed Messina M, Ho S, Alekel DL (2004) Skeletal benefits of soy isoflavones: a review of the clinical trial and epidemiologic data. Curr Opin Clin Nutr Metab Care 7:649–658CrossRefPubMed
36.
go back to reference Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, Zheng Y, Zheng W, Pierce JP, Shu XO (2012) Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr 96:123–132CrossRefPubMedCentralPubMed Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, Zheng Y, Zheng W, Pierce JP, Shu XO (2012) Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr 96:123–132CrossRefPubMedCentralPubMed
37.
go back to reference Dorjgochoo T, Gu K, Zheng Y, Kallianpur A, Chen Z, Zheng W, Lu W, Shu XO (2011) Soy intake in association with menopausal symptoms during the first 6 and 36 months after breast cancer diagnosis. Breast Cancer Res Treat 130:879–889CrossRefPubMedCentralPubMed Dorjgochoo T, Gu K, Zheng Y, Kallianpur A, Chen Z, Zheng W, Lu W, Shu XO (2011) Soy intake in association with menopausal symptoms during the first 6 and 36 months after breast cancer diagnosis. Breast Cancer Res Treat 130:879–889CrossRefPubMedCentralPubMed
38.
go back to reference Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230CrossRefPubMed Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230CrossRefPubMed
Metadata
Title
Soy isoflavone intake and bone mineral density in breast cancer survivors
Authors
Michelle L. Baglia
Kai Gu
Xianglan Zhang
Ying Zheng
Peng Peng
Hui Cai
Ping-Ping Bao
Wei Zheng
Wei Lu
Xiao-Ou Shu
Publication date
01-04-2015
Publisher
Springer International Publishing
Published in
Cancer Causes & Control / Issue 4/2015
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-015-0534-3

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