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Calcium, vitamin D, bisphosphonates, and denosumab have been considered and partly confirmed as factors potentially influencing the risk of <jats:styled-content style=\"fixed-case\">BC<\/jats:styled-content>. This retrospective observational study investigated the association between serum calcium level and <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content>. A total of 982 <jats:styled-content style=\"fixed-case\">BC<\/jats:styled-content> patients identified in the research database at the University Breast Center for Franconia with unilateral <jats:styled-content style=\"fixed-case\">BC<\/jats:styled-content>, calcium and albumin values, and mammogram at the time of first diagnosis were included. <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content> was assessed, using a semiautomated method by two readers. Linear regression analyses were conducted to investigate the impact on <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content> of the parameters of serum calcium level adjusted for albumin level, and well\u2010known clinical predictors such as age, body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>), menopausal status and confounder for serum calcium like season in which the <jats:styled-content style=\"fixed-case\">BC<\/jats:styled-content> was diagnosed. Increased calcium levels were associated with reduced <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.024). Furthermore, <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content> was inversely associated with <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and age (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). There was also an association between <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content> and menopausal status (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The goodness\u2010of\u2010fit of the regression model was moderate. This is the first study assessing the association between serum calcium level and <jats:styled-content style=\"fixed-case\">PMD<\/jats:styled-content>. An inverse association with adjusted serum calcium levels was observed. These findings add to previously published data relating to vitamin D, bisphosphonates, denosumab, and the <jats:styled-content style=\"fixed-case\">RANK<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RANKL<\/jats:styled-content> signaling pathway in breast cancer risk and prevention.<\/jats:p>","DOI":"10.1002\/cam4.1066","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T17:20:29Z","timestamp":1493745629000},"page":"1473-1481","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Correlation of mammographic density and serum calcium levels in patients with primary breast cancer"],"prefix":"10.1002","volume":"6","author":[{"given":"Carolin C.","family":"Hack","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics Erlangen University Hospital Comprehensive Cancer Center Erlangen\/European Metropolitan Area Nuremberg (CCC ER\u2010EMN)  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