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Fracture Risk Among Older Cancer Survivors


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In a study reported in JAMA Oncology, Rees-Punia et al found that the risk of frailty-related bone fractures among older cancer survivors was significantly greater vs that among older adults without a history of cancer.

Study Details

The longitudinal cohort study used data from 92,431 older adults in the U.S. Cancer Prevention Study II Nutrition Cohort linked with 1999 to 2017 Medicare claims. Among the 92,431 participants, 12,943 had a frailty-related bone fracture. A total of 78,272 had no cancer history, and 14,159 had a cancer history during follow-up.

Key Findings

Compared with participants without a history of cancer, cancer survivors had a higher risk of total frailty-related fractures for several years after diagnosis, with a hazard ratio (HR) of 1.57 (95% confidence interval [CI] = 1.38–1.79) within the first year after diagnosis. Compared with participants without a history of cancer, cancer survivors who were diagnosed 1 to < 5 years earlier with advanced-stage cancer had a higher risk of fracture (HR = 2.12, 95% CI = 1.75–2.58), including a higher risk of vertebral fracture (HR = 2.46, 95% CI = 1.93–3.13) and pelvic fracture (HR = 2.46, 95% CI = 1.84–3.29).

Compared with female participants without a history of cancer, male participants without a history of cancer had a significantly reduced risk of fracture (HR = 0.51, 95% CI = 0.48–0.54). Compared with female cancer survivors, male cancer survivors had a significantly reduced risk of fracture within 5 years of diagnosis (HR = 0.53, 95% CI = 0.41–0.69) and a numerically reduced risk at ≥ 5 years after diagnosis (HR = 0.74, 95% CI = 0.54–1.01).

Compared with cancer survivors who did not receive chemotherapy, those who received chemotherapy were significantly more likely to have a fracture within 5 years of diagnosis (HR = 1.31, 95% CI = 1.09–1.57), with a numerically increased risk at ≥ 5 years after diagnosis (HR = 1.22, 95% CI = 0.99–1.51). Receipt vs no receipt of radiotherapy was not associated with an increased fracture risk within 5 years of diagnosis (HR = 0.96, 95% CI = 0.82–1.13) or at ≥ 5 years after diagnosis (HR = 0.85, 95% CI = 0.72–1.01).

Among cancer survivors, risk of fracture was reduced in those with a body mass index (BMI) ≥ 25 kg/m2 vs lower BMI within 5 years of diagnosis (HR = 0.72, 95% CI = 0.62–0.85). Physically active cancer survivors had a numerically reduced risk of fracture at ≥ 5 years after diagnosis vs less active survivors (HR = 0.76, 95% CI = 0.54–1.07). At ≥ 5 years after diagnosis, current smokers had an increased risk of fracture vs never-smokers (HR = 2.27, 95% CI = 1.55–3.33).

The investigators concluded, “Findings from this cohort study suggest that older adults with a history of cancer may benefit from clinical guidance on prevention of frailty-related fractures. If study findings are replicated, fracture prevention programs for survivors might include referrals for physical activity with cancer exercise professionals and smoking cessation programs.”

Erika Rees-Punia, PhD, of the Department of Population Science, American Cancer Society, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was funded by the American Cancer Society. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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