In a Canadian population–based cohort study reported in JAMA Oncology, Ye et al found that patients with cancer were at increased risk of fracture compared with individuals without cancer. In addition, a Fracture Risk Assessment Tool (FRAX) provided accurate prediction of this increased risk.
As stated by the investigators: “…FRAX is a fracture risk prediction tool for 10-year probability of major osteoporotic fracture … and hip fracture in the general population. Whether FRAX is useful in individuals with cancer is uncertain.”
Study Details
The study included residents of Manitoba with or without cancer diagnoses between 1987 and 2014. Incident fractures were identified through the end of March 2021 using population-based health-care data. FRAX scores were determined for individuals with and without cancer, with bone mineral density (BMD) results recorded in the Manitoba BMD Registry.
Key Findings
The cohort included 9,877 individuals with cancer (mean age = 67.1 years) and 45, 877 individuals without cancer (mean age = 66.2 years). Compared with individuals without cancer, those with cancer had higher rates of incident major osteoporotic fracture (14.5 vs 12.9 per 1,000 person-years, P < .001) and hip fracture (4.2 vs 3.5 per 1,000 person-years, P = .002).
Among patients with cancer, FRAX with BMD results were associated with incident major osteoporotic fracture (hazard ratio [HR] per standard deviation [SD] increase = 1.84, 95% CI = 1.74–1.95) and hip fracture (HR per SD increase = 3.61, 95% CI = 3.13–4.15). Among patients with cancer, calibration slopes for FRAX with BMD vs incident fractures were 1.03 for major osteoporotic fractures and 0.97 for hip fractures.
The investigators concluded: “In this retrospective cohort study, FRAX with BMD showed good stratification and calibration for predicting incident fractures in patients with cancer. These results suggest that FRAX with BMD can be a reliable tool for predicting incident fractures in individuals with cancer.
Carrie Ye, MD, of the University of Alberta, Edmonton, is the corresponding author of the JAMA Oncology article.
Disclosure: The study was funded by the CancerCare Manitoba Foundation. For full disclosures of the study authors, visit jamanetwork.com.
