Older cancer survivors at higher risk for bone fracture
Click Here to Manage Email Alerts
Older cancer survivors have an increased risk for pelvic and vertebral bone fracture compared with older adults without a history of cancer, research published in JAMA Oncology showed.
The increased risk for fracture is most pronounced among older patients diagnosed within the last 5 years and those who previously received chemotherapy.
Survivors with a history of smoking had a higher risk, and some evidence indicated physical activity may be associated with a lower risk, the investigators noted.
Background
Erika Rees-Punia, MD, MPH, is a senior principal scientist with American Cancer Society, where her research focuses on improving patients’ quality of life after a cancer diagnosis.
Fractures of the pelvis and vertebrae have implications beyond the nuisance of dealing with a broken bone for older patients, she said.
“Pelvic and vertebral fractures can cause a lot of issues down the road: high health care costs, limited mobility and, as some studies suggest, a higher risk for premature mortality,” she told Healio. “So, we wanted to understand if older cancer survivors are at a higher risk for these bone fractures and, if so, what factors may be associated with a reduced risk.”
Methodology
Rees-Punia and colleagues conducted a longitudinal cohort study of 92,431 older adults (mean age, 69.4 ± 6 years; 56% women; 97.9% white) from the U.S. Cancer Prevention Study II Nutrition Cohort with data linked to Medicare claims from 1999 to 2017.
The investigators sought to identify any associations between subsequent fracture and cancer history, time since diagnosis and cancer stage. They also examined the possible impact of clinical factors, including modifiable behaviors, cancer type and treatment type.
Risk for pelvic, radial, vertebral or total frailty-related fractures served as the study’s main outcome measurement.
Key findings
The analysis showed 12,943 study participants had a frailty-related bone fracture during the study period.
Investigators observed a higher risk for fracture among cancer survivors with advanced-stage cancer diagnosed within 5 years of the fracture event compared with adults without a history of cancer (HR = 2.12; 95% CI, 1.75-2.58).
The results showed increased risk for cancer survivors with a recent advanced-stage cancer diagnosis for both vertebral (HR = 2.46; 95% CI, 1.93-3.13) and pelvic fracture (HR = 2.46; 95% CI, 1.84-3.29) compared with adults without a history of cancer.
Older cancer survivors who received chemotherapy had increased risk for fracture that was highest within 5 years of diagnosis (HR = 1.31; 95% CI, 1.09-1.57) and decreased 5 years or more after diagnosis (HR = 1.22; 95% CI, 0.99-1.51).
Researchers found that older cancer survivors who smoked had a significantly higher risk (HR = 2.27; 95% CI, 1.55-3.33), whereas physically active cancer survivors had a lower risk (HR = 0.76; 95% CI, 0.54-1.07) at 5 or more years after diagnosis that did not reach statistical significance.
Clinical implications
Higher rates of osteoporosis and low muscle mass are primary contributors to bone fractures among older patients, Rees-Punia said. Balance issues and unexpected gait changes associated with chemotherapy among cancer survivors have the potential to impact fracture risk, as well, she added.
Her group has plans to further explore fracture risk among cancer survivors by examining the impact of aerobic exercise and strength training as part of a future study.
“We hope that results impact the guidance clinicians provide cancer survivors around how to avoid bone fractures,” Rees-Punia told Healio. “Fracture prevention programs for survivors could include smoking-cessation programs and referrals for physical activity with cancer exercise professionals.”
For more information :
Erika Rees-Punia, PhD, can be reached at Department of Population Science, American Cancer Society, 3380 Chastain Meadows Pkwy. NW, Kennesaw, GA 30144; email: erika.rees-punia@cancer.org.
Collapse
Read more about
Click Here to Manage Email Alerts