medwireNews: Older individuals with a history of cancer, especially those with a more recent diagnosis, have a higher risk for frailty-related bone fractures than their cancer-free counterparts, suggests a large longitudinal study.
The increased risk was driven primarily by an elevated risk for vertebral and pelvic fractures, whereas the risk for radial fractures was comparable between people with and without cancer, note the researchers.
“The reasons for site-specific differences in fracture risks are unclear but may be associated with various mechanisms of action,” they write in JAMA Oncology.
“For example, hip fractures tend to occur in adults who are older, very physically inactive, and more likely to fall (95% of hip fractures are caused by falling), whereas radial fractures are more likely to occur among more active, relatively healthy adults who walk more and participate in a wider range of activities.”
The team collated data for 92,431 participants (mean age, 69.4 years) of the US Cancer Prevention Study II Nutrition Cohort who were also enrolled in Medicare between 1999 and 2017. Just over half (56.1%) of the cohort were women and the large majority (97.9%) were White. During follow-up, 15.3% of the participants developed cancer and 14.0% experienced a frailty-related bone fracture.
People who did versus did not develop cancer during follow-up had a significantly increased risk for frailty-related fractures for several years after diagnosis, with, for instance, a 1.57-fold higher risk in the first year postdiagnosis relative to those without cancer.
The risk was especially high for individuals with distant metastases and a time since diagnosis of 1 year to less than 5 years, at a significant hazard ratio (HR) of 2.12 compared with participants without cancer, say Erika Rees-Punia, from the American Cancer Society in Kennesaw, Georgia, USA, and colleagues.
When this specific patient subgroup was further assessed by fracture type, the risk for vertebral and pelvic fractures was significantly higher among those with versus without cancer, at an HR of 2.46 in both cases. By contrast, there was no significant increase in the risk for radial fractures among cancer survivors with distant metastases in the past 1 to less than 5 years (nonsignificant HR=1.09).
Looking at other factors in patients who developed cancer during follow-up, the investigators found that the fracture risk was significantly elevated for women compared with men, “a pattern that has been demonstrated in several prior studies of older adults,” they say.
The fracture risk was also increased for survivors who were current smokers and those who received chemotherapy. Specifically, current smokers had a significant 2.27-fold increased risk for fractures at 5 or more years after the cancer diagnosis, relative to never smokers. And cancer patients who received chemotherapy had a significant 1.31-fold increased fracture risk at 1 to less than 5 years after diagnosis compared with those who did not receive chemotherapy.
Rees-Punia et al also observed a numerically lower risk for fracture at 5 or more years since diagnosis among people with cancer who were physically active, but this did not reach statistical significance.
And they conclude: “Cancer survivors, especially those who received chemotherapy or received a cancer diagnosis more recently (<5 years), may benefit from clinical guidance on frailty-related fracture prevention.
“If findings from this study are replicated, fracture prevention programs for survivors might include referrals for physical activity with cancer exercise professionals and for smoking cessation programs.”
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