Skip to main content
Erschienen in:

29.08.2022 | Original Article

Fractures and long-term mortality in cancer patients: a population-based cohort study

verfasst von: Carrie Ye, William D. Leslie, Saeed Al-Azazi, Lin Yan, Lisa M. Lix, Piotr Czaykowski, Harminder Singh

Erschienen in: Osteoporosis International | Ausgabe 12/2022

Einloggen, um Zugang zu erhalten

Abstract

Summary

We assessed post-fracture mortality in a population-based cohort of 122,045 individuals with cancers. Major fractures (hip, vertebrae, humerus, and forearm) were associated with early and long-term increased all-cause mortality.

Introduction

Currently, there are no population-based data among cancer patients on post-fracture mortality risk across a broad range of cancer diagnoses. Our objective was to estimate the association of fracture with mortality in cancer survivors.

Methods

Using Manitoba Cancer Registry data from the province of Manitoba, Canada, we identified all women and men with cancer diagnosed between January 1, 1987, and March 31, 2014. We then linked cancer data to provincial healthcare administrative data and ascertained fractures after cancer diagnosis and mortality to March 31, 2015. Hazard ratios for all-cause mortality in those with versus without fracture were estimated from time-dependent Cox proportional hazards models adjusted for multiple covariates.

Results

The study cohort consisted of 122,045 cancer patients (median age 68 years, IQR 58–77, 49.2% female). During the median follow-up of 5.8 years from cancer diagnosis, we ascertained 7120 (5.8%) major fractures. All fracture sites, except for the forearm, were associated with increased mortality risk, even after multivariable adjustment. Excess mortality risk associated with a major fracture was greatest in the first year after fracture (HR 2.42, 95% CI 2.30–2.54) and remained significant > 5 years after fracture (HR 1.60, 95% CI 1.50–1.70) and for fractures occurring > 10 years after cancer diagnosis (HR 1.93, 95% CI 1.79–2.07).

Conclusion

Fractures among cancer patients are associated with increased all-cause mortality. This excess risk is greatest in the first year and persists more than 5 years post-fracture; increased risk is also noted for fractures occurring up to and beyond 10 years after cancer diagnosis.
Literatur
1.
Zurück zum Zitat Coleman MP, Forman D, Bryant H et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. The Lancet 377:127–138CrossRef Coleman MP, Forman D, Bryant H et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. The Lancet 377:127–138CrossRef
2.
3.
Zurück zum Zitat Shapiro CL, Van Poznak C, Lacchetti C et al (2019) Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO Clinical Practice Guideline. J Clin Oncol 37:2916–2946CrossRefPubMed Shapiro CL, Van Poznak C, Lacchetti C et al (2019) Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO Clinical Practice Guideline. J Clin Oncol 37:2916–2946CrossRefPubMed
4.
5.
Zurück zum Zitat Wu CC, Chen PY, Wang SW et al (2021) Risk of fracture during androgen deprivation therapy among patients with prostate cancer: a systematic review and meta-analysis of cohort studies. Front Pharmacol 12:652979CrossRefPubMedPubMedCentral Wu CC, Chen PY, Wang SW et al (2021) Risk of fracture during androgen deprivation therapy among patients with prostate cancer: a systematic review and meta-analysis of cohort studies. Front Pharmacol 12:652979CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Lustberg MB, Reinbolt RE, Shapiro CL (2012) Bone health in adult cancer survivorship. J Clin Oncol 30:3665–3674CrossRefPubMed Lustberg MB, Reinbolt RE, Shapiro CL (2012) Bone health in adult cancer survivorship. J Clin Oncol 30:3665–3674CrossRefPubMed
8.
Zurück zum Zitat Centers for Disease Control and Prevention (CDC) (2011) Cancer survivors–United States, 2007. MMWR Morb Mortal Wkly Rep 60:269–272 Centers for Disease Control and Prevention (CDC) (2011) Cancer survivors–United States, 2007. MMWR Morb Mortal Wkly Rep 60:269–272
9.
Zurück zum Zitat Hadji P, Aapro MS, Body JJ et al (2011) Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 22:2546–2555CrossRefPubMed Hadji P, Aapro MS, Body JJ et al (2011) Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 22:2546–2555CrossRefPubMed
10.
Zurück zum Zitat Lee CE, Leslie WD, Czaykowski P et al (2011) A comprehensive bone-health management approach for men with prostate cancer receiving androgen deprivation therapy. Curr Oncol 18:e163–e172CrossRefPubMedPubMedCentral Lee CE, Leslie WD, Czaykowski P et al (2011) A comprehensive bone-health management approach for men with prostate cancer receiving androgen deprivation therapy. Curr Oncol 18:e163–e172CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Coleman R, Hadji P, Body J-J et al (2020) Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol 31:1650–1663CrossRefPubMed Coleman R, Hadji P, Body J-J et al (2020) Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol 31:1650–1663CrossRefPubMed
12.
Zurück zum Zitat Daniell HW, Dunn SR, Ferguson DW et al (2000) Progressive osteoporosis during androgen deprivation therapy for prostate cancer. J Urol 163:181–186CrossRefPubMed Daniell HW, Dunn SR, Ferguson DW et al (2000) Progressive osteoporosis during androgen deprivation therapy for prostate cancer. J Urol 163:181–186CrossRefPubMed
13.
Zurück zum Zitat Hong AR, Kim JH, Lee KH et al (2017) Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer. Osteoporos Int 28:1413–1422CrossRefPubMed Hong AR, Kim JH, Lee KH et al (2017) Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer. Osteoporos Int 28:1413–1422CrossRefPubMed
15.
Zurück zum Zitat Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87:398–403CrossRefPubMedPubMedCentral Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87:398–403CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Center JR, Center JR, Nguyen TV et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. The Lancet 353:878–882CrossRef Center JR, Center JR, Nguyen TV et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. The Lancet 353:878–882CrossRef
17.
Zurück zum Zitat Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005CrossRefPubMed Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005CrossRefPubMed
18.
Zurück zum Zitat Morin S, Lix LM, Azimaee M et al (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448CrossRefPubMed Morin S, Lix LM, Azimaee M et al (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448CrossRefPubMed
19.
Zurück zum Zitat Ioannidis G, Papaioannou A, Hopman WM et al (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271CrossRefPubMedPubMedCentral Ioannidis G, Papaioannou A, Hopman WM et al (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Sattui SE, Saag KG (2014) Fracture mortality: associations with epidemiology and osteoporosis treatment. Nat Rev Endocrinol 10:592–602CrossRefPubMed Sattui SE, Saag KG (2014) Fracture mortality: associations with epidemiology and osteoporosis treatment. Nat Rev Endocrinol 10:592–602CrossRefPubMed
21.
Zurück zum Zitat Tucker TC, Howe HL, Weir HK (1999) Certification for population-based cancer registries. J Reg Mgmt 26:24–27 Tucker TC, Howe HL, Weir HK (1999) Certification for population-based cancer registries. J Reg Mgmt 26:24–27
22.
Zurück zum Zitat Hotes Ellison J, Wu XC, McLaughlin C, et al (2006) Cancer in North America: 1999--2003. Incidence North American Asociation of Central Cancer Registeries Inc Hotes Ellison J, Wu XC, McLaughlin C, et al (2006) Cancer in North America: 1999--2003. Incidence North American Asociation of Central Cancer Registeries Inc
24.
Zurück zum Zitat Lix LM, Azimaee M, Osman BA et al (2012) Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health 12:301CrossRefPubMedPubMedCentral Lix LM, Azimaee M, Osman BA et al (2012) Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health 12:301CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Epp R, Alhrbi M, Ward L, Leslie W (2018) Radiological validation of fracture definitions from administrative data: the Manitoba bone mineral density database. In: JOURNAL OF BONE AND MINERAL RESEARCH. WILEY 111 RIVER ST, HOBOKEN 07030–5774, NJ USA, pp 275–275 Epp R, Alhrbi M, Ward L, Leslie W (2018) Radiological validation of fracture definitions from administrative data: the Manitoba bone mineral density database. In: JOURNAL OF BONE AND MINERAL RESEARCH. WILEY 111 RIVER ST, HOBOKEN 07030–5774, NJ USA, pp 275–275
26.
Zurück zum Zitat O’Donnell S, Canadian Chronic Disease Surveillance System (CCDSS) Osteoporosis Working Group (2013) Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study. Arch Osteoporos 8:143CrossRefPubMedPubMedCentral O’Donnell S, Canadian Chronic Disease Surveillance System (CCDSS) Osteoporosis Working Group (2013) Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study. Arch Osteoporos 8:143CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
28.
Zurück zum Zitat Lix LM, Quail J, Fadahunsi O, Teare GF (2013) Predictive performance of comorbidity measures in administrative databases for diabetes cohorts. BMC Health Serv Res 13:340CrossRefPubMedPubMedCentral Lix LM, Quail J, Fadahunsi O, Teare GF (2013) Predictive performance of comorbidity measures in administrative databases for diabetes cohorts. BMC Health Serv Res 13:340CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Lix L, Smith M, Pitz M, Ahmed R, Quon H, Griffith J, Turner D, Hong S, Prior H, Banerjee A, Koseva I, Kulbaba C. Cancer data linkage in Manitoba: expanding the infrastructure for research. Winnipeg, MB. Manitoba Centre for Health Policy, January 2016 Lix L, Smith M, Pitz M, Ahmed R, Quon H, Griffith J, Turner D, Hong S, Prior H, Banerjee A, Koseva I, Kulbaba C. Cancer data linkage in Manitoba: expanding the infrastructure for research. Winnipeg, MB. Manitoba Centre for Health Policy, January 2016
30.
Zurück zum Zitat Bliuc D, Nguyen ND, Milch VE et al (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521CrossRefPubMed Bliuc D, Nguyen ND, Milch VE et al (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521CrossRefPubMed
31.
Zurück zum Zitat Haentjens P, Magaziner J, Colón-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390CrossRefPubMedPubMedCentral Haentjens P, Magaziner J, Colón-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Bellera CA, MacGrogan G, Debled M et al (2010) Variables with time-varying effects and the Cox model: some statistical concepts illustrated with a prognostic factor study in breast cancer. BMC Med Res Methodol 10:20CrossRefPubMedPubMedCentral Bellera CA, MacGrogan G, Debled M et al (2010) Variables with time-varying effects and the Cox model: some statistical concepts illustrated with a prognostic factor study in breast cancer. BMC Med Res Methodol 10:20CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Behnke NK, Baker DK, Xu S et al (2017) Risk factors for same-admission mortality after pathologic fracture secondary to metastatic cancer. Support Care Cancer 25:513–521CrossRefPubMed Behnke NK, Baker DK, Xu S et al (2017) Risk factors for same-admission mortality after pathologic fracture secondary to metastatic cancer. Support Care Cancer 25:513–521CrossRefPubMed
34.
Zurück zum Zitat Tosteson ANA, Gottlieb DJ, Radley DC et al (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18:1463–1472CrossRefPubMedPubMedCentral Tosteson ANA, Gottlieb DJ, Radley DC et al (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18:1463–1472CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Cummings SR, Eastell R (2020) Stop (mis)classifying fractures as high- or low-trauma or as fragility fractures. Osteoporos Int 31:1023–1024CrossRefPubMed Cummings SR, Eastell R (2020) Stop (mis)classifying fractures as high- or low-trauma or as fragility fractures. Osteoporos Int 31:1023–1024CrossRefPubMed
Metadaten
Titel
Fractures and long-term mortality in cancer patients: a population-based cohort study
verfasst von
Carrie Ye
William D. Leslie
Saeed Al-Azazi
Lin Yan
Lisa M. Lix
Piotr Czaykowski
Harminder Singh
Publikationsdatum
29.08.2022
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 12/2022
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-022-06542-4

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).


Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Aerobes Training hilft bei Fibromyalgie

Sport im aeroben Bereich ist ein veritables Mittel, um die Schmerzen von Menschen mit Fibromyalgie zu reduzieren, wie eine Metaanalyse zeigt. Frequenz, Dauer und Intensität der Übungen geben den Ausschlag.

Positive Langzeitdaten zu Inlays aus hochvernetztem Polyethylen

10-Jahres-Daten einer randomisierten Studie sprechen dafür, dass Knie-TEP-Inlays aus hochvernetztem (HXLPE) und konventionellem Polyethylen selten Revisionen erfordern – und HXLPE in puncto Abnutzung vielleicht sogar die Nase vorn hat.

Was bringt die Spritze ins Gelenk bei Arthrose?

Ein hochkarätiges Studienteam hat untersucht, wie gut intraartikulär verabreichte Substanzen zur Behandlung von Knie- und Hüftarthrose wirken. Für die meisten ist die Wirksamkeit alles andere als klar, einige werden offenbar überschätzt, für eine Substanz wird deutlich, dass sie vor allem schadet.

Leitlinienkonformes Management thermischer Verletzungen

Thermische Verletzungen gehören zu den schwerwiegendsten Traumen und hinterlassen oft langfristige körperliche und psychische Spuren. Die aktuelle S2k-Leitlinie „Behandlung thermischer Verletzungen im Kindesalter (Verbrennung, Verbrühung)“ bietet eine strukturierte Übersicht über das empfohlene Vorgehen.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.