TY - JOUR
T1 - Fractures frequently occur in older cancer patients
T2 - the MD Anderson Cancer Center experience
AU - Edwards, Beatrice J.
AU - Sun, Ming
AU - Zhang, Xiaotao
AU - Holmes, Holly M.
AU - Song, Juhee
AU - Khalil, Peter
AU - Karuturi, Meghan
AU - Shah, Jay B.
AU - Dinney, Colin P.
AU - Gagel, Robert F.
AU - Valero, Vicente
AU - Champlin, Richard E.
AU - Tripathy, Debasish
AU - Murphy, William A.
N1 - Publisher Copyright:
© 2017, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Purpose and Introduction: A growing number of cancer patients are older adults aged 65 years and older. Patients with cancer are at increased risk for developing osteoporosis, falls, and fractures. We sought to identify the incidence of fractures in older adults who underwent cancer care between January 2013 and December 2015. Methods: A comprehensive geriatric assessment was performed, and bone densitometry was measured at baseline, with a 2-year follow-up. Results: In this study, among 304 patients with gastrointestinal, urologic, breast, lung, and gynecologic cancers we evaluated, and who completed the bone density testing (n = 199), 80% had osteoporosis or low bone mass (osteopenia). There was a higher prevalence of osteoporosis in cancer patients (40 vs. 16%, p = 0.05) than in population studies. Vitamin D insufficiency (< 30 ng/ml) was identified in 49% of tested cases (n = 245). Risk factors for low bone mass or osteoporosis were advanced age (p = 0.05), malnutrition (p = 0.04), and frailty (p = 0.01). Over the following 2 years (median follow-up 18 months), there was an incidence of fractures of 110 per 1000 person-years, or 2.8 times higher than reported in individuals without cancer. Risk factors for fractures included advanced age (70–79 vs. 60–69 years, p = 0.05) and frailty (p = 0.03). Conclusion: Most older cancer patients studied have osteoporosis or low bone mass, resulting in an almost 3-fold increase in fracture risk as compared to epidemiologic studies. Bone health issues are commonly seen in older cancer patients, we recommend universal bone density testing. The initiation of antiresorptive treatment when findings are of osteopenia or osteoporosis will reduce the risk of fractures.
AB - Purpose and Introduction: A growing number of cancer patients are older adults aged 65 years and older. Patients with cancer are at increased risk for developing osteoporosis, falls, and fractures. We sought to identify the incidence of fractures in older adults who underwent cancer care between January 2013 and December 2015. Methods: A comprehensive geriatric assessment was performed, and bone densitometry was measured at baseline, with a 2-year follow-up. Results: In this study, among 304 patients with gastrointestinal, urologic, breast, lung, and gynecologic cancers we evaluated, and who completed the bone density testing (n = 199), 80% had osteoporosis or low bone mass (osteopenia). There was a higher prevalence of osteoporosis in cancer patients (40 vs. 16%, p = 0.05) than in population studies. Vitamin D insufficiency (< 30 ng/ml) was identified in 49% of tested cases (n = 245). Risk factors for low bone mass or osteoporosis were advanced age (p = 0.05), malnutrition (p = 0.04), and frailty (p = 0.01). Over the following 2 years (median follow-up 18 months), there was an incidence of fractures of 110 per 1000 person-years, or 2.8 times higher than reported in individuals without cancer. Risk factors for fractures included advanced age (70–79 vs. 60–69 years, p = 0.05) and frailty (p = 0.03). Conclusion: Most older cancer patients studied have osteoporosis or low bone mass, resulting in an almost 3-fold increase in fracture risk as compared to epidemiologic studies. Bone health issues are commonly seen in older cancer patients, we recommend universal bone density testing. The initiation of antiresorptive treatment when findings are of osteopenia or osteoporosis will reduce the risk of fractures.
KW - Falls
KW - Fractures
KW - Low bone mass
KW - Malignancy
KW - Older adults
UR - http://www.scopus.com/inward/record.url?scp=85035776967&partnerID=8YFLogxK
U2 - 10.1007/s00520-017-3962-7
DO - 10.1007/s00520-017-3962-7
M3 - Article
C2 - 29197959
AN - SCOPUS:85035776967
SN - 0941-4355
VL - 26
SP - 1561
EP - 1568
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 5
ER -