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Fracture risk among patients with cancer compared to individuals without cancer: a population-based study

British Journal of Cancer volume 129, pages 665–671 (2023)Cite this article

Subjects

Abstract

Background

Patients with cancer may be at increased risk of osteoporosis and fracture; however, gaps exist in the existing literature and the association between cancer and fracture requires further examination.

Methods

We conducted a population-based cohort study of Ontario patients with cancer (breast, prostate, lung, gastrointestinal, haematologic) diagnosed between January 2007 to December 2018 and 1:1 matched non-cancer controls. The primary outcome was incident fracture (end of follow-up December 2019). Multivariable Cox regression analysis was used to estimate the relative fracture risk with sensitivity analysis accounting for competing risk of death.

Results

Among 172,963 cancer patients with non-cancer controls, 70.6% of patients with cancer were <65 years old, 58% were female, and 9375 and 8141 fracture events were observed in the cancer and non-cancer group, respectively (median follow-up 6.5 years). Compared to non-cancer controls, patients with cancer had higher risk of fracture (adjusted HR [aHR] 1.10, 95% CI 1.07–1.14, p < 0.0001), which was also observed for both solid (aHR 1.09, 95% CI 1.05–1.13, p < 0.0001) and haematologic cancers (aHR 1.20, 95% CI 1.10–1.31, p < 0.0001). Sensitivity analysis accounting for competing risk of death did not change these findings.

Conclusions

Our study indicates that patients with cancer are at modest risk of fractures compared to non-cancer controls.

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Fig. 1: Cumulative incidence curves of incident fracture in a retrospectively identified population cohort.
Fig. 2: Cumulative incidence curves of incident fracture.

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Data availability

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and providers (e.g. healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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Acknowledgements

This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from Canada Post Corporation and Statistics Canada. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI), Ontario Health (OH), Ontario Ministry of Health (MOH), and the Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. We thank IQVIA Solutions Canada Inc. for use of their Drug Information File.

Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This work was also funded by the Canadian Centre for Applied Research in Cancer Control (ARCC). ARCC receives core funding from the Canadian Cancer Society (Grant #2020-706936).

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Inna Y. Gong, Kelvin K. W. Chan, Lorraine L. Lipscombe, Matthew C. Cheung & Lee Mozessohn

  2. ICES, Toronto, ON, Canada

    Kelvin K. W. Chan, Lorraine L. Lipscombe, Matthew C. Cheung & Lee Mozessohn

  3. Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada

    Kelvin K. W. Chan, Matthew C. Cheung & Lee Mozessohn

  4. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Lorraine L. Lipscombe

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Contributions

Conceptualisation: IYG, LM, MCC, KKWC. Data curation: LM, MCC, KKWC. Formal analysis: IYG, LM, MCC, KKWC. Funding acquisition: LM. Investigation: IYG, LM, MCC, KKWC. Methodology: all authors. Project administration, resources, software, supervision, validation, visualisation: LM, MCC. Writing—original draft: IYG. Writing—review and editing: all authors.

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Correspondence to Lee Mozessohn.

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The authors declare no competing interests.

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This study was approved by the Research Ethics Board at Sunnybrook Health Sciences Center.

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Gong, I.Y., Chan, K.K.W., Lipscombe, L.L. et al. Fracture risk among patients with cancer compared to individuals without cancer: a population-based study. Br J Cancer 129, 665–671 (2023). https://doi.org/10.1038/s41416-023-02353-4

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