Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience.
Support Care Cancer. 2017 Dec 2. doi: 10.1007/s00520-017-3962-7. [Epub ahead of print]
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- Overview Fractures and vitamin D
- Cancers and Cancer therapy reduce levels of Vitamin D
- Reduced Vitamin D levels increase risk of bone fracture
Edwards BJ1, Sun M2, Zhang X2, Holmes HM3, Song J4, Khalil P2, Karuturi M5, Shah JB6, Dinney CP6, Gagel RF2, Valero V5, Champlin RE7, Tripathy D5, Murphy WA Jr8.
1 Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA. Beatrice.Edwards at va.gov.
2 Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA.
3 Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA.
4 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5 Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6 Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
7 Department of Stem Cell Transplantation, Houston, TX, USA.
8 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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.
A comprehensive geriatric assessment was performed, and bone densitometry was measured at baseline, with a 2-year follow-up.
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).
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.
PMID: 29197959 DOI: 10.1007/s00520-017-3962-7