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Cancer patients with fractures are rarely assessed or treated for osteoporosis: a population-based study

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Abstract

Summary

Among 4238 cancer and 16,418 cancer-free individuals with incident major non-traumatic fractures (hip, clinical vertebral, forearm, humerus), post-fracture osteoporosis care was equally poor for both groups, whether assessed from bone mineral density (BMD) testing, initiation of osteoporosis therapy or either intervention (BMD testing and/or osteoporosis therapy).

Introduction

Most individuals sustaining a fracture do not undergo evaluation and/or treatment for osteoporosis. Cancer survivors are at increased risk for osteoporosis and fracture. Whether cancer survivors experience a similar post-fracture “care gap” is unclear. Using population-based databases, we assessed whether cancer patients are evaluated and/or treated for osteoporosis after a major fracture.

Methods

From the Manitoba Cancer Registry, we identified cancer cases (first cancer diagnosis between 1987 and 2013) and cancer-free controls with incident major non-traumatic fractures (from provincial physician billing claims and hospitalization databases). The outcomes were performance of BMD testing (from the BMD Registry), initiation of osteoporosis therapy (from drug dispensation database) or either intervention (BMD testing and/or osteoporosis therapy) in the 12 months post-fracture.

Results

There were 4238 cancer and 16,418 cancer-free individuals who sustained a fracture after the index date (cancer diagnosis) and were followed for at least 1 year post-fracture. Subsequent BMD testing was performed in 11.0% of cancer cases versus 11.5% non-cancer controls (P = 0.43), osteoporosis treatment in 22.9% cancer cases versus 21.8% non-cancer controls (P = 0.15), and either testing or treatment in 28.9% cancer cases versus 28.4% non-cancer controls (P = 0.53). Predictors of BMD testing and/or initiation of therapy were similar for non-cancer and cancer patients. Post-fracture interventions were consistently used more frequently among women, older patients (age 50 years or older), those who sustained fractures in a later calendar period, and (for treatment) after vertebral fracture. Cancer-specific variables (cancer type, years from cancer diagnosis to fracture, specialty of care provider) showed only weak and inconsistent effects.

Conclusions

A large care gap exists among cancer patients who sustain a fracture, similar to the general population, whereby the evaluation or treatment for osteoporosis is seldom conducted. Care maps may need to be developed for cancer populations to improve post-fracture care.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository (2015/2016-10). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. LML is supported by a Tier I Canada Research Chair.

Funding

This study was funded through a Research Operating Grant from the CancerCare Manitoba Foundation (grant # 763045126).

Author information

Authors and Affiliations

  1. University of Manitoba, Winnipeg, Canada

    W. D. Leslie, S. Al-Azazi, L. Yan, L. M. Lix, P. Czaykowski & H. Singh

  2. Department of Medicine (C5121), Saint Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada

    W. D. Leslie

  3. University of Texas Dell Medical School, Temple, TX, USA

    B. Edwards

  4. Veterans Healthcare Administration System, Temple, TX, USA

    B. Edwards

  5. CancerCare Manitoba, Winnipeg, Manitoba, Canada

    P. Czaykowski & H. Singh

Authors
  1. W. D. Leslie
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  2. B. Edwards
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  3. S. Al-Azazi
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  4. L. Yan
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  5. L. M. Lix
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  6. P. Czaykowski
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  7. H. Singh
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Corresponding author

Correspondence to W. D. Leslie.

Ethics declarations

The study was approved by the Research Ethics Board of the University of Manitoba and the Health Information Privacy Committee of Manitoba Health.

Conflicts of interest

William Leslie, Beatrice Edwards, Saeed Al-Azazi, Lin Yan, Lisa Lix, and Piotr Czaykowski declare that they have no conflict of interest.

Harminder Singh has been on advisory board of Takeda Canada, Pendopharm, Ferring Merck Canada and Guardant Health, Inc., has received an educational grant from Ferring and research funding from Merck Canada.

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Leslie, W.D., Edwards, B., Al-Azazi, S. et al. Cancer patients with fractures are rarely assessed or treated for osteoporosis: a population-based study. Osteoporos Int 32, 333–341 (2021). https://doi.org/10.1007/s00198-020-05596-6

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  • DOI: https://doi.org/10.1007/s00198-020-05596-6

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