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

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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.

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Acknowledgements

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 and Seniors Care, or other data providers is intended or should be inferred. 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).

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Authors and Affiliations

  1. University of Alberta, Edmonton, Canada

    Carrie Ye

  2. University of Manitoba, Winnipeg, Canada

    William D. Leslie, Saeed Al-Azazi, Lin Yan, Lisa M. Lix, Piotr Czaykowski & Harminder Singh

  3. CancerCare Manitoba, Winnipeg, MB, Canada

    Piotr Czaykowski & Harminder Singh

Authors
  1. Carrie Ye
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  2. William D. Leslie
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  3. Saeed Al-Azazi
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  4. Lin Yan
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  5. Lisa M. Lix
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  6. Piotr Czaykowski
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  7. Harminder Singh
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Corresponding author

Correspondence to Carrie Ye.

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Ethics approval

Obtained from the University of Manitoba Health Research Ethics Board, data access approved by Manitoba Health, Health Information and Privacy Committee.

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Waiver of consent approved (administrative database study).

Conflicts of interest

Carrie Ye, William Leslie, Saeed Al-Azazi, Lin Yan, Lisa Lix, and Piotr Czaykowski do not have any conflicts of interest to declare. Harminder Singh has been on the advisory boards of Takeda Canada, Amgen Canada, and Guardant Health, Inc.

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Ye, C., Leslie, W.D., Al-Azazi, S. et al. Fractures and long-term mortality in cancer patients: a population-based cohort study. Osteoporos Int 33, 2629–2635 (2022). https://doi.org/10.1007/s00198-022-06542-4

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  • DOI: https://doi.org/10.1007/s00198-022-06542-4

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