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Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience

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Abstract

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.

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Acknowledgements

This study was presented at MASCC/ISOO 2016 Annual Meeting.

Funding

This study was supported by a grant from the University of Texas MD Anderson Cancer Center; the statistical analysis work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).

Author information

Authors and Affiliations

  1. Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA

    Beatrice J. Edwards, Ming Sun, Xiaotao Zhang, Peter Khalil & Robert F. Gagel

  2. Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA

    Holly M. Holmes

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Juhee Song

  4. Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Meghan Karuturi, Vicente Valero & Debasish Tripathy

  5. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jay B. Shah & Colin P. Dinney

  6. Department of Stem Cell Transplantation, Houston, TX, USA

    Richard E. Champlin

  7. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    William A. Murphy Jr

Authors
  1. Beatrice J. Edwards
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  2. Ming Sun
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  9. Colin P. Dinney
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  14. William A. Murphy Jr
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Corresponding author

Correspondence to Beatrice J. Edwards.

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The research protocol was approved by the institutional review board.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Edwards, B.J., Sun, M., Zhang, X. et al. Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience. Support Care Cancer 26, 1561–1568 (2018). https://doi.org/10.1007/s00520-017-3962-7

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  • DOI: https://doi.org/10.1007/s00520-017-3962-7

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