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Risk of fracture incidence in prostate cancer survivors: a nationwide cohort study in South Korea

Abstract

Purpose

We analyzed the risk of fracture in prostate cancer (PC) survivors compared to that in the general population in South Korea and according to the primary treatment.

Methods

From 2007 to 2013, a total of 41,733 PC survivors newly diagnosed with PC in South Korea were identified and matched to non-cancer controls. Cox proportional hazards regression analysis was performed to determine the relative risk of fracture.

Results

Compared to the matched controls, PC survivors had a higher risk of fracture (adjusted hazard ratio (aHR) 1.39; 95% confidence interval (CI) 1.33–1.45). Compared to the matched controls, the active surveillance/watchful waiting and radiotherapy group showed a similar risk of fracture (aHR 1.08; 95% CI 0.98–1.20, and aHR 1.04; 95% CI 0.63–1.73, respectively). PC survivors who underwent surgery showed a lower risk of fracture (aHR 0.89; 95% CI 0.82–0.96), while those who underwent surgery + androgen deprivation therapy (ADT) (aHR 1.41; 95% CI 1.26–1.57), radiotherapy + ADT (aHR 1.86; 95% CI 1.50–2.32), and only ADT (aHR 1.92; 95% CI 1.82–2.02) showed a higher risk of fracture than the control group.

Conclusion

The risk of fracture differed according to the primary treatment method for PC; survivors who underwent surgery had a lower risk of fracture compared to that of the general population. However, PC survivors treated with ADT showed a higher risk of fracture than the other PC treatment groups or the general population. Therefore, more attention and preventive bone care are required for PC survivors who receive ADT.

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Data availability

Not applicable (because access to the big data requires permission of KNHIS).

Abbreviations

AS/WW:

Active surveillance/watchful waiting

RT:

Radiotherapy

ADT:

Androgen deprivation therapy

BMD:

Bone mineral density

KNHIS:

Korean National Health Insurance Service

ICD-10:

International Classification of Disease, 10th revision

LHRH:

Luteinizing hormone-releasing hormone

aHR:

Adjusted hazard ratio

CI:

Confidence interval

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Acknowledgments

This study used National Health Insurance Service (NHIS) data (NHIS-2020-1-115 made by NHIS.

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Authors and Affiliations

Authors

Contributions

Hyun Bin Shin: investigation, visualization, writing—original draft. Hyun Sik Park: supervision, validation. Jung Eun Yoo: supervision, validation, writing—review and editing. Kyungdo Han: data curation, formal analysis, software. Sang Hyun Park: data curation, formal analysis, software. Dong Wook Shin: conceptualization, investigation, methodology, resources, supervision, writing—review and editing. Jinsung Park: conceptualization, investigation, methodology, resources, supervision, writing—review and editing.

Corresponding authors

Correspondence to Dong Wook Shin or Jinsung Park.

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Conflicts of interest

None.

Ethics approval

For this type of study formal consent is not required. (IRB No. 2018-09-001).

Consent to participate

Waived because our study used deidentified data of KNHIS database.

Consent for publication

Yes. Corresponding author, Dr. Jinsung Park, has full responsibility for publication.

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Not applicable.

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Cite this article

Shin, H.B., Park, H.S., Yoo, J.E. et al. Risk of fracture incidence in prostate cancer survivors: a nationwide cohort study in South Korea. Arch Osteoporos 15, 110 (2020). https://doi.org/10.1007/s11657-020-00785-6

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  • DOI: https://doi.org/10.1007/s11657-020-00785-6

Keywords

  • Prostate cancer
  • Fracture
  • Androgen deprivation therapy
  • Population-based national wide study