A study published online on JAMA Oncology on November 3 found that the risk of pelvic and vertebral fractures in elderly people who have experienced cancer, especially those who have been diagnosed within 5 years or who have received chemotherapy, is significantly higher than that in elderly people without a history of cancer.
About one in seven people with cancer have experienced fractures associated with weakness. Factors associated with a higher risk of fractures include cancer diagnosis, distant metastasis, chemotherapy and smoking.
"The severity and burden of pelvic and vertebral fractures are far greater than those of general fractures," Dr. Erikares punia, the first author of the paper, a master of public health, and the senior chief scientist of epidemiology and behavioral research of the American Cancer Society, said in a statement.
Therefore, it is particularly important to understand the fracture incidence and prevention strategies of this population. “
This longitudinal cohort study used data from 92431 elderly people in the US Cancer Prevention Study II nutrition cohort (mean age at baseline was 69 years; 56% were female).
The data will be analyzed from July 15, 2021 to May 3, 2022. Multivariate Cox proportional hazard regression was used to estimate the risk ratios (HRs) and 95% confidence intervals for pelvic, radial, vertebral, and total weakness related fracture risks. Tiering is used for secondary goals.
Of the participants, 12943 (14%) experienced fractures associated with weakness during follow-up.
Compared with adults without cancer history, cancer survivors diagnosed with advanced cancer within 5 years had more than twice the risk of fracture (HR, 2.12), mainly driven by vertebral and pelvic fractures (HR, 2.46). Compared with cancer patients who did not receive chemotherapy, cancer patients who received chemotherapy were also more likely to fracture.
This association is stronger within 5 years after diagnosis (HR, 1.31). Although the risk is relatively low after 5 years and longer, it is still relevant (HR, 1.22; 95% CI, 0.99-1.51).
In addition, physical activity seems to have a tendency to reduce the risk of fractures. Among physically active cancer survivors 5 years or more after diagnosis, the HR of fracture risk was low (HR, 0.76; 95% CI, 0.54-1.07), but this result was not statistically significant.
However, in an earlier study, the researchers showed that long-term cancer survivors who met the guidelines for physical exercise had a significantly lower risk of weakness related fractures than those who exercised less. Smoking was another factor significantly associated with a high risk of fracture (HR 2.27; 95% CI 1.55-3.33).
"We hope that our findings will provide information for clinical guidance on fracture prevention, including physical activity programs and smoking cessation programs, to improve the quality of life after cancer diagnosis," Rees Punia said.
In his comments, Jonas Sokolof pointed out that "many chemotherapy drugs will have direct adverse effects on the musculoskeletal system and lead to subsequent fractures“
"This further supports our work in rehabilitation medicine, which is to optimize physical function and quality of life in the entire cancer care continuum," said Sokolof, director of cancer rehabilitation at Langone Health, New York University, New York City.
Sokolof also pointed out that the importance of strengthening physical activity during chemotherapy is changing. In the past, the mantra for cancer patients was to relax and rest, but he said: "Now let exercise be a measure of early cancer care, so that patients can receive exercise therapy when receiving treatment, because we know that exercise is as effective as drugs." "Randomized controlled data suggest that exercise actually improves cancer related health outcomes, including osteoporosis and fractures."
Reference:
Rees-Punia E, Newton CC, Parsons HM, et al. Fracture Risk Among Older Cancer Survivors Compared With Older Adults Without a History of Cancer. JAMA Oncol. Published online November 03, 2022.
Article link:
https://www.cn-healthcare.com/articlewm/20221112/content-1465598.html
