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.

中文翻译：

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癌症患者的骨折和长期死亡率：基于人群的队列研究

概括

我们在一个由 122,045 名癌症患者组成的基于人群的队列中评估了骨折后死亡率。严重骨折（髋部、椎骨、肱骨和前臂）与早期和长期全因死亡率增加有关。

介绍

目前，在癌症患者中没有关于广泛癌症诊断的骨折后死亡风险的基于人群的数据。我们的目标是评估骨折与癌症幸存者死亡率的关系。

方法

使用加拿大曼尼托巴省的曼尼托巴癌症登记数据，我们确定了 1987 年 1 月 1 日至 2014 年 3 月 31 日期间诊断出的所有癌症女性和男性。然后，我们将癌症数据与省级医疗保健管理数据联系起来，并确定癌症诊断后的骨折和死亡率至 2015 年 3 月 31 日。根据针对多个协变量调整的时间依赖性 Cox 比例风险模型估计有骨折与无骨折的全因死亡率的风险比。

结果

研究队列由 122,045 名癌症患者组成（中位年龄 68 岁，IQR 58-77，49.2% 为女性）。在癌症诊断后 5.8 年的中位随访期间，我们确定了 7120 例（5.8%）大骨折。除前臂外，所有骨折部位都与死亡风险增加相关，即使在多变量调整后也是如此。与严重骨折相关的超额死亡风险在骨折后第一年最大（HR 2.42, 95% CI 2.30–2.54），并且在骨折后 > 5 年（HR 1.60, 95% CI 1.50–1.70）和发生骨折时仍然显着> 癌症诊断后 10 年（HR 1.93, 95% CI 1.79–2.07）。

结论

癌症患者的骨折与全因死亡率增加有关。这种超额风险在第一年最大，并在骨折后持续 5 年以上；癌症诊断后 10 年或以上发生骨折的风险也增加。