与无癌症史的老年人相比，老年癌症生存者的骨折风险

SCI 20 November 2022

Fracture Risk Among Older Cancer Survivors Compared With Older Adults Without a History of Cancer

（JAMA Oncology, IF: 33.006）

Erika Rees-Punia, PhD; Christina C. Newton, MSPH; Helen M. Parsons, PhD; Corinne R. Leach, PhD; W. Ryan Diver, MSPH; Amber C. Grant, MPH; Matthew Masters, MPH; Alpa V. Patel, PhD; Lauren R. Teras, PhD 

CORRESPONDENCE TO: erika.rees-punia@cancer.org

IMPORTANCE 意义  

 The number of cancer survivors living in the US is projected to be 26.1 million by 2040. Cancer survivors may be at increased risk of bone fractures, but research is limited in several important ways. 

到2040年，美国癌症生存者的人数预计将达到2610万。癌症生存者可能面临骨折风险增加，但研究在几个方面受到限制。

OBJECTIVE 目的

 To investigate the associations of cancer diagnoses, including time since diagnosis and stage at diagnosis, with risks of pelvic, radial, and vertebral fractures (separately and combined) among older cancer survivors and compared with fracture risk among older adults without a history of cancer. Secondarily, to examine differences in risk of fracture stratified by modifiable behaviors, treatment, and cancer type. 

为了调查癌症诊断的相关性，时间包括自诊断起和诊断阶段，将老年癌症生存者和无癌症史老年人的骨盆、桡骨和脊椎骨折风险进行比较。其次，根据可改变的行为、治疗和癌症类型，分析骨折风险的差异。

DESIGN, SETTING, AND PARTICIPANTS 研究设计和参与者

This longitudinal cohort study used data from 92 431 older adults in the US Cancer Prevention Study II Nutrition Cohort linked with 1999 to 2017 Medicare claims. Data were analyzed from July 15, 2021, to May 3, 2022. 

这项纵向队列研究使用了美国癌症预防研究II营养队列中92431名老年人的数据，该队列与1999年至2017年的医疗保险索赔相关。数据分析时间为2021年7月15日至2022年5月3日。

EXPOSURES 风险

 Cancer history, time since cancer diagnosis, and stage at cancer diagnosis. 

癌症病史、癌症诊断时间和癌症分期。

MAIN OUTCOMES AND MEASURES 研究方法

Hazard ratios (HRs) and 95% CIs for the risk of pelvic, radial, vertebral, and total frailty-related fractures were estimated using multivariate Cox proportional hazards regression. Stratification was used for secondary aims. 

使用多元Cox比例风险回归估计骨盆、桡骨、脊椎和全身脆弱相关骨折风险的风险比和95%CI。分层用于进一步分析。

RESULTS 结果

Among 92 431 participants (mean [SD] age, was 69.4 [6.0] years, 51 820 [56%] women, and 90 458 [97.9%] White], 12 943 participants experienced a frailty-related bone fracture. Compared with participants without a history of cancer, cancer survivors who were diagnosed 1 to less than 5 years earlier with advanced stage cancer had higher risk of fracture (HR, 2.12; 95% CI, 1.75-2.58). The higher fracture risk in cancer survivors with recent advanced stage diagnosis (vs no cancer) was driven largely by vertebral (HR, 2.46; 95% CI, 1.93-3.13) and pelvic (HR, 2.46; 95% CI, 1.84-3.29) fracture sites. Compared with cancer survivors who did not receive chemotherapy, survivors who received chemotherapy were more likely to have a fracture; this association was stronger within 5 years of diagnosis (HR, 1.31; 95% CI, 1.09-1.57) than 5 or more years after diagnosis (HR, 1.22; 95% CI, 0.99-1.51). Although the HR for risk of fracture was lower among physically active cancer survivors 5 or more years after diagnosis (HR, 0.76; 95% CI, 0.54-1.07), this result was not statistically significant, whereas current smoking was significantly associated with higher risk of fracture (HR, 2.27; 95% CI, 1.55-3.33). 

在92431名参与者中（平均年龄为69.4[6.0]岁，女性51820位[56%]，白人90458位[97.9%]），12943位经历了与脆弱相关的骨折。与没有癌症病史的参与者相比，提前1至5年诊断为晚期癌症的癌症生存者骨折风险更高（HR，2.12；95%CI，1.75-2.58）。近期诊断为晚期癌症（与无癌症相比）的骨折风险主要由在椎骨（HR，2.46；95%CI，1.93-3.13）和骨盆（HR 2.46；95%CI，1.84-3.29）部位。与未接受化疗的癌症生存者相比，接受化疗的生存者更容易骨折，这种关联在诊断后5年内（HR，1.31；95%CI，1.09-1.57）比诊断后5或5年以上（HR 1.22；95%CI 0.99-1.51）更强。尽管在诊断后5年或5年以上的体力活动癌症幸存者中，骨折风险的HR较低（HR，0.76；95%CI，0.54-1.07），但无显著性差异，而吸烟与骨折风险显著相关（HR为2.27；95%CI为1.55-3.33）。

CONCLUSIONS AND RELEVANCE 结论和相关性

 Findings from this cohort study suggest that older adults with a history of cancer may benefit from clinical guidance on prevention of frailty-related fractures. If study findings are replicated, fracture prevention programs for survivors might include referrals for physical activity with cancer exercise professionals and smoking cessation programs. 

这项队列研究的结果表明，有癌症病史的老年人可能受益于预防虚弱相关骨折的临床指导。如果重复研究，癌症生存者的骨折预防计划可能包含癌症运动专业人士推荐的体育活动和戒烟计划。

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