Risk of osteoporosis and pathologic fractures in cancer patients who underwent hematopoietic stem cell transplantation: a nationwide retrospective cohort study
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Jiun-Nong Lin1,2,3, Hsuan-Ju Chen4,5, Chih-Hui Yang6, Chung-Hsu Lai3, Hsi-Hsun Lin3, Chao-Sung Chang7, Ji-An Liang8,9
1Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
3Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
4Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
5College of Medicine, China Medical University, Taichung, Taiwan
6Department of Biological Science and Technology, Meiho University, Pingtung, Taiwan
7Department of Hematology/Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
8Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
9Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
Ji-An Liang, email: email@example.com
Keywords: hematopoietic stem cell transplantation, osteoporosis, fracture, bone loss
Received: October 06, 2016 Accepted: March 21, 2017 Published: March 31, 2017
Background: Long-term data on post-hematopoietic stem cell transplantation (HSCT) osteoporosis and fracture are limited. This study evaluated the long-term risk of osteoporosis and fracture in cancer patients who underwent HSCT.
Results: The incidence density rate of osteoporosis was 12.5 per 1000 person-years in the HSCT group, which was significantly higher than that in the non-HSCT group (5.65 per 1000 person-years) after adjustment for associated factors and consideration of competing risk factors (adjusted subhazard ratio, 1.48; 95% confidence interval, 1.06–2.07). The incidence density rate of fracture was 4.89 per 1000 person-years in the HSCT group, and the risk of fracture was 1.40 times higher in the HSCT group than in the non-HSCT group (95% confidence interval, 0.83–2.40). The vertebra was the most common site of fracture after HSCT (68.4%). The risk of osteoporosis and fracture significantly increased in post-HSCT patients with both hematological malignancies and solid tumors. Both autologous and allogeneic HSCTs increased the risk of osteoporosis, whereas only autologous HSCT recipients had an increased risk of fracture.
Materials and Methods: This nationwide retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database. We identified an HSCT group comprising 1040 cancer patients who underwent HSCT during 2000–2008 and a non-HSCT group comprising 4160 propensity score-matched cancer patients who did not undergo HSCT. All patients were followed up until the occurrence of osteoporosis; fracture; December 31, 2011; or withdrawal from the insurance program.
Conclusions: HSCT recipients have an increased risk of osteoporosis.
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