Cancer risk in patients with osteoporosis: a population-based cohort study

Abstract

Background: Osteoporosis has been associated with cancer development. We conducted a nationwide population-based cohort study in Taiwan to evaluate this possible association of osteoporosis with subsequent cancer development.

Methods: A total of 35,979 patients diagnosed with osteoporosis between 2000 and 2010 identified from the National Health Insurance Research Database comprised the osteoporosis cohort, and each patient was randomly frequency matched with one individual from the general population (without osteoporosis) based on age, sex, and year of osteoporosis diagnosis to form the non-osteoporosis (control) cohort. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios and 95% confidence intervals and determine the effect of osteoporosis on cancer risk.

Results: Patients with osteoporosis showed a significantly higher risk of developing liver and thyroid cancers and lower risk of colorectal cancer than did individuals without osteoporosis. Male patients with osteoporosis had a significantly increased risk for liver cancer, whereas female patients with osteoporosis had a significantly increased risk for thyroid cancer, but a significantly decreased risk for overall and colorectal cancers. In addition, more significant findings were observed when age ≤64 years or the follow-up duration was ≤5 years; however, a significantly lower risk for colorectal cancer was observed when follow-up duration was >5 years. Study limits including lack of data for some health-related behaviors, inclusion criteria of osteoporosis and potential selection bias have been discussed.

Conclusion: Patients with osteoporosis showed a higher risk for liver and thyroid cancers and a lower risk for colorectal cancer than did control individuals. Stratified analyses by sex, age, and follow-up duration showed various patterns in different cancers.

Keywords:

• Cohort study
• malignancy
• osteoporosis
• population-based

Transparency

Declaration of funding

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan, and Health and welfare surcharge of tobacco products, and China Medical University Hospital Cancer Research Center of Excellence (MOHW105-TDU-B-212-134003, Taiwan). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.

Author contributions: conception/design: L.-M.S., C.-H.K.; provision of study materials: C.-H.K.; collection and/or assembly of data: L.-M.S., J.-A.L., C.-L.L., M.-C.L., N.-J.C., C.-H.K.; data analysis and interpretation: L.-M.S., J.-A.L., C.-L.L., M.-C.L., N.-J.C., C.-H.K.; manuscript writing: L.-M.S., J.-A.L., C.-L.L., M.-C.L., N.-J.C., C.-H.K.; final approval of manuscript: L.-M.S., J.-A.L., C.-L.L., M.-C.L., N.-J.C., C.-H.K.

Declaration of financial/other relationships

L.-M.S., J.-A.L., C.-L.L., M.-C.L., N.-J.C., and C.-H.K. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewer 1 has disclosed that he has been the recipient of sponsorship funding from Servier, Novartis and IBSA; has been the recipient of research/grant funding from Servier, Novartis, IBSA, Rottapharm and Wyeth; and is a consultant/advisor to Servier and Rottapharm. CMRO peer reviewer 2 has no relevant financial or other relationships to disclose.