Fracture risk in patients with different types of cancer

Figures & data

Table I.  Baseline characteristics of the patients with cancer. Figures for age and time since diagnosis is mean and SEM.

Cancer type	N	Age (1) (years)	Time from diagnosis (years)	Fractures in cases/controls (number)
Mouth, pharynx and salivary glands	653	70.0±0.6	6.6±0.2	221/432
Oesophagus, ventricle and small intestine	500	75.2±0.7	7.8±0.3	180/320
Liver, gall bladder, pancreas	304	73.1±0.8	5.9±0.4	109/105
Colon and rectum	3 869	78.4±0.2	7.9±0.1	1 032/2 837
Nose, larynx	394	70.4±0.7	7.9±0.3	128/266
Lung	1 193	70.5±0.4	5.4±0.2	486/707
Malignant melanoma	1 290	68.9±0.4	9.0±0.2	325/965
Non melanoma skin cancer	2 936	78.4±0.3	5.7±0.1	801/2 135
Kidney and urinary tract	1 564	74.9±0.4	7.9±0.2	477/1 087
Breast cancer (women only)	6 411	72.8±0.2	8.7±0.1	1 817/4 594
Female genitalia (women only)	3 789	73.1±0.2	10.9±0.1	1 006/2 783
Male genitalia (men only)	512	48.4±0.8	8.9±0.3	138/374
Prostate cancer (men only)	1 036	78.9±0.3	4.7±0.1	406/630
Primary bone cancer	188	60.8±1.6	7.4±0.5	83/105
Lymphomas and leukaemia	1 461	63.6±0.6	7.3±0.2	439/1 022
Multiple myeloma	238	73.8±0.8	4.7±0.3	123/115
Bone metastases	314	72.3±0.7	3.4±0.3	206/108
Other metastases excl. bone	1 416	70.9±0.4	6.2±0.2	536/880
Other and non-specified	1 178	63.3±0.7	7.1±0.2	372/806

(1) Age in years at time of fracture or comparative dummy date among the controls. N: Number of patients with cancer (fracture cases and control patients combined).

Table II.  Risk of any fracture in patients with various cancer forms compared to patients without any type of cancer.

Cancer type	Crude OR (95% CI)	Mutually Adjusted	Multiply Adjusted**
Mouth, pharynx and salivary glands	1.54 (1.31–1.81)*	1.38 (1.17–1.68)*	1.00 (0.84–1.18)
Oesophagus, ventricle and small intestine	1.69 (1.41–2.03)*	1.59 (1.32–1.91)*	1.13 (0.94–1.38)
Liver, gall bladder, pancreas	1.68 (1.33–2.12)*	1.52 (1.20–1.93)*	1.08 (0.84–1.38)
Colon and rectum	1.09 (1.02–1.17)*	1.04 (0.97–1.12)	0.79 (0.74–0.84)
Nose, larynx	1.44 (1.17–1.78)*	1.28 (1.04–1.59)*	1.00 (0.80–1.25)
Lung	2.07 (1.84–2.32)*	1.83 (1.63–2.08)*	1.30 (1.15–1.47)*
Malignant melanoma	1.01 (0.89–1.15)	0.95 (0.83–1.08)	0.87 (0.76–0.99)*
Non melanoma skin cancer	1.13 (1.04–1.22)*	1.08 (0.99–1.17)	0.85 (0.78–0.93)*
Kidney and urinary tract	1.32 (1.18–1.47)*	1.22 (1.09–1.36)*	0.96 (0.85–1.07)
Breast cancer (women only)	1.19 (1.13–1.26)*	1.11 (1.05–1.18)*	0.85 (0.81–0.91)*
Female genitalia (women only)	1.09 (1.01–1.17)*	1.05 (0.98–1.13)	0.84 (0.78–0.91)*
Male genitalia (men only)	1.11 (0.91–1.35)	1.06 (0.87–1.29)	1.03 (0.84–1.26)
Prostate cancer (men only)	1.94 (1.71–2.20)*	1.64 (1.44–1.87)*	1.35 (1.18–1.55)*
Primary bone cancer	2.37 (1.78–3.16)*	1.74 (1.29–2.34)*	1.35 (0.99–1.85)
Lymphomas and leukaemia	1.29 (1.15–1.44)*	1.17 (1.04–1.31)*	0.99 (0.88–1.12)
Multiple myeloma	3.21 (2.49–4.14)*	2.91 (2.25–3.76)*	1.96 (1.50–2.57)*
Bone metastases	5.73 (4.54–7.23)*	3.98 (3.13–5.06)*	3.01 (2.34–3.86)*
Other metastases excl. bone	1.83 (1.64–2.04)*	1.43 (1.28–1.61)*	1.30 (1.16–1.47)*
Other and non-specified	1.39 (1.23–1.57)*	1.18 (1.04–1.34)*	1.00 (0.87–1.14)

*2p < 0.05, Adjusted for other cancers (occurrence of mouth, pharynx, salivary gland cancer, oesophagus, ventricle and small intestine cancer, liver, gall bladder, and pancreas cancer etc.), **adjusted for other cancers, use of corticosteroids, alcoholism, use of pain medication (morphine and other opioid agonists, NSAIDs, Acetylsalicylic acid, and acetaminophen), and prior fracture.

Table III.  Effect of time since diagnosis on risk of any fracture – multiply adjusted OR and 95% CI**.

Cancer type	≤1 year	1–5 years	>5 years
Mouth, pharynx and salivary glands	0.81 (0.49–1.34)	1.09 (0.83–1.43)	0.96 (0.75–1.24)
Oesophagus, ventricle and small intestine	0.84 (0.51–1.39)	1.44 (1.02–2.03)*	1.08 (0.83–1.41)
Liver, gall bladder, pancreas	2.14 (1.39–3.31)*	0.90 (0.56–1.46)	0.66 (0.43–1.01)
Colon and rectum	0.82 (0.66–1.03)	0.83 (0.73–0.94)*	0.77 (0.70–0.85)*
Nose, larynx	0.84 (0.44–1.59)	0.91 (0.61–1.35)	1.09 (0.81–1.47)
Lung	1.90 (1.51–2.38)*	1.33 (1.08–1.65)*	0.86 (0.69–1.07)
Malignant melanoma	1.12 (0.75–1.69)	0.95 (0.74–1.21)	0.81 (0.69–0.96)*
Non melanoma skin cancer	0.96 (0.75–1.22)	0.82 (0.72–0.93)*	0.86 (0.75–0.98)*
Kidney and urinary tract	1.25 (0.92–1.70)	0.98 (0.80–1.21)	0.86 (0.74–1.00)
Breast cancer (women only)	0.78 (0.64–0.96)	0.88 (0.79–0.98)*	0.87 (0.81–0.93)*
Female genitalia (women only)	0.76 (0.56–1.04)	0.87 (0.74–1.02)	0.84 (0.77–0.92)*
Male genitalia (men only)	0.70 (0.33–1.50)	1.19 (0.82–1.71)	1.03 (0.79–1.33)
Prostate cancer (men only)	1.19 (0.87–1.64)	1.36 (1.12–1.65)*	1.44 (1.14–1.81)*
Primary bone cancer	3.51 (1.54–8.01)*	1.34 (0.77–2.32)	1.01 (0.63–1.59)
Lymphomas and leukaemia	1.21 (0.98–1.64)	0.92 (0.75–1.14)	1.00 (0.85–1.17)
Multiple myeloma	5.21 (2.96–9.19)*	1.54 (1.01–2.33)*	1.31 (0.82–2.12)
Bone metastases	5.28 (3.58–7.79)*	2.39 (1.54–3.71)*	1.07 (0.62–1.86)
Other metastases excl. bone	1.85 (1.50–2.29)*	1.37 (1.10–1.71)*	0.88 (0.73–1.07)
Other and non-specified	1.39 (1.01–1.93)*	0.80 (0.63–1.01)	1.02 (0.85–1.23)

*2p < 0.05, **adjusted for use of corticosteroids, alcoholism, use of pain medication (morphine and other opioid agonists, NSAIDs, Acetylsalicylic acid, and acetaminophen), and prior fracture.

Table IV.  Risk of hip fracture associated with various cancer types stratified by time since diagnosis – multiply adjusted OR and 95% CI**.

Cancer type	≤1 year	1–5 years	>5 years
Mouth, pharynx and salivary glands	2.53 (0.56–11.4)	1.17 (0.64–2.15)	1.16 (0.70–1.91)
Oesophagus, ventricle and small intestine	1.28 (0.43–3.82)	1.68 (0.79–3.56)	0.99 (0.59–1.66)
Liver, gall bladder, pancreas	3.24 (1.49–7.05)*	4.53 (1.38–14.9)*	0.74 (0.33–1.68)
Colon and rectum	1.08 (0.69–1.70)	0.89 (0.67–1.18)	0.91 (0.75–1.10)
Nose, larynx	–	2.00 (0.82–4.90)	1.31 (0.68–2.50)
Lung	5.21 (2.97–9.16)*	3.04 (1.82–5.07)*	0.82 (0.51–1.33)
Malignant melanoma	2.05 (0.80–5.27)	0.96 (0.49–1.89)	0.83 (0.54–1.29)
Non melanoma skin cancer	1.06 (0.66–1.70)	0.96 (0.75–1.22)	1.12 (0.87–1.45)
Kidney and urinary tract	1.91 (1.00–3.62)*	1.50 (0.99–2.25)	1.11 (0.82–1.51)
Breast cancer (women only)	1.03 (0.63–1.69)	0.94 (0.74–1.20)	0.90 (0.76–1.07)
Female genitalia (women only)	1.25 (0.60–2.61)	0.81 (0.53–1.23)	0.86 (0.70–1.05)
Male genitalia (men only)	1.69 (0.31–9.37)	1.17 (0.32–4.27)	1.61 (0.59–4.39)
Prostate cancer (men only)	1.70 (0.95–3.03)	1.70 (1.20–2.40)*	1.30 (0.88–1.93)
Primary bone cancer	15.0 (1.45–155)*	2.56 (0.84–7.76)	1.74 (0.37–8.12)
Lymphomas and leukaemia	2.49 (1.27–4.89)*	0.89 (0.53–1.49)	1.13 (0.76–1.68)
Multiple myeloma	6.00 (1.68–21.4)*	1.76 (0.76–4.05)	0.60 (0.20–1.79)
Bone metastases	6.50 (2.78–15.2)*	2.91 (1.19–7.12)*	0.82 (0.25–2.65)
Other metastases excl. bone	2.34 (1.43–3.82)*	1.65 (1.00–2.71)*	1.14 (0.75–1.75)
Other and non-specified	1.12 (0.49–2.57)	1.05 (0.61–1.80)	1.15 (0.72–1.84)

*2p < 0.05, **adjusted for use of corticosteroids, alcoholism, use of pain medication (morphine and other opioid agonists, NSAIDs, Acetylsalicylic acid, and acetaminophen), and prior fracture. –: Too few for analysis.

Table V.  Risk of forearm fracture associated with various cancer types stratified by time since diagnosis – multiply adjusted OR and 95% CI**.

Cancer type	≤1 year	1–5 years	>5 years
Mouth, pharynx and salivary glands	0.78 (0.20–3.05)	1.63 (0.77–3.41)	0.59 (0.28–1.23)
Oesophagus, ventricle and small intestine	0.40 (0.04–3.95)	2.71 (1.25–5.87)*	1.03 (0.54–1.97)
Liver, gall bladder, pancreas	8.75 (1.73–44.3)*	0.39 (0.08–1.84)	0.26 (0.06–1.14)
Colon and rectum	0.93 (0.51–1.70)	0.89 (0.64–1.23)	1.11 (0.88–1.42)
Nose, larynx	0.67 (0.13–3.52)	0.86 (0.32–2.34)	1.77 (0.79–3.92)
Lung	0.91 (0.46–1.80)	1.22 (0.70–2.13)	0.83 (0.48–1.44)
Malignant melanoma	0.98 (0.26–3.73)	1.25 (0.65–2.40)	0.85 (0.56–1.29)
Non melanoma skin cancer	0.70 (0.32–1.54)	0.98 (0.72–1.32)	1.10 (0.78–1.55)
Kidney and urinary tract	1.25 (0.45–3.46)	0.77 (0.44–1.37)	0.72 (0.46–1.11)
Breast cancer (women only)	0.87 (0.55–1.36)	0.89 (0.69–1.14)	1.12 (0.95–1.32)
Female genitalia (women only)	0.39 (0.17–0.88)*	0.87 (0.61–1.24)	0.97 (0.80–1.19)
Male genitalia (men only)	6.06 (0.54–66.6)	1.15 (0.30–4.44)	1.33 (0.51–3.45)
Prostate cancer (men only)	1.53 (0.46–5.14)	1.44 (0.74–2.80)	2.94 (1.36–6.33)*
Primary bone cancer	1.81 (0.11–31.2)	0.24 (0.03–2.01)	0.92 (0.30–2.81)
Lymphomas and leukaemia	1.03 (0.49–2.15)	0.80 (0.44–1.45)	0.68 (0.43–1.08)
Multiple myeloma	–	0.90 (0.18–4.52)	1.81 (0.59–5.58)
Bone metastases	4.60 (1.29–16.5)*	1.02 (0.26–3.97)	0.81 (0.16–4.15)
Other metastases excl. bone	1.47 (0.85–2.57)	1.35 (0.77–2.37)	0.67 (0.42–1.06)
Other and non-specified	1.46 (0.56–3.83)	0.92 (0.49–1.73)	0.66 (0.38–1.16)

*2p < 0.05, **adjusted for use of corticosteroids, alcoholism, use of pain medication (morphine and other opioid agonists, NSAIDs, Acetylsalicylic acid, and acetaminophen), and prior fracture. –: Too few for analysis.

Table VI.  Risk of vertebral fracture associated with various cancer types stratified by time since diagnosis – multiply adjusted OR and 95% CI**.

Cancer type	≤1 year	1–5 years	>5 years
Mouth, pharynx and salivary glands	0.89 (0.07–11.7)	0.86 (0.20–3.65)	2.10 (0.71–6.25)
Oesophagus, ventricle and small intestine	–	0.76 (0.20–2.84)	6.26 (2.10–18.7)*
Liver, gall bladder, pancreas	2.12 (0.18–25.2)	0.94 (0.06–14.4)	0.49 (0.07–3.30)
Colon and rectum	2.36 (0.96–5.81)	0.72 (0.38–1.39)	0.57 (0.34–0.94)
Nose, larynx	1.41 (0.11–17.6)	0.22 (0.01–4.96)	1.50 (0.41–5.40)
Lung	0.59 (0.21–1.68)	1.16 (0.47–2.84)	1.18 (0.40–3.44)
Malignant melanoma	–	–	0.13 (0.02–1.03)
Non melanoma skin cancer	2.32 (0.90–6.00)	0.54 (0.28–1.04)	1.10 (0.60–2.01)
Kidney and urinary tract	0.92 (0.26–3.23)	0.45 (0.14–1.50)	0.80 (0.37–1.71)
Breast cancer (women only)	1.30 (0.43–3.90)	0.65 (0.36–1.19)	0.62 (0.43–0.90)*
Female genitalia (women only)	0.46 (0.08–2.80)	0.41 (0.15–1.11)	0.87 (0.57–1.33)
Male genitalia (men only)	2.58 (0.40–16.5)	1.02 (0.15–6.85)	–
Prostate cancer (men only)	0.52 (0.10–2.65)	1.05 (0.33–3.32)	1.38 (0.44–4.39)
Primary bone cancer	–	2.54 (0.08–80.4)	0.38 (0.02–6.78)
Lymphomas and leukaemia	5.26 (1.18–23.5)*	1.20 (0.52–2.73)	1.19 (0.54–2.64)
Multiple myeloma	23.0 (2.40–220)	7.53 (0.67–85.1)	0.61 (0.06–6.13)
Bone metastases	6.96 (1.72–28.2)*	–	–
Other metastases excl. bone	1.94 (0.73–5.12)	0.69 (0.18–2.70)	1.11 (0.36–3.46)
Other and non-specified	1.44 (0.35–5.88)	0.27 (0.04–1.68)	2.51 (0.91–6.91)

*2p < 0.05, **adjusted for use of corticosteroids, alcoholism, use of pain medication (morphine and other opioid agonists, NSAIDs, Acetylsalicylic acid, and acetaminophen), and prior fracture, –: Too few for analysis.