Increased risk of osteoporosis following commonly used first-line treatments for lymphoma: a Danish Nationwide Cohort Study

Abstract

High-dose prednisolone is used in first-line treatment for lymphoma, but the potential adverse impact on bone health is unclear. Danish patients with diffuse large B-cell lymphoma or follicular lymphoma diagnosed between 2000 and 2012 were matched to the background population. Osteoporotic events (osteoporosis treatment or low-energy fracture) were identified using the Danish National Patient Registry and Prescription Registry. In total, 2589 patients and 12,945 controls were included. Lymphoma patients had increased risk of osteoporotic events compared to the matched population (hazard ratio 1.61 [95% confidence interval 1.40;1.84]). The 5- and 10-year cumulative risks of osteoporotic events for lymphoma patients were 10.0% [8.6;11.4] and 16.3% [13.8;18.7], whereas corresponding risks in the background population were 6.8% [6.3;7.3] and 13.5% [12.4;14.6]. Patients without osteoporotic event in the first two years after treatment were not at higher risk of osteoporotic events in subsequent years. Risk factors for osteoporotic events were female sex and age >70 years.

Keywords:

• Chemotherapeutic approaches
• immunotherapeutic approaches
• lymphoma and Hodgkin disease

Acknowledgements

JB received research support from Danish Lymphoma Group, Health Research Foundation of North Denmark Region and Trigon Foundation; TEG received research support from the Danish Cancer Society and Health Research Foundation of North Denmark Region. Tarec Christoffer El-Galaly was employed by Roche, Basel, from 1st of January 2019. The present work has been conducted as part of his academic affiliation as a clinical professor in hematology at Aalborg University. A great thanks to everyone who has collected data for LYFO.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Danish Cancer Society, Danish lymphoma Group and Trigon Foundation.