Risk of Falls, Fractures Greater Among Elderly Patients with Cancer

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Frailty and cognitive impairment may contribute to a greater risk of falling and fractures.
Frailty and cognitive impairment may contribute to a greater risk of falling and fractures.

Older patients with cancer may have up to a 3-fold increase in risk for fractures, which can be attributed to osteoporosis or low bone mass, according to a study published in Supportive Care in Cancer.

The population of advanced-age patients with cancer is increasing, accompanied by a greater risk of osteoporosis, falls, and fractures.


For this study, researchers assessed the outcomes of 304 patients with various cancers. The patients were older than 65 years and had undergone a geriatric assessment at baseline. The assessment measured factors such as frailty, cognitive impairment, and malnutrition; all factors that may contribute to an increased risk of falling and fractures. Bone density assessment was ordered for all patients but was completed in only 199 patients.

Of the patients who completed the bone density testing, approximately 80% were found to have osteoporosis or osteopenia, and prevalence of osteoporosis was higher in patients with cancer (40%) compared with just 16% of patients who did not have cancer (P <.05). Nearly 50% of tested patients had insufficient vitamin D.


Over the 2-year duration of the study (with median follow-up of 18.8 months) researchers observed a rate of 110 fractures per 1000 person-years among elderly patients with cancer, which was 2.8 times greater than the rate among patients without cancer.

Risk factors that were identified for reduced bone mass or osteoporosis were advanced age (P =.05), malnutrition (P =.04), and frailty (P =.01), and risk factors for fractures were advanced age (P =.05) and frailty (P =.03).

The authors concluded, “[b]one health issues are commonly seen in older cancer patients; we recommend universal bone density testing.” They recommend initiating antiresorptive treatment in patients found to have osteopenia or osteoporosis to reduce their risk of fractures.

Reference

Edwards BJ, Sun M, Zhang X, et al. Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience [published online December 2, 2017]. Support Care Cancer. doi: 10.1007/s00520-017-3962-7

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