- Researchers report that people who have survived cancer, especially those treated with chemotherapy, have a higher risk of bone fracture.
- They say the higher risk may stem from osteoporosis, low muscle mass, and even balance issues.
- They note that bone fractures can lead to other long-term health issues.
Those potential side effects include hearing loss from high doses of chemotherapy, increased risk of stroke from high doses of radiation to the brain, dental problems, early menopause, and infertility.
Researchers used data from 92,431 older adults in the US Cancer Prevention Study II Nutrition Cohort linked with 1999 to 2017 Medicare claims.
The data was analyzed from July 15, 2021, to May 3, 2022.
Researchers investigated the associations between cancer diagnoses, including time since and stage at diagnosis, and risk of pelvic, radial, and vertebral fractures (separately and combined) compared to adults without a history of cancer.
They also examined differences in the risk of fracture stratified by modifiable behaviors, treatment, and cancer type.
The results showed among the92,431 participants included in the study, 12,943 experienced a frailty-related bone fracture.
Compared to participants without a history of cancer, cancer survivors who were more recently diagnosed within five years with an advanced stage cancer had the highest risk of fracture.
Researchers reported the higher fracture risk in cancer survivors was driven largely by vertebral and pelvic fracture sites.
“We found that older cancer survivors, especially survivors who were more recently diagnosed — less than 5 years since diagnosis — or who had a history of chemotherapy, had higher risks of pelvic and vertebral fractures than older adults without a history of cancer,”
Rees-Punia noted that smoking was also associated with a higher risk and there was some suggestion that physical activity may be associated with a lower risk of fractures in cancer survivors.
“Although we did not study why cancer survivors might be at higher risk of fractures in this paper,” she said, “cancer survivors may be at a higher risk of bone fractures because of higher rates of osteoporosis coupled with low muscle mass and potentially also because of balance issues and unexpected changes in gait associated with chemotherapy.”
Compared to cancer survivors who did not receive chemotherapy, the study found that people who received chemotherapy were more likely to have a fracture.
“Although we did not study why cancer survivors with a history of chemotherapy might be at a higher risk of fractures, they may be at higher risk because of balance issues and unexpected changes in gait associated with chemotherapy,” she said.
Rees-Punia said that cancer survivors should attempt to meet the American Cancer Society’s physical activity
Dr. Thomas Buchholz, the medical director at the Scripps MD Anderson Cancer Center in San Diego and a Scripps Clinic physician, told Healthline that as more people with cancer survive and live longer, the issue of bone health will only become more significant.
“The strength of the study is that it has a large cohort and robust comparisons,’ said Buchholz. “Finding of increased fractures among people with cancer is not surprising, but the study confirms the importance of ongoing wellness and staying in close touch with your doctors.”
“The disease itself can spread to bones and predispose people to have related fractures,” he added. “And our treatments, too, can weaken the bones. Breast cancer patients, for example, are often treated with hormonal therapy and this can reduce bone health, and chemotherapy can affect bone health as well.”
The most important thing that people who have had cancer should know, Rees-Punia said, is that bone fractures, especially fractures of the pelvis and vertebrae, are more than just a broken bone.
“Pelvic and vertebral fractures can cause a lot of issues down the road, including high healthcare costs, limited mobility, and, as some studies suggest, a higher risk of premature mortality,” she said.
Understanding what factors may be associated with a reduced risk of fractures in cancer survivors is key, she said.
“Our study suggests that fracture prevention programs for survivors could include smoking cessation programs and referrals for physical activity with cancer exercise professionals,” Rees-Punia said.
The findings in this study are important, she added, as cancer survivors living in the United States are projected to rise to 26 million by 2040.
“Research like this seeks ways for cancer survivors to have a better quality of life after their diagnosis,” Rees-Punia said in a press statement.