The risk of fracture among patients who have undergone hematopoietic stem-cell transplantation was seven to nine times higher among recipients aged 45-64 years compared with the age- and sex-matched subjects in the general U.S. population, according to a study published online March 16 in the Journal of Clinical Oncology.
The retrospective chart review followed 7,620 patients who underwent hematopoietic stem-cell transplantation (HSCT) from 1997 to 2011 at the University of Texas MD Anderson Cancer Center for a median 85 months. The researchers found that 8% developed a fracture. Autologous transplant recipients were 45% more likely to have a fracture than were allogeneic transplant recipients (11% vs. 5%). Factors associated with higher risk included age older than 50 years at the time of HSCT, multiple myeloma, solid organ tumors, and autologous HSCT.
“We discovered an increased risk of fracture at almost all ages in both males and females compared with the corresponding U.S. general population. To the best of our knowledge, this study is the first to quantify the increased incidence of fractures in patients with cancer who undergo HSCT,” wrote Dr. Xerxes Pundole and colleagues at the University of Texas MD Anderson Cancer Center, Houston.
The researchers compared the fracture rates of HSCT recipients to those of the U.S. general population using the 1994 National Health Interview (representing 89,100 individuals) and the 2004 National Hospital Discharge Survey (representing 270,000 patients discharged from hospitals).
Female HSCT recipients aged 45-64 years were eight times more likely to develop a fracture than were age-matched females in the general population, and male HSCT recipients aged 45-64 years were seven to nine times more likely to have a fracture than were age-matched males in the general population, the investigators reported (J. Clin. Oncol. 2015 March 16 [doi:10.1200/JCO.2014.57.8195]).
The current study did not assess comorbid conditions, although these likely influence fracture risk. HSCT transplant recipients often undergo intensive chemotherapy, total-body irradiation, and posttransplantation glucocorticoid use, all of which may contribute to bone loss. The authors noted that increased rates of fractures also occur in patients undergoing solid organ (e.g., kidney, liver, and heart) transplantation.
“This similarity suggests that transplantation and the associated supportive therapies administered may play a key role in this increased risk of fracture,” they wrote.
Dr. Pundole reported having no financial disclosures. One author disclosed ties with Takeda Pharmaceuticals, Celgene, Amgen, Alexion Pharmaceuticals, AiCuris, and Actinium Pharmaceuticals.