Risk of osteoporosis and pathologic fractures in cancer patients who underwent hematopoietic stem cell transplantation: a nationwide retrospective cohort study

// Jiun-Nong Lin 1, 2, 3 , Hsuan-Ju Chen 4, 5 , Chih-Hui Yang 6 , Chung-Hsu Lai 3 , Hsi-Hsun Lin 3 , Chao-Sung Chang 7 , Ji-An Liang 8, 9 1 Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 3 Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 4 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan 5 College of Medicine, China Medical University, Taichung, Taiwan 6 Department of Biological Science and Technology, Meiho University, Pingtung, Taiwan 7 Department of Hematology/Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan 8 Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan 9 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan Correspondence to: Ji-An Liang, email: d4615@mail.cmuh.org.tw Keywords: hematopoietic stem cell transplantation, osteoporosis, fracture, bone loss Received: October 06, 2016      Accepted: March 21, 2017      Published: March 31, 2017 ABSTRACT Background: Long-term data on post-hematopoietic stem cell transplantation (HSCT) osteoporosis and fracture are limited. This study evaluated the long-term risk of osteoporosis and fracture in cancer patients who underwent HSCT. Results: The incidence density rate of osteoporosis was 12.5 per 1000 person-years in the HSCT group, which was significantly higher than that in the non-HSCT group (5.65 per 1000 person-years) after adjustment for associated factors and consideration of competing risk factors (adjusted subhazard ratio, 1.48; 95% confidence interval, 1.06–2.07). The incidence density rate of fracture was 4.89 per 1000 person-years in the HSCT group, and the risk of fracture was 1.40 times higher in the HSCT group than in the non-HSCT group (95% confidence interval, 0.83–2.40). The vertebra was the most common site of fracture after HSCT (68.4%). The risk of osteoporosis and fracture significantly increased in post-HSCT patients with both hematological malignancies and solid tumors. Both autologous and allogeneic HSCTs increased the risk of osteoporosis, whereas only autologous HSCT recipients had an increased risk of fracture. Materials and Methods: This nationwide retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database. We identified an HSCT group comprising 1040 cancer patients who underwent HSCT during 2000–2008 and a non-HSCT group comprising 4160 propensity score-matched cancer patients who did not undergo HSCT. All patients were followed up until the occurrence of osteoporosis; fracture; December 31, 2011; or withdrawal from the insurance program. Conclusions: HSCT recipients have an increased risk of osteoporosis.