Abstract
Background:Blood cancer is the third most common cancer in Sweden and lymphoma is the most common of hematologic malignancies. A significant proportion of lymphoma patients are cured and others are living many years with disease. Bone loss has been noted in lymphoma patients. However, the incidence of fracture, the most devastating outcome of osteoporosis, and in particular hip fracture is not known in this group of patients.Aims:To determine the risk of hip fracture in patients with lymphoma diagnosed between 1995 and 2015Methods:We conducted a retrospective population based cohort study of Swedish lymphoma patients older than age 18 years, diagnosed from 1995 to the end of 2015 to determine the risk of hip fracture. Patients were identified from the National Cancer Register and from inpatient registers including all Swedish hospitals. They were followed up to 22 years (mean follow up 5.5 years). Fracture risk in lymphoma patients was compared with the Swedish population registry during the same time of period and adjusted for age, sex and calendar year.Results:37236 lymphoma patients were identified (45% women). 2.2 % of the men and 4.7% of women developed a hip‐fracture, in mean time 4.9 years after they were diagnosed with lymphoma. The incidence of hip‐fracture was higher in women than in men, increased by age and decreased by calendar year. The risk (hazard ratio‐HR) for hip fracture was increased in lymphoma patients compared with the Swedish general population, especially in younger women. The HR was 2.80 (95% CI 1.95‐4.03) in females aged 40 years in 2016 and for men corresponding HR was 1.70 (95% CI 1.44‐2.00). There was a trend to lower HR with increasing calendar year and older age. However, in elderly men (80 years of age) the risk for hip fracture was even lower, HR 0.83 (95% CI 0.81‐0.85) compared with the Swedish population. No differences between hip fracture incidence in patients with Hodgkin lymphoma or diffuse large B‐cell lymphoma compared with other lymphomas was noted (p>0.30). In multivariate analysis, unmarried men had a two times higher risk for hip‐fracture compared with men with other marital status with lymphoma (HR; 2.02 95% CI 1.63‐2.50).Summary/Conclusion:We conclude that lymphoma patients, especially younger women, are at higher risk of hip fracture than the general population independentlyimage
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