Rate of fracture among women undergoing treatment for gynecologic malignancies

Abstract

Objectives: Women undergoing treatment for gynecologic malignancies have multiple risk factors for developing fractures, including surgically-induced menopause, cytotoxic chemotherapy, and radiation therapy. The incidence of fracture among women treated for gynecologic cancers is estimated to be as high as 20%, however there is limited data regarding the rate of and risk factors for fracture in this population. The objective of this study was to evaluate the incidence of fracture and characteristics of patients with fracture among women undergoing treatment for gynecologic malignancies. Methods: This was a single-institution retrospective cohort study of patients who received surgery, chemotherapy, hormonal therapy, and/or radiation for the treatment of cervical, uterine, and/or vulvar cancer between January 2012 and December 2014. Data on patient demographics, comorbidities, cancer therapies, and risk factors for fracture were manually extracted from patients’ medical records. Results: Of the 469 women included in the analysis, most (93.8%) were White or African American (3.6%), with a mean age of 58.2 (SD=13.7) years at the time of cancer diagnosis. The mean BMI was 34.8 (SD=9.8) kg/m2. Most (70.4%) patients were menopausal prior to cancer treatment and 16.4% underwent surgically-induced menopause. The majority (69.7%) of patients had a diagnosis of uterine cancer, followed by cervical cancer (16.8%) and vulvar cancer (8.5%). One third (33.7, n=158) received neoadjuvant or adjuvant chemotherapy and 28.4% (n=133) underwent adjuvant radiation. The mean pre- and post-treatment risk of major osteoporotic fracture by FRAX score was 6.9% (SD=5.7) and 8.5% (SD=6.5). Only 20 patients (4.3%) had a DXA scan performed prior to cancer treatment. The proportion of post-treatment fracture within the first two years following treatment was 3.6% (n=17). Of these, most (88.2%, n=15) were diagnosed by x-ray (n=9, 54.8%), followed by MRI (n=4, 23.5%) and CT (n=2, 11.8%). Patients with post-treatment fractures tended to be older at time of treatment (61.9 vs 57.6 years), current tobacco users (47.1% vs 14.1%), and postmenopausal prior to cancer therapy (100% vs 69.7%). Patients with post-treatment fractures also tended to have one or more comorbidity (100% vs 89.4%), have cervical cancer (41.2% vs 15.9%), and to have undergone radiation treatment (64.7% vs 27.4%) as well as chemotherapy treatment (70.6% vs 32.7%). Download : Download high-res image (274KB) Download : Download full-size image Conclusions: Our findings indicate the rate of fracture in the first two years following treatment for gynecologic malignancies is approximately 3.6%. Few women undergo bone mineral density screening prior to cancer treatment. Women with cervical cancer who are postmenopausal with multiple co-morbidities prior to treatment who receive chemotherapy and/or radiation are at higher risk. The mean post-treatment FRAX of 8.5% suggests that many patients may benefit from bone mineral density testing and risk stratification for osteoporosis following cancer therapy.