HSCT increases fracture risk

By Shreeya Nanda, Senior medwireNews Reporter

Fracture incidence is greatly increased in individuals who undergo haematopoietic stem cell transplantation (HSCT) compared with the general US population, research shows.

The team from the University of Texas MD Anderson Cancer Center in Houston, USA, reports that fractures developed in 602 (8%) of the 7620 patients treated with HSCT between 1997 and 2011 at their institution.

Using the 1994 National Health Interview Survey, which is a personal self-report survey, the researchers found a significantly higher risk of fracture in HSCT-treated women and men than in the general US population. This was the case across all age groups except for the 18 to 24 years age group in men.

The difference was especially “striking” in HSCT-treated individuals aged between 45 and 64 years, say Huifang Lu and co-workers, with an estimated relative risk of 8.0 for women and 9.0 for men compared with the general US population of the same age.

When the 2004 National Hospital Discharge Survey, comprising data from hospital records, was used for comparison, the estimated risk relative to the general population for 45 to 64 year old HSCT-treated women remained at 8.0, but that for male recipients in the same age group was 6.6.

Multivariable analysis showed that individuals aged 50 years or older at transplantation were significantly more likely to develop a fracture than those younger than 50 years. As were patients with multiple myeloma compared with other haematological malignancies, and individuals who underwent autologous rather than allogeneic HSCT.

“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”, the researchers write in the Journal of Clinical Oncology. They add that “[p]atients undergoing or planning to undergo HSCT should have their bone health assessed early in their treatment and, if indicated, should start preventative therapy to prevent bone loss and fractures.”

They conclude: “A comprehensive assessment of risk factors involved in fracture development following HSCT still remains necessary.”

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