Female Colon Cancer survivors had 74 percent increased risk of osteoporosis (perhaps low vitamin D) – July 2019

Osteoporosis in colorectal cancer survivors: analysis of the linkage between SWOG trial enrollees and Medicare claims.

Arch Osteoporos. 2019 Jul 28;14(1):83. doi: 10.1007/s11657-019-0629-7

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Barzi A1, Hershman DL2, Till C3, Barlow WE3, Ramsey S4, Lenz HJ5, Hochster HS6, Unger JM3.
1 Norris Comprehensive Cancer Center, U. of Southern California, 1441 Eastlake Ave. Suite 3440, Los Angeles, CA, 90033, USA. barzi@usc.edu.
2 Columbia University Medical Center, New York, NY, USA.
3 SWOG Statistical Center, Seattle, WA, USA.
4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
5 Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 3440, Los Angeles, CA, 90033, USA.
6 Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.

To explore the rates of osteoporosis (diagnosis and screening) and fractures in colorectal cancer survivors (CRCS), records of clinical trial enrollees was linked to Medicare. Female/male risk of fracture in CRCS is 74% higher than general population. Less than 30% of male and female CRCS receive osteoporosis screening. Osteoporosis is a significant morbidity in CRCS.

In the USA, the population of colorectal cancer survivors (CRCS) is on the rise. Calcium and vitamin D are the common thread between colorectal cancer and osteoporosis. We set to explore the patterns and prevalence of osteoporosis (OP) and osteoporotic fractures (OF) in CRCS who received fluorouracil-based therapy on SWOG trials.

Data for CRCS from three SWOG phase III treatment trials between 1994 and 2000 (N = 3775) were linked to Medicare claims (N = 1233). OP was identified using ICD9 and HCPCS codes; OF was defined using a more restricted set of codes. We compared patterns of OP, OF, and screening for OP by gender in CRCS. Given the gender disparities in the rates of OP and OF, we used data from the National Health Interview Survey (NHIS) and the National Hospital Discharge Survey (NHDS) to assess the ratio of OF in females and males in general population.

Forty-seven percent of females and 15% of men CRCS had OP claims. Female CRCS were more likely than males to have OP (HR = 4.76 3.77-6.01, p < 0.0001) and OF (HR = 2.64 2.04-3.42, p < 0.0001). In the general population, the female to male ratio of OF was 1.67 as opposed to 2.90 in CRCS, indicating a significantly larger gender disparity of OF in CRCS (p < 0.001). Only 7% of men and 27% of women CRCS had OP screening.

Despite a low rate of OP screening, the gender disparity of OF in CRCS is more pronounced than the general population. These findings provide an impetus for studying OP and OF in CRCS.

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