Chemotherapy and smoking can increase the risk of fractures

Chemotherapy and smoking can increase the risk of fractures

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Older adults who have undergone chemotherapy may need to monitor their bone health. Michela Ravasio/Stocksys
  • While many people survive cancer, older people often experience bone fracture injuries later on.
  • A new study finds that, especially in the first five years after a diagnosis of advanced cancer, there is a higher chance of bone fractures for older patients.
  • The most likely injuries are vertebral fractures and hip fractures.

There’s a Estimate 18.1 million cancer survivors currently in the United States. Due to the growth and aging of the country’s population, there may be 26.1 million survivors by 2024. Of these, 73% will be over 65 years old..

For the elderly, however, completing cancer treatment may not spell the end of related medical challenges. Bone injuries related to brittleness, for example, are common among survivors. a new cohort-based study from the American Cancer Society, involving 92,431 older adults whose average age was 69.4 years, investigates how often such injuries can occur.

The new study found that older cancer survivors are more likely to have a bone fracture for several years after diagnosis than people who have not had cancer; in particular, this risk is 57% higher during the first year of diagnosis.

Older cancer survivors who were diagnosed with advanced-stage cancer 1 to 5 years earlier also had a 112% higher fracture risk than participants with no history of cancer.

“This is one of the first studies to investigate associations between cancer diagnoses, including time since diagnosis and stage at diagnosis, health behaviors and treatment, with risk of bone fractures.” Dr. Erika Rees-Punia saying Today’s medical news.

Dr. Rees-Punia is a Senior Principal Scientist for Epidemiology and Behavioral Research at the American Cancer Society and Principal Investigator of the study.

The study is published in Journal of Oncology of the American Medical Association (JAMA).

“Previous studies on cancer and bone fractures focus largely on breast cancer survivors. We were able to include survivors of various types of cancer in our study,” said Dr. Rees-Punia.

“Earlier studies usually focus on one fracture site (mainly hip) or combine all bone fracture sites. We were able to examine fracture risk by site for pelvic, vertebral, and wrist fractures,” he noted.

The researchers also found that the increased likelihood of injury was higher for vertebral and pelvic fractures, as opposed to radial fractures.

Dr. Anna L. Schwartzauthor and researcher specializing in the beneficial effects of exercise for cancer survivors, who was not involved in the study, noted MNT:

“The finding that older cancer survivors are at increased risk of fracture for an extended time after treatment ends speaks to the critical need for oncology rehabilitation of exercise to restore balance and strength to reduce fall risk.” “.

Dr. Schwartz explained that bone fractures can cause a rapid decline in health in both older adults and older cancer survivors and that it can often be “difficult to fully recover.”

“These fractures, specifically of the hip and spine, lead to decreased functional ability, loss of independence, pain, suffering, high health care use, and cost/burden (morbidity and mortality) to society,” he said. MNT.

“[Older cancer survivors] they often have chemotherapy-induced peripheral neuropathy of the feet, which affects their balance and ability to stand and walk. This, combined with decreased physical function, predisposes them to a fall which could be downwards, fracturing the pelvis, or falling backwards, causing a vertebral fracture.”
— Dr. Anna L. Schwartz

Dr. Schwartz said that bone loss is expected to occur naturally as one ages, but that many drugs used to treat cancer, such as doxorubicin, cyclophosphamide, anastrozole, letazol, leuprolide and goserelin, can speed up this process.

“In addition, many older adults have comorbidities and take medications that prevent bone healing (eg, NSAIDs),” she added.

Dr. Schwartz further explained the possible mechanisms behind why older adults are prone to bone fractures:

“Multiple factors affect delayed bone healing in older cancer survivors and the elderly in general. These factors include age-related changes in the inflammatory response, deterioration angiogenesispoor vascularization, decreased quantity and quality of osteochondral stem cells.”

The study also found that having received chemotherapy or being a current smoker also increased the likelihood of bone fractures.

“Cancer survivors may be at increased risk of bone fractures due to higher rates of osteoporosis coupled with low muscle mass, and potentially also due to balance problems and unexpected gait changes associated with chemotherapy.” said Dr. Rees-Punia.

“Unfortunately, we were not able to study the role of different types of chemotherapy on the risk of bone fractures.”

“Bone that is lost during chemotherapy does not return to its original state because bone remodeling is a slow process. Resistance exercise (eg, weight lifting) can increase bone density, but the changes are small and it takes about a year to see a measurable change in a DEXA scan.”
— Dr. Erika Rees-Punia

“The finding that older cancer survivors who currently smoke are at increased risk of fracture is a new finding and may be helpful in motivating cancer survivors (hopefully of all ages) to quit smoking. More cancer exercise research is needed for fracture prevention trials among older cancer survivors,” said Dr. Schwartz.

“These findings come from a large cohort study and not a prospective randomized control study, but it is reasonable to recommend that older adults with a history of current smoking stop smoking to potentially reduce their fracture risks and, of course, improve survival. cardiopulmonary health. she added.

Dr. Rees-Punia said they did see some site-specific differences in fracture risks, but the mechanisms were unclear.

“It is possible that the older cancer survivors included in this study were risk-averse and therefore did not participate in activities that could result in a forward fall contributing to a radial fracture,” he said.

“For example, hip fractures tend to occur in older, very physically inactive adults who are more likely to fall (95% of hip fractures are caused by falls), while radial fractures are more likely to occur among more active and relatively young people. healthy adults who walk more and participate in a wider range of activities,” she explained.

Dr. Rees-Punia said she hoped the study results would help guide doctors and cancer patients on how to avoid bone fractures.

“Fracture prevention programs for survivors could include smoking cessation programs and referrals for physical activity with cancer exercise professionals,” he said.

“Clearly, clinical recommendations for fall prevention are indicated in this group of frail elderly. This study provides further support for moderate to vigorous physical activity and strength training to reduce fracture risk after a cancer diagnosis.”
— Dr. Anna L. Schwartz

Dr. Schwartz advised that, for safety, “older cancer survivors should be triaged into an appropriate exercise oncology program that meets their individual needs, either in a supervised rehabilitation setting, for example, with a psychiatrist or a physical therapist. [physical therapist] — or a community setting (with a cancer exercise coach).”

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