Comparative analysis of osteoporotic versus pathologic fracture in metastatic colorectal cancer patients

In metastatic colorectal cancer (mCRC) patients, the incidence rate of osteoporotic fracture (OF) was comparable to that of pathologic fracture (4.5% vs 4.2% over 2 years), and even higher in those aged ≥ 70. Because age and osteoporosis are significant risk factors, assessing osteoporosis is critical to prevent OF in older mCRC patients.

Fractures in patients with metastatic colorectal cancer (mCRC) have been reported; however, most of these are pathologic fractures (PFs). This study aimed to identify the incidence rates of and risk factors for osteoporotic fracture (OF) and PF.

We retrospectively analyzed the clinical data of mCRC patients who received palliative chemotherapy.

We enrolled 622 patients (359 male) consecutively. The median patient age was 61 (range, 20-91) years. Before chemotherapy, 42 (6.8%) patients had bone metastases. During follow-up, 86 (13.8%) patients experienced 96 fracture events. The cumulative incidence rates over the 2-year period were 4.5% (95% confidence interval [CI], 2.9-6.1%) and 4.2% (95% CI, 2.6-5.8%) for OF and PF, respectively. The crude incidence rate of OF was higher than that of PF in patients aged ≥ 70 years with an incidence rate ratio of 4.65 (95% CI, 1.72-15.7). Multivariable analysis identified older age (hazard ratio [HR], 1.04 [95% CI, 1.00-1.08]; p = 0.03) and osteoporosis (HR, 4.79 [95% CI, 1.51-15.16]; p = 0.01) as significant risk factors for OF after adjustment for bone and cancer-related variables. For PF, bone metastasis was a significant risk factor (HR, 9.48 [95% CI, 4.02-22.38]; p < 0.01).

The incidence rate of OF was comparable to that of PF and even higher in mCRC patients aged ≥ 70 years. While bone metastasis was a risk factor for PF, advanced age and osteoporosis were the risk factors for OF. Therefore, osteoporosis assessment and treatment are crucial to prevent OF during chemotherapy, particularly in the elderly.