Risk of fracture among esophageal cancer survivors: A population-based retrospective cohort study

Evidence regarding the occurrence of fracture in esophageal cancer (EC) survivors remains limited. We aimed to investigate the risk of fractures among EC survivors who received curative-intent surgery.

We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service database (2009-2022), including patients who underwent surgery for EC (n = 4847) and their 1:3 propensity score matched controls (n = 14,541). We performed competing risk analyses to estimate the risk of fractures.

We observed 305 incident fractures among EC survivors (24 [0.50 %], 119 [2.46 %], and 195 [4.02 %] at 1, 3, and 5 years post-surgery, respectively) and 980 fractures among matched controls (118 [0.81 %], 342 [2.35 %], and 557 [3.83 %]) during mean follow-up periods of 5.3 ± 3.7 and 8.1 ± 2.9 years, respectively. EC survivors had a significantly higher fracture risk than controls, with cause-specific hazard ratios of 1.46 (95 % confidence interval [CI] 1.28-1.66) for any fracture, 1.66 (95 % CI 1.31-2.10) for vertebral fracture, and 1.68 (95 % CI 1.28-2.21) for hip fracture, although risk was not significant within the first year after surgery. EC survivors are at a greater risk of fractures than controls regardless of treatment modality, with the highest fracture risk present among those receiving radiation therapy (RT) along with surgery.

EC survivors had persistently higher risks of any, vertebral, and hip fracture than non-cancer controls, except for during the first year after surgery. The risk of fracture was prominent among EC survivors who received surgery combined with RT.