Bone mineral density testing rates and fracture risk across cancers with different mortality risks: a nationwide...

In our study, patients with cancer underwent bone mineral density testing more frequently than matched non-cancer patients. High-mortality cancers showed the highest relative rates of both BMD testing and osteoporotic fracture, whereas thyroid cancer showed comparatively low fracture risk despite higher testing rates.

We aimed to compare the rates of bone mineral density (BMD) testing and osteoporotic fractures among patients with incident cancer and matched non-cancer patients according to cancer mortality risk.

We conducted a nationwide matched cohort study of individuals aged ≥ 50 years between 2005 and 2019. Patients with incident cancer were risk-set matched 1:2 to non-cancer patients using time-dependent propensity scores. Cancer types were categorized by mortality risk (thyroid, intermediate-, and high-mortality). Outcomes included receipt of BMD testing and incidence of osteoporotic fractures within 5 years. Cox proportional hazards models with robust variance estimators were used, with stratified analyses according to prior osteoporosis medication use.

The final cohort comprised 28,537 patients with cancer and 57,074 matched non-cancer patients. Overall, patients with cancer were more likely to undergo BMD testing than non-cancer patients; however, the magnitude varied by cancer mortality risk. Among patients without prior osteoporosis treatment, BMD testing was most frequent in high-mortality cancers (adjusted hazard ratio [aHR] 2.17; 95% CI 2.12-2.23), followed by thyroid (aHR 1.59; 95% CI 1.48-1.71) and intermediate-mortality cancers (aHR 1.49; 95% CI 1.45-1.54). In contrast, osteoporotic fracture risk increased stepwise with worsening cancer prognosis, with the highest risk observed in high-mortality cancers (aHR 2.80; 95% CI 2.72-2.89), while thyroid cancer was not associated with increased fracture risk.

Both BMD testing and fracture risk varied across cancer mortality groups, with high-mortality cancers showing the highest relative fracture risk. These findings demonstrate differing rates of BMD testing and osteoporotic fracture across cancer populations with differing prognoses.