Risk of Pelvic Fractures in Older Women Following Pelvic Irradiation

Details

• Personal Author:
  Baxter NN ; Durham SB ; Habermann EB ; Tepper JE ; Virnig BA
• Description:
  Context: Pelvic fractures, including hip fractures, are a major source of morbidity and mortality in older women. Although therapeutic pelvic irradiation could increase the risk of such fractures, this effect has not been studied. Objective: To determine if women who undergo pelvic irradiation for pelvic malignancies (anal, cervical, or rectal cancers) have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation. Design, Setting, and Participants: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included. We compared results for women who did (n = 2855) vs did not (n = 3573) undergo radiation therapy. To assess the influence of selection bias, we also evaluated the effect of irradiation on osteoporotic fractures in nonirradiated sites (arm and spine). Main Outcome Measure: We evaluated the effect of irradiation on the incidence of pelvic fractures over time, and adjusted for potential confounders using a proportional hazards model. Results Women who underwent radiation therapy were more likely to have a pelvic fracture than women who did not undergo radiation therapy (cumulative 5-year fracture rate, 14.0% vs 7.5% in women with anal cancer, 8.2% vs 5.9% in women with cervical cancer, and 11.2% vs 8.7% in women with rectal cancer); the difference was statistically significant and most fractures (90%) were hip fractures. We controlled for potential confounders including age, race, cancer stage, and geographic location. The impact of irradiation varied by cancer site: treatment for anal cancer was associated with a higher risk of pelvic fractures (hazard ratio, 3.16; 95% confidence interval, 1.48-6.73); than for cervical cancer (hazard ratio, 1.66; 95% confidence interval, 1.06-2.59); or rectal cancer (hazard ratio, 1.65; 95% confidence interval, 1.33-2.05). No statistically significant difference was found in the rate of arm or spine fractures between the irradiated and nonirradiated groups (hazard ratio, 1.15; 95% confidence interval, 0.89-1.48). Conclusions: Pelvic irradiation substantially increases the risk of pelvic fractures in older women. Given the high baseline risk of pelvic fracture, this finding is of particular concern. [Description provided by NIOSH]
• Subjects:
  Age Factors Aging Delivery Of Health Care Demography Environmental Health Environmental Monitoring Epidemiology Neoplasms Occupational Health Preventive Medicine Race Factors Radiation Risk Assessment Risk Factors Safety Women

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• Keywords:
  Age-factors Age-groups Biological-effects Cancer-rates Demographic-characteristics Environmental-factors Exposure-assessment Exposure-methods Irradiation Mathematical-models Medical-care Preventive-medicine Qualitative-analysis Quantitative-analysis Racial-factors Risk-analysis Risk-factors Statistical-analysis Therapeutic-agents

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• ISSN:
  0098-7484
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Minnesota ; North Carolina ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  294
• Issue:
  20
• NIOSHTIC Number:
  nn:20037564
• Citation:
  JAMA 2005 Nov; 294(20):2587-2593
• Contact Point Address:
  Nancy N. Baxter, MD, PhD, Division of Colon and Rectal Surgery, University of Minnesota, MMC 450, 420 Delaware St SE, Minneapolis, MN 55455
• Email:
  baxtern@smh.toronto.on.ca
• Federal Fiscal Year:
  2006
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of the American Medical Association
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:0395684584e1901c492cc4eeb90ad5102e59a2a4505184bb7c5f6b22c6f68e7fdf9813cee3756ba75dd1c7b20c1ac4625a410addf565f75f0266478ff8f2ad24
• Download URL:
  https://stacks.cdc.gov/view/cdc/188637/cdc_188637_DS1.pdf
• File Type:
  [PDF - 186.23 KB ]