Older women who receive pelvic irradiation for cancer have increased risk for pelvic fracture

Older women who received radiation therapy for cervical, rectal or anal cancer have a substantially increased risk for pelvic fractures, according to a study in the November 23/30 issue of JAMA.

Pelvic fractures, including hip fractures, are common in older people and are a major source of illness and death, particularly in women, according to background information in the article. The lifetime risk of a hip fracture after 50 years of age for white women is estimated at 17 percent. Within the first year after a hip fracture, 10 percent to 20 percent more women die than expected for age. The number of deaths due to hip fractures is comparable with the number of deaths due to pancreatic cancer and is only slightly lower than the number of deaths due to breast cancer. It is well recognized that therapeutic radiation can result in bone damage and may increase fracture risks. However, the risks have not been well studied. Because of the high baseline incidence of fractures in older people and the significant illness and death associated with fractures, even a small increase in the fracture rate would be an important finding.

Nancy Baxter, M.D., Ph.D., of the University of Minnesota, Minneapolis, and colleagues conducted a study 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. The researchers used Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6,428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included.

The researchers found that the cumulative incidence of pelvic fractures was greater in the irradiated group than in the nonirradiated group for all 3 types of cancer diagnoses. Within the first 5 years of the study period, the incidence of pelvic fractures was: for

Contact: Sarah Buss
JAMA and Archives Journals

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