Lin Jiun-Nong, Chen Hsuan-Ju, Yang Chih-Hui, Lai Chung-Hsu, Lin Hsi-Hsun, Chang Chao-Sung, Liang Ji-An
Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Oncotarget. 2017 May 23;8(21):34811-34819. doi: 10.18632/oncotarget.16746.
Long-term data on post-hematopoietic stem cell transplantation (HSCT) osteoporosis and fracture are limited. This study evaluated the long-term risk of osteoporosis and fracture in cancer patients who underwent HSCT.
The incidence density rate of osteoporosis was 12.5 per 1000 person-years in the HSCT group, which was significantly higher than that in the non-HSCT group (5.65 per 1000 person-years) after adjustment for associated factors and consideration of competing risk factors (adjusted subhazard ratio, 1.48; 95% confidence interval, 1.06-2.07). The incidence density rate of fracture was 4.89 per 1000 person-years in the HSCT group, and the risk of fracture was 1.40 times higher in the HSCT group than in the non-HSCT group (95% confidence interval, 0.83-2.40). The vertebra was the most common site of fracture after HSCT (68.4%). The risk of osteoporosis and fracture significantly increased in post-HSCT patients with both hematological malignancies and solid tumors. Both autologous and allogeneic HSCTs increased the risk of osteoporosis, whereas only autologous HSCT recipients had an increased risk of fracture.
This nationwide retrospective cohort study analyzed data from Taiwan's National Health Insurance Research Database. We identified an HSCT group comprising 1040 cancer patients who underwent HSCT during 2000-2008 and a non-HSCT group comprising 4160 propensity score-matched cancer patients who did not undergo HSCT. All patients were followed up until the occurrence of osteoporosis; fracture; December 31, 2011; or withdrawal from the insurance program.
HSCT recipients have an increased risk of osteoporosis.
关于造血干细胞移植（HSCT）后骨质疏松和骨折的长期数据有限。本研究评估了接受HSCT的癌症患者发生骨质疏松和骨折的长期风险。
在对相关因素进行调整并考虑竞争风险因素后，HSCT组骨质疏松的发病密度率为每1000人年12.5例，显著高于非HSCT组（每1000人年5.65例）（调整后的亚风险比为1.48；95%置信区间为1.06 - 2.07）。HSCT组骨折的发病密度率为每1000人年4.89例，HSCT组骨折风险比非HSCT组高1.40倍（95%置信区间为0.83 - 2.40）。椎体是HSCT后最常见的骨折部位（68.4%）。血液系统恶性肿瘤和实体肿瘤并存的HSCT后患者发生骨质疏松和骨折的风险显著增加。自体和异基因HSCT均增加了骨质疏松的风险，而只有自体HSCT受者骨折风险增加。
这项全国性回顾性队列研究分析了台湾国民健康保险研究数据库的数据。我们确定了一个HSCT组，包括2000年至2008年期间接受HSCT的1040例癌症患者，以及一个非HSCT组，包括4160例倾向评分匹配的未接受HSCT的癌症患者。所有患者均随访至发生骨质疏松、骨折、2011年12月31日或退出保险计划。
HSCT受者骨质疏松风险增加。
