Seo Gi Hyeon, Kang Hae Yeon, Choe Eun Kyung
Health Insurance Review and Assessment Service.
Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center.
Medicine (Baltimore). 2018 Apr;97(17):e0532. doi: 10.1097/MD.0000000000010532.
This study was planned to evaluate the incidence and risk factors of osteoporosis and fracture after gastrectomy for stomach cancer using a nationwide claims database in South Korea.Data from 41,512 patients (50-79 years) who underwent gastrectomy for stomach cancer from 2008 to 2010 with at least 5 years of follow-up were obtained from the Health Insurance Review and Assessment Service database. Patients diagnosed with osteoporosis and prescribed bisphosphonate or raloxifene or who experienced osteoporotic fractures after gastrectomy were operationally defined as osteoporosis. Osteoporotic fracture was defined as a fracture at common osteoporotic fracture sites (spine, pelvis, hip, forearm, or rib).In total, 37,076 patients were included in the final analysis. The incidences of postgastrectomy osteoporosis and osteoporotic fractures were 41.9 and 27.6 cases per 1000 person-years, respectively. Multivariate analysis showed that older age (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.79-1.96), female gender (HR 2.46; 2.35-2.58), total gastrectomy (HR 1.10; 1.04-1.16), and diabetes (HR 1.16; 1.11-1.22) were significantly associated with osteoporosis and that older age (HR 1.90; 95% CI 1.80-2.01), female gender (HR 1.50; 1.41-1.58), total gastrectomy (HR 1.17; 1.10-1.25), chemotherapy (HR 1.06; 1.00-1.12), and diabetes (HR 1.26; 1.19-1.33) were significantly associated with fractures. Osteoporotic fractures occurred a median 3.1 years after gastrectomy. Among the 5175 fracture patients, 780 (15.1%) experienced multisite fractures, mostly in the elderly and chemotherapy groups.The osteoporosis and osteoporotic fracture incidences are high in patients within a relatively short timeframe after gastrectomy for stomach cancer. Systematic management of osteoporosis is necessary after this surgery.
本研究旨在利用韩国全国性理赔数据库评估胃癌胃切除术后骨质疏松症和骨折的发生率及危险因素。从健康保险审查和评估服务数据库中获取了2008年至2010年接受胃癌胃切除术且至少随访5年的41,512例患者（50 - 79岁）的数据。将胃切除术后被诊断为骨质疏松症并开具双膦酸盐或雷洛昔芬处方的患者，或经历骨质疏松性骨折的患者在操作上定义为骨质疏松症。骨质疏松性骨折定义为常见骨质疏松性骨折部位（脊柱、骨盆、髋部、前臂或肋骨）的骨折。
总共37,076例患者纳入最终分析。胃切除术后骨质疏松症和骨质疏松性骨折的发生率分别为每1000人年41.9例和27.6例。多因素分析显示，年龄较大（风险比[HR] 1.88；95%置信区间[CI] 1.79 - 1.96）、女性（HR 2.46；2.35 - 2.58）、全胃切除术（HR 1.10；1.04 - 1.16）和糖尿病（HR 1.16；1.11 - 1.22）与骨质疏松症显著相关，年龄较大（HR 1.90；95% CI 1.80 - 2.01）、女性（HR 1.50；1.41 - 1.58）、全胃切除术（HR 1.17；1.10 - 1.25）、化疗（HR 1.06；1.00 - 1.12）和糖尿病（HR 1.26；1.19 - 1.33）与骨折显著相关。骨质疏松性骨折发生在胃切除术后中位3.1年。在5175例骨折患者中，780例（15.1%）发生多部位骨折，主要发生在老年患者和化疗组。
胃癌胃切除术后相对较短时间内患者的骨质疏松症和骨质疏松性骨折发生率较高。术后对骨质疏松症进行系统管理是必要的。
