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Increased Risk of Osteoporotic Fracture in Postgastrectomy Gastric Cancer Survivors Compared With Matched Controls

A Nationwide Cohort Study in Korea

Shin, Dong Wook MD, PH, MBA1,2; Suh, Beomseok MD, MPH, MBA2,3; Lim, Hyunsun PhD4; Suh, Yun-Suhk MD, PhD5; Choi, Yoon Jin MD, PhD, MD6; Jeong, Su-Min MD1,7; Yun, Jae Moon MD, MPH8; Song, Sun Ok MD, PhD9; Park, Youngmin MD, MPH10

American Journal of Gastroenterology: November 2019 - Volume 114 - Issue 11 - p 1735–1743
doi: 10.14309/ajg.0000000000000436

OBJECTIVES: Gastrectomy can lead to bone loss. Previous studies have suggested that there is an increased risk of fracture in gastric cancer survivors. However, these studies were performed without proper control groups. Therefore, we used Korean national health insurance data to compare the fracture risk in gastric cancer survivors who received gastrectomy to that of the general population.

METHODS: A total of 133,179 gastric cancer survivors were included and matched to noncancer controls using 1:1 propensity score matching. Cox proportional hazards regression analysis was used to determine the relative risk of fracture between the gastric cancer survivors and matched controls. We also examined the factors associated with fracture in gastric cancer survivors.

RESULTS: Compared with the matched controls, gastric cancer survivors had an elevated risk of osteoporotic fracture (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.53–1.70), which was most prominent in patients who underwent total gastrectomy (HR 2.18, 95% CI 1.96–2.44) and adjuvant chemotherapy (HR 2.01, 95% CI 1.81–2.23). In multivariate analysis, anemia was significantly associated with increased fracture risk (aHR 1.34, 95% CI 1.13–1.59), while decrease in weight >5% was not (aHR 1.06, 95% CI 0.89–1.25).

DISCUSSION: Gastric cancer survivors who underwent gastrectomy had an increased osteoporotic fracture risk than did matched controls. Total gastrectomy, adjuvant chemotherapy, and anemia were associated with an even higher risk in these patients. Additional studies are needed to establish optimal strategies, such as screening for osteoporosis and preventive interventions, that will reduce fracture risk in this population.

1Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;

2Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea;

3Lunit Inc, Seoul, Republic of Korea;

4Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea;

5Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea;

6Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea;

7Department of Nutrition, TH Chan School of Public Health, Harvard University, Boston, Massachusetts;

8Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea;

9Division of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea;

10Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.

Correspondence: Youngmin Park, MD, MPH. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received June 01, 2019

Accepted September 17, 2019

Online date: October 25, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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