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The risk of osteoporotic fracture in gastric cancer survivors: total gastrectomy versus subtotal gastrectomy versus endoscopic treatment

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Abstract

Purposes

Previous studies have suggested that there is an increased risk of osteoporotic fracture in gastric cancer survivors. However, the data was not classified according to surgery type. This study investigated the cumulative incidence osteoporotic fracture (OF) in gastric cancer survivors according to treatment modality.

Methods

A total of 85,124 gastric cancer survivors during 2008–2016 were included. The type of surgery was classified as total gastrectomy (TG, n = 14,428)/subtotal gastrectomy (SG, n = 52,572)/endoscopic mucosal dissection and endoscopic mucosal resection (ESD/EMR, n = 18,125). The site of osteoporotic fractures included the spine, hip, wrist, and humerus. We examined cumulative incidence using Kaplan–Meier survivor analysis and cox proportional hazards regression analysis to determine the risk factor of OF.

Results

The incidence of OF per 100,000 patient year was 2.6, 2.1, 1.8 in TG, SG, ESD/EMR group. The cumulative incidence rate was 2.3% at 3 years, 4.0% at 5 years, and 5.8% at 7 years in gastrectomy group, and 1.8% at 3 years, 3.3% at 5 years in the SG group, and 4.9% at 7 years postoperatively in ESD/EMR group. TG increased the risk of OF compared to patients who underwent SG (HR 1.75, 95% confidence interval [CI] 1.57–1.94), and ESD/EMR (hazard ratio [HR] 2.23, 95% CI 2.14–2.32).

Conclusion

Gastric cancer survivors who underwent TG had an increased osteoporotic fracture risk than did SG or ESD/EMR in these patients. The amount of gastric resection and accompanying metabolic changes seemed to mediate such risk. Additional research is needed to establish an optimal strategy for each type of surgery.

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Data availability

Data is available on a reasonable request after the review of the corresponding author (ykleemd@gmail.com).

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Acknowledgements

None.

Funding

This study was funded by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. HI18C0284).

This research was supported by the National Evidence-based Healthcare Collaborating Agency (NECA) funded by the Ministry of Health and welfare (Grant number NS21-004).

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Author notes

  1. HyunJin Oh and Byung-Ho Yoon contributed equally as first authors.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection, National Cancer Center, Goyang-si, Republic of Korea

    HyunJin Oh

  2. Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea

    Byung-Ho Yoon

  3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea

    Jung-Wee Park & Young-Kyun Lee

  4. Department Statistics, Yonsei University, Seoul, Korea

    Ye Jhin Jeon

  5. National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea

    Bit-Na Yoo & Jean Kyung Bak

  6. Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea

    Yong-Chan Ha

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Correspondence to Young-Kyun Lee.

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The Ethics Committee of the medical university approved the study protocol.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Oh, H., Yoon, BH., Park, JW. et al. The risk of osteoporotic fracture in gastric cancer survivors: total gastrectomy versus subtotal gastrectomy versus endoscopic treatment. Gastric Cancer 26, 814–822 (2023). https://doi.org/10.1007/s10120-023-01397-y

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