Increased Risk of Osteoporosis in Gastric Cancer Survivors Compared to General Population Control: A Study with Representative Korean Population

다국어 초록 (Multilingual Abstract)

Purpose Although several studies have suggested that osteoporosis is common in survivors of gastric cancer (GC), no study to date has directly assessed the risk for osteoporosis in GC survivors compared to matched controls. Thus, we aimed to investigate the relative risk for osteoporosis in survivors of GC compared to general population.
Materials and Methods We used the Korea National Health and Nutrition Examination Survey data (2008-2011).
Patients with a history of GC (n=94) were defined as case among 8,142 individuals over 50 years old who were evaluated by dual-energy X-ray absorptiometry. Controls (n=470) were matched to cases by age and sex in a 1:5 ratio. Osteopenia (–2.5 < T-score < –1.0) and osteoporosis (T-score  –2.5) were defined.
Results The prevalence of osteoporosis in GC survivors was 30.2%, which was significantly greater than that of controls (19.7%). In total, GC survivors had a 3.7-fold increased risk for osteoporosis compared to controls (p=0.021). In addition, the risk for osteoporosis of the total proximal femur total (TF) and femur neck (FN) was significantly increased among GC survivors compared to controls (adjusted relative risk, 4.64; 95% confidence interval, 1.16 to 18.6 in TF and adjusted relative risk, 3.58; 95% confidence interval, 1.19 to 10.8 in FN).
Furthermore, we found sub-optimal daily calcium intake and mean serum levels of 25- hydroxy-vitamin D in both groups.
Conclusion GC survivors are at significantly increased risk for osteoporosis, especially in the femur. Clinically, our finding supports the importance of screening bone health and adequate nutrient supplementation in survivors of GC.

참고문헌 (Reference)

1 Cho S, "Validity of self-reported cancer history in the health examinees(HEXA)study : a comparison of self-report and cancer registry records" 50 : 16-21, 2017

2 Cho LY, "Validation of self-reported cancer incidence at follow-up in a prospective cohort study" 19 : 644-646, 2009

3 서민아, "Trends in Cancer Screening Rates among Korean Men and Women: Results of the Korean National Cancer Screening Survey, 2004-2013" 대한암학회 48 (48): 1-10, 2016

4 Bang YJ, "Trastuzumab in combination with chemother-apy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer(ToGA) : a phase 3, open-label, randomised controlled trial" 376 : 687-697, 2010

5 Oh MG, "The prevalence of vitamin D deficiency among cancer survivors in a nationwide survey of the Korean population" 10 : e0129901-, 2015

6 Straatman J, "Systematic review of exocrine pancreatic insufficiency after gastrectomy for cancer" 34 : 364-370, 2017

7 정규원, "Survival of Korean Adult Cancer Patients by Stage at Diagnosis, 2006-2010: National Cancer Registry Study" 대한암학회 45 (45): 162-171, 2013

8 Baek KH, "Short-term changes in bone and mineral metabolism following gastrectomy in gastric cancer patients" 42 : 61-67, 2008

9 Howlader N, "SEER cancer statistics review, 1975-2014" National Cancer Institute 2016

10 Yoo SH, "Risk of osteoporosis after gastrectomy in long-term gastric cancer survivors" 21 : 720-727, 2018

11 Kanis J, "Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study" 9 : 45-54, 1999

12 Eom BW, "Recovery of food intake after gastrectomy for gastric cancer : based on a large-scale gastric cancer cohort" 35 : 220-229, 2018

13 Duan Y, "Parathyroid hormone deficiency and excess : similar effects on trabecular bone but differing effects on cortical bone" 84 : 718-722, 1999

14 Cheng N, "Osteoporosis screening for men: are family physicians following the guidelines?" 54 : 1140-1141, 2008

15 Adachi Y, "Osteoporosis after gastrectomy : bone mineral density of lumbar spine assessed by dual-energy X-ray absorptiometry" 66 : 119-122, 2000

16 이지은, "One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea" 대한의학회 31 (31): 859-865, 2016

17 Teng GG, "Mortality and osteoporotic fractures:is the link causal, and is it modifiable?" 26 (26): S125-S137, 2008

18 Jin J, "Increases in parathyroid hormone(PTH)after gastric bypass surgery appear to be of a secondary nature" 142 : 914-920, 2007

19 Lim JS, "High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy" 13 : 6492-6497, 2007

20 Oh HJ, "Fracture after gastrectomy for gastric cancer : a long-term follow-up observational study" 72 : 28-36, 2017

21 Kweon S, "Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES)." 43 : 69-77, 2014

22 Oh Jeong, "Clinicopathological Features and Surgical Treatment of Gastric Cancer in South Korea: The Results of 2009 Nationwide Survey on Surgically Treated Gastric Cancer Patients" 대한위암학회 11 (11): 69-77, 2011

23 유완식, "Chronological Changes of Quality of Life in Long-Term Survivors after Gastrectomy for Gastric Cancer" 대한암학회 48 (48): 1030-1036, 2016

24 Ferlay J, "Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012" 136 : E359-E386, 2015

25 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014" 대한암학회 49 (49): 292-305, 2017

26 Kochersberger G, "Calcium supplementation lowers serum parathyroid hormone levels in elderly subjects" 45 : M159-M162, 1990

27 김경민, "Calcium and Vitamin D Supplementations: 2015 Position Statement of the Korean Society for Bone and Mineral Research" 대한골대사학회 22 (22): 143-149, 2015

28 Recker RR, "Calcium absorption and achlorhydria" 313 : 70-73, 1985

29 Costa AG, "Bone turnover markers in primary hyperparathyroidism" 16 : 22-27, 2013

30 Heiskanen JT, "Bone mineral metabolism after total gastrectomy" 28 : 123-127, 2001

31 Stein EM, "Bariatric surgery results in cortical bone loss" 98 : 541-549, 2013

32 Seo SH, "Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients" 16 : 900-, 2016

33 Kanis JA on behalf of the World Health Organization Scientific Group, "Assessment of osteoporosis at the primary health-care level" World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield 2007

34 Bernstein CN, "AGA technical review on osteoporosis in gastrointestinal diseases" 124 : 795-841, 2003