{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:00:37Z","timestamp":1785409237077,"version":"3.56.0"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T00:00:00Z","timestamp":1583193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["CA016672"],"award-info":[{"award-number":["CA016672"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007313","name":"University of Texas MD Anderson Cancer Center","doi-asserted-by":"publisher","award":["MD Anderson Cancer Center Institutional Research G"],"award-info":[{"award-number":["MD Anderson Cancer Center Institutional Research G"]}],"id":[{"id":"10.13039\/100007313","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long\u2010term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two hundred thirty\u2010nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3\u00a0months, 1\u00a0year, and 2\u00a0years after RT. Imaging studies were assessed for pelvic fractures for up to 5\u00a0years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age at diagnosis was 51\u00a0years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%\u201012.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3\u00a0years, respectively. Fractures were associated with baseline osteoporosis (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), higher baseline bone\u2010specific alkaline phosphatase (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), and older age (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.007). The proportion of patients with osteopenia\/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3\u00a0months, 1\u00a0year, and 2\u00a0years, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high\u2010risk women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.32807","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T09:26:47Z","timestamp":1583227607000},"page":"2607-2613","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: A prospective study of 239 women"],"prefix":"10.1002","volume":"126","author":[{"given":"Mila P.","family":"Salcedo","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Department Federal University of Health Sciences\/Irmandade Santa Casa de Misericordia Porto Alegre Brazil"},{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil K.","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuja","family":"Jhingran","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia J.","family":"Eifel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann H.","family":"Klopp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Revathy B.","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan M.","family":"Fellman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo","family":"Jimenez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9670-4189","authenticated-orcid":false,"given":"Kathleen M.","family":"Schmeler","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)09075-8"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/8756-3282(95)00258-4"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7041.1254"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.22.2815"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1550-8579(04)80013-5"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.167.5.8911181"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2002.6756"},{"key":"e_1_2_8_9_1","first-page":"CD010604","article-title":"Pharmacological interventions for the prevention of insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults","volume":"4","author":"Blink QU","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24811"},{"key":"e_1_2_8_11_1","unstructured":"World Health Organization.WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. Summary Meeting Report. Brussels Belgium 5\u20107 May 2004. 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