{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:37:59Z","timestamp":1792525079364,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although immune checkpoint inhibitors (ICIs) are associated with different immune\u2010related adverse events (irAEs), the potential effect on the skeleton is poorly defined albeit biologically plausible and assessable through pharmacovigilance. We described a case series of patients experiencing skeletal fractures while on ICIs at the National Cancer Institute of Milan. To better characterize the clinical features of skeletal irAEs reported with ICIs, we queried the FDA Adverse Event Reporting System (FAERS) and performed disproportionality analysis by means of reporting odds ratios (RORs), deemed significant by a lower limit of the 95% confidence interval (LL95% CI)\u2009&gt;\u20091. Bone AEs emerging as significant were scrutinized in terms of demographic and clinical data, including concomitant irAEs or drugs affecting bone resorption or causing bone damage. Four patients with skeletal events while on ICIs were included in our case series, of which three exhibited vertebral fractures. In FAERS, 650 patients with bone and joint injuries and treated with ICIs were retrieved, accounting for 822 drug\u2010event pairs. Statistically significant ROR was found for eight, two and one bone AEs respectively with PD\u20101, PD\u2010L1 and CTLA\u20104 inhibitors, being pathological fracture (N = 46; ROR = 3.17; LL95%CI = 2.37), spinal compression fracture (42; 2.51; 1.91), and femoral neck fracture (26; 2.38; 1.62) the most common. Concomitant irAEs or drugs affecting bone metabolism were poorly reported. The increased reporting of serious vertebral fractures in patients without concomitant irAEs and no apparent preexisting risk factors could suggest a possible cause\u2010effect relationship and calls for close clinical monitoring and implementation of dedicated guidelines.<\/jats:p>","DOI":"10.1002\/ijc.33592","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T20:44:08Z","timestamp":1618260248000},"page":"675-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Bone fracture as a novel immune\u2010related adverse event with immune checkpoint inhibitors: Case series and large\u2010scale pharmacovigilance analysis"],"prefix":"10.1002","volume":"149","author":[{"given":"Daria Maria","family":"Filippini","sequence":"first","affiliation":[{"name":"Head and Neck Medical Oncology Unit Fondazione IRCCS\u2014Istituto Nazionale dei Tumori  Milan Italy"},{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Medical Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine Policlinico S. Orsola\u2010Malpighi, Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-3779","authenticated-orcid":false,"given":"Milo","family":"Gatti","sequence":"additional","affiliation":[{"name":"Pharmacology Unit, Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Di Martino","sequence":"additional","affiliation":[{"name":"Head and Neck Medical Oncology Unit Fondazione IRCCS\u2014Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Cavalieri","sequence":"additional","affiliation":[{"name":"Head and Neck Medical Oncology Unit Fondazione IRCCS\u2014Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Fusaroli","sequence":"additional","affiliation":[{"name":"Pharmacology Unit, Department of Medical and Surgical Sciences Alma Mater Studiorum\u2014University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ardizzoni","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine Policlinico S. 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