{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:34:16Z","timestamp":1793255656174,"version":"4.5.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CIHR and the Canada Research Chairs Program","award":["CRC-2023-00349"],"award-info":[{"award-number":["CRC-2023-00349"]}],"id":[{"id":"https:\/\/ror.org\/0517h6h17","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009395","name":"CancerCare Manitoba Foundation","doi-asserted-by":"publisher","award":["763045126"],"award-info":[{"award-number":["763045126"]}],"id":[{"id":"10.13039\/100009395","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Individuals with cancer have numerous risk factors for fracture. The objective of this study was to compare fracture risk trajectories in individuals with and without cancer before and after cancer diagnosis. We conducted a matched retrospective cohort study using administrative healthcare and cancer registry data for Manitoba, Canada. We identified residents diagnosed with cancer (excluding nonmelanoma skin cancer) at age \u226518\u00a0yr between 1987 and 2014. Each cancer patient was uniquely matched with up to 4 non-cancer individuals based on age, sex, length of residency, and area of residence. Incident clinical fractures were identified using linked healthcare records and validated case definition, before and after cancer diagnosis (index date) up to March 31, 2021. Our cohort comprised 122\u2009255 cancer cases and 460\u2009029 matched controls (average 3.8 non-cancer matches per case). The incident rate of major fracture in the year prior to cancer diagnosis was 10.45 per 1000 person-years (95% CI: 9.77-11.19), increasing to a peak of 20.30 (95% CI: 19.63-21.00) at 1-5\u00a0yr post-diagnosis. Incident rate ratios (IRRs) for major, humerus, and vertebral fractures were significantly elevated in cancer vs non-cancer individuals in the year before the index date and remained significantly elevated for up to 5-10\u00a0yr. Fracture IRRs were increased across all cancer types except gynecological, melanoma, and thyroid cancers. In conclusion, fracture risk is elevated in the year preceding cancer diagnosis and persists at a higher level compared to the non-cancer population for up to 10\u00a0yr. This study emphasizes the necessity of timely and ongoing fracture risk assessment and prompt anti-osteoporosis therapy initiation.<\/jats:p>","DOI":"10.1093\/jbmr\/zjag048","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T12:44:48Z","timestamp":1772887488000},"page":"1232-1240","source":"Crossref","is-referenced-by-count":0,"title":["A population-based cohort study of fracture risk among 122\u2009255 adults before and after cancer diagnosis compared with matched controls"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9858-5398","authenticated-orcid":false,"given":"Carrie","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Alberta , Edmonton, AB T6G 2G3 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1056-1691","authenticated-orcid":false,"given":"William D","family":"Leslie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba , Winnipeg R3E 0V9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Al-Azazi","sequence":"additional","affiliation":[{"name":"George and Fay Yee Centre for Healthcare Innovation, University of Manitoba , Winnipeg, R3E0T6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yan","sequence":"additional","affiliation":[{"name":"College of Community and Global Health, University of Manitoba , Winnipeg, R3E 0W3 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8685-3212","authenticated-orcid":false,"given":"Lisa M","family":"Lix","sequence":"additional","affiliation":[{"name":"College of Community and Global Health, University of Manitoba , Winnipeg, R3E 0W3 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Czaykowski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba , Winnipeg R3E 0V9 ,","place":["Canada"]},{"name":"CancerCare Manitoba , Winnipeg, MB R3E 0V9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9354-2356","authenticated-orcid":false,"given":"Harminder","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba , Winnipeg R3E 0V9 ,","place":["Canada"]},{"name":"CancerCare Manitoba , Winnipeg, MB R3E 0V9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"issue":"3","key":"2026102901480577600_ref1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"10125","key":"2026102901480577600_ref2","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0140-6736(17)33326-3","article-title":"Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries","volume":"391","author":"Allemani","year":"2018","journal-title":"Lancet"},{"issue":"12","key":"2026102901480577600_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06542-4","article-title":"Fractures and long-term mortality in cancer patients: a population-based cohort study","volume":"33","author":"Ye","year":"2022","journal-title":"Osteoporos Int"},{"issue":"2","key":"2026102901480577600_ref4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00198-020-05596-6","article-title":"Cancer patients with fractures are rarely assessed or treated for osteoporosis: a population-based study","volume":"32","author":"Leslie","year":"2021","journal-title":"Osteoporos Int"},{"issue":"5","key":"2026102901480577600_ref5","first-page":"409","article-title":"Cancer treatment and survivorship statistics, 2022","volume":"72","author":"Miller","year":"2022","journal-title":"CA Cancer J Clin"},{"issue":"12","key":"2026102901480577600_ref6","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.annonc.2020.07.019","article-title":"Bone health in cancer: ESMO Clinical Practice Guidelines","volume":"31","author":"Coleman","year":"2020","journal-title":"Ann Oncol"},{"issue":"30","key":"2026102901480577600_ref7","doi-asserted-by":"crossref","first-page":"3665","DOI":"10.1200\/JCO.2012.42.2097","article-title":"Bone health in adult cancer survivorship","volume":"30","author":"Lustberg","year":"2012","journal-title":"J Clin Oncol"},{"issue":"3","key":"2026102901480577600_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06631-4","article-title":"Fracture risk and assessment in adults with cancer","volume":"34","author":"Ye","year":"2022","journal-title":"Osteoporos Int"},{"issue":"4","key":"2026102901480577600_ref9","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1038\/s41416-023-02353-4","article-title":"Fracture risk among patients with cancer compared to individuals without cancer: a population-based study","volume":"129","author":"Gong","year":"2023","journal-title":"Br J Cancer"},{"issue":"3","key":"2026102901480577600_ref10","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1016\/S2666-7568(23)00285-4","article-title":"Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records","volume":"5","author":"Buzasi","year":"2024","journal-title":"Lancet Healthy Longev"},{"issue":"1","key":"2026102901480577600_ref11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1001\/jamaoncol.2022.5153","article-title":"Fracture risk among older cancer survivors compared with older adults without a history of cancer","volume":"9","author":"Rees-Punia","year":"2023","journal-title":"JAMA Oncol"},{"key":"2026102901480577600_ref12","volume-title":"Canada\u2019s Population Estimates, Quarterly [Internet]","author":"Government of Canada","year":"2024"},{"issue":"6 Suppl","key":"2026102901480577600_ref13","first-page":"JS10","article-title":"Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system","volume":"37","author":"Roos","year":"1999","journal-title":"Med Care"},{"key":"2026102901480577600_ref14","volume-title":"Certified Registries - NAACCR [Internet]. NAACCR - Welcome to the North American Association of Central Cancer Registries (NAACCR, Inc.)","year":"2016"},{"key":"2026102901480577600_ref15","article-title":"Canadian Cancer Registry [Internet]. Canadian Research Data Centre Network","year":"2021"},{"key":"2026102901480577600_ref16","volume-title":"Incidence. North American Association of Central Cancer Registries Inc","author":"Hotes"},{"issue":"11","key":"2026102901480577600_ref17","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1345\/aph.18117","article-title":"Validation of an electronic, population-based prescription database","volume":"32","author":"Kozyrskyj","year":"1998","journal-title":"Ann Pharmacother"},{"key":"2026102901480577600_ref18","volume-title":"Manitoba Vital Statistics Branch [Internet]. Province of Manitoba - Manitoba Vital Statistics Branch"},{"key":"2026102901480577600_ref19","volume-title":"Concept: Regional Health Authority (RHA) Districts and Zones in Manitoba [Internet]"},{"issue":"2","key":"2026102901480577600_ref20","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/aje\/kwt247","article-title":"Parental bereavement after the death of an offspring in a motor vehicle collision: a population-based study","volume":"179","author":"Bolton","year":"2014","journal-title":"Am J Epidemiol"},{"issue":"8","key":"2026102901480577600_ref21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s11657-013-0143-2","article-title":"Canadian Chronic Disease Surveillance System (CCDSS) Osteoporosis Working Group. Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study","volume":"6","author":"O\u2019Donnell","year":"2013","journal-title":"Arch Osteoporos"},{"issue":"1","key":"2026102901480577600_ref22","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11657-021-00980-z","article-title":"Assessment of site-specific X-ray procedure codes for fracture ascertainment: a registry-based cohort study","volume":"16","author":"Leslie","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"12","key":"2026102901480577600_ref23","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1186\/1471-2458-12-301","article-title":"Osteoporosis-related fracture case definitions for population-based administrative data","volume":"18","author":"Lix","year":"2012","journal-title":"BMC Public Health"},{"key":"2026102901480577600_ref24","volume-title":"Concept: Socioeconomic Factor Index (SEFI)"},{"key":"2026102901480577600_ref25","volume-title":"Concept: Charlson Comorbidity Index [Internet]"},{"key":"2026102901480577600_ref26","volume-title":"Cancer Data Linkage in Manitoba: Expanding the Infrastructure for Research","author":"Lix","year":"2016"},{"issue":"27","key":"2026102901480577600_ref27","doi-asserted-by":"crossref","DOI":"10.1002\/sim.7501","article-title":"Practical recommendations for reporting Fine-Gray model analyses for competing risk data","volume":"36","author":"Austin","year":"2017","journal-title":"Stat Med"},{"issue":"5","key":"2026102901480577600_ref28","first-page":"1561","article-title":"Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience","volume":"26","author":"Edwards","year":"2018","journal-title":"Support Care Cancer"},{"issue":"10","key":"2026102901480577600_ref29","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1093\/qjmed\/hcac015","article-title":"Bone mineral density, osteopenia and osteoporosis among US adults with cancer","volume":"115","author":"Huang","year":"2022","journal-title":"QJM"},{"issue":"Suppl 3","key":"2026102901480577600_ref30","doi-asserted-by":"crossref","first-page":"iii124","DOI":"10.1093\/annonc\/mdu103","article-title":"Bone health in cancer patients: ESMO Clinical Practice Guidelines","volume":"25","author":"Coleman","year":"2014","journal-title":"Ann Oncol"},{"issue":"3","key":"2026102901480577600_ref31","doi-asserted-by":"crossref","first-page":"e0248188","DOI":"10.1371\/journal.pone.0248188","article-title":"Current practice patterns of osteoporosis treatment in cancer patients and effects of therapeutic interventions in a tertiary center","volume":"16","author":"Fujihara","year":"2021","journal-title":"PLoS One"},{"issue":"12","key":"2026102901480577600_ref32","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1016\/j.clnu.2023.10.013","article-title":"The effect of overweight or obesity on osteoporosis: a systematic review and meta-analysis","volume":"42","author":"Liu","year":"2023","journal-title":"Clin Nutr"},{"issue":"8","key":"2026102901480577600_ref33","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1056\/NEJMsr1606602","article-title":"Body fatness and cancer--viewpoint of the IARC Working Group","volume":"375","author":"Lauby-Secretan","year":"2016","journal-title":"N Engl J Med"},{"issue":"3","key":"2026102901480577600_ref34","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s10549-010-1138-y","article-title":"Bone mineral density and risk of postmenopausal breast cancer","volume":"126","author":"Grenier","year":"2011","journal-title":"Breast Cancer Res Treat"},{"issue":"5","key":"2026102901480577600_ref35","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1002\/cncr.23674","article-title":"Women\u2019s Health Initiative Program, National Heart, Lung and Blood Institute, US Department of Health and Human Services. Hip bone density predicts breast cancer risk independently of Gail score: results from the Women\u2019s Health Initiative","volume":"113","author":"Chen","year":"2008","journal-title":"Cancer"},{"issue":"11","key":"2026102901480577600_ref36","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00198-009-0840-2","article-title":"\u201cPathologic\u201d fractures: should these be included in epidemiologic studies of osteoporotic fractures?","volume":"20","author":"Curtis","year":"2009","journal-title":"Osteoporos Int"},{"issue":"1","key":"2026102901480577600_ref37","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s00198-018-4758-4","article-title":"Hormone therapy and osteoporosis in breast cancer survivors: assessment of risk and adherence to screening recommendations","volume":"30","author":"Hamood","year":"2019","journal-title":"Osteoporos Int"},{"issue":"11","key":"2026102901480577600_ref38","doi-asserted-by":"crossref","DOI":"10.1001\/jamaoncol.2024.4318","article-title":"Fracture risk prediction using the fracture risk assessment tool in individuals with cancer","volume":"10","author":"Ye","year":"2024","journal-title":"JAMA Oncol"},{"issue":"5","key":"2026102901480577600_ref39","doi-asserted-by":"crossref","first-page":"e192535","DOI":"10.1001\/jamanetworkopen.2019.2535","article-title":"Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs","volume":"2","author":"Haslam","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2026102901480577600_ref40","article-title":"Increase in major osteoporotic fractures after therapy with immune checkpoint inhibitors","volume":"3","author":"Ye","year":"2024","journal-title":"BMJ Oncol"},{"issue":"7","key":"2026102901480577600_ref41","doi-asserted-by":"crossref","first-page":"e009309","DOI":"10.1136\/jitc-2024-009309","article-title":"Osteoporotic fractures: an unrecognized adverse event of immune checkpoint inhibitors?","volume":"12","author":"Elsayed","year":"2024","journal-title":"J Immunother Cancer"},{"issue":"3","key":"2026102901480577600_ref42","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1002\/ijc.33592","article-title":"Bone fracture as a novel immune-related adverse event with immune checkpoint inhibitors: case series and large-scale pharmacovigilance analysis","volume":"149","author":"Filippini","year":"2021","journal-title":"Int J Cancer"},{"issue":"4","key":"2026102901480577600_ref43","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-023-06690-1","article-title":"Fracture rate increases after immune checkpoint inhibitor treatment: a potential new immune related adverse event","volume":"34","author":"Ye","year":"2023","journal-title":"Osteoporos Int"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbmr\/advance-article-pdf\/doi\/10.1093\/jbmr\/zjag048\/67285427\/zjag048.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/41\/11\/1232\/67285427\/zjag048.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/41\/11\/1232\/67285427\/zjag048.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:48:15Z","timestamp":1793252895000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/41\/11\/1232\/8512680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,10,29]]}},"URL":"https:\/\/doi.org\/10.1093\/jbmr\/zjag048","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,3,10]]}}}