# Association between endometrial cancer and subsequent risk of fracture: a national cohort study

## TL;DR

This study finds that endometrial cancer patients with diabetes have a higher risk of fractures compared to those without diabetes.

## Contribution

The study identifies a significant increase in fracture risk among endometrial cancer patients with diabetes mellitus.

## Key findings

- Endometrial cancer patients with diabetes had a higher risk of osteoporotic, hip, and vertebral fractures.
- Diabetes mellitus was associated with increased hazard ratios for specific fracture types in endometrial cancer patients.
- No significant fracture risk was observed in endometrial cancer patients without diabetes compared to the general population.

## Abstract

Most endometrial cancer (EC) cases are estrogen-dependent, and some are associated with diabetes mellitus (DM). We aimed to estimate the risk of fracture among patients with EC and those with DM.

A total of 20814 patients with EC were identified from the Taiwan National Cancer Registry from 2007 to 2018, with the outcome ascertainment using the National Health Insurance Research Database from 2004 to 2019. This observational study investigated the hazard ratios (HRs) for fracture and mortality events using Cox proportional hazards regression, with 95% confidence intervals (CIs). We adjusted baseline comorbidities, cancer therapy, cancer staging and grade, and pathological status of estrogen receptor and progesterone receptor. Considering the competing death events, we estimated the subdistribution hazard model to predict the probability of the fracture risk in the competing risks context.

Among 15,505 EC patients, there were 3,044 patients with and 12,461 patients without DM. Patients with EC exhibited a no significant association of fracture when compared to the matched general population. EC patients with DM, compared to those without DM, had a significantly increased odds of osteoporotic fracture (HR 1.29 [95% CI 1.08–1.55]), hip fracture (HR 2.37 [95% CI 1.44–3.92]), and vertebral fracture (HR 1.71 [95% CI 1.06–2.74]). Patients with DM had a no significant association of upper extremity fracture (HR 1.33 [95% CI 0.95–1.87]) compared with those with EC but without DM.

EC patients had a no significant association of fracture, while DM increased the fracture risk in EC patients.