title: Fracture after gastrectomy for gastric cancer: A long-term follow-up observational study.
abstract: Gastrectomy is a known risk factor for decreased bone mass. We aimed to evaluate the cumulative incidence and predictive factors of fracture in gastric cancer patients who underwent gastrectomy.
  
  
  
  We retrospectively reviewed the records of 1687 patients who underwent gastrectomy for gastric cancer at our hospital between September 1991 and December 2008. The exclusion criteria were stage IV gastric cancer, history of cancer recurrence, medical conditions that cause osteoporosis and high-energy injury. Fractures at sites considered to be associated with osteoporosis were diagnosed radiologically.
  
  
  
  In total, our analysis included the records of 1131 patients. The incidence of postgastrectomy fracture was 42.1 cases per 1000 person-years. Fractures typically occurred within 3.7 ± 0.5 years postoperatively. The cumulative incidence of fracture was 9.1%, 19.7%, and 37.3% by postoperative year 2, 4, and 6, respectively. During the following years, the cumulative incidence increased slowly, up to a final 40.6%. Multivariate analysis showed that older age (hazard ratio, 1.03; 95% confidence interval, 1.01-1.04) and smoking (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73) were significantly associated with fracture, whereas sex, body mass index, percent weight loss, diabetes mellitus, tumour stage, and type of gastrectomy were not.
  
  
  
  The cumulative incidence of fracture is high in gastric cancer patients who have undergone gastrectomy, and fracture rate is higher during the early postoperative period. Old age and smoking are independent risk factors for postgastrectomy fracture in these patients. More detailed postoperative surveillance and pharmacological intervention should be considered to prevent fracture.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea. Electronic address: diluck@catholic.ac.kr.
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Republic of Korea.
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Yoon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Yoon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Myong Ki
authors.initials: MK
authors.lastname: Baeg
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Han Mo
authors.initials: HM
authors.lastname: Yoo
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Hae Myung
authors.initials: HM
authors.lastname: Jeon
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Cho Hyun
authors.initials: CH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Fracture; Gastrectomy; Gastric cancer; Osteoporosis; Risk factor