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Introducción: Las fracturas por fragilidad constituyen un problema de salud pública. El objetivo fue analizar la asociación de los principales factores de riesgo de osteoporosis con la fracturas por fragilidad en una cohorte de mujeres con indicación de densitometría ósea. Métodos: Cohorte retrospectiva con seguimiento hasta una fractura por fragilidad, de una población de mujeres de 40 a 90 años de edad con una primera visita para realizarse una densitometría entre enero de 1992 y febrero de 2008. Se calcularon la tasa de incidencia de fracturas por 1000 mujeres-año de seguimiento y la hazard ratio (HR) de fractura mediante un modelo de regresión de Cox. Resultados: Se estudiaron 49.735 mujeres con una edad media de 57,8 años (desviación estándar: 8,5). De ellas, 3631 mujeres (7,1%) declararon al menos una fractura por fragilidad en las visitas posteriores a la basal. Los factores de riesgo con una mayor HR ajustada fueron la edad >75 años respecto a < 55 años (HR: 3,8; intervalo de confianza del 95% [IC95%]: 3,3-4,4) y tener un resultado de la densitometría valorable como osteoporosis respecto a normal (HR: 2; IC95%: 1,8-2,2). Los antecedentes de fracturas de húmero, cadera o vertebral tuvieron una HR ajustada de 1,2 (IC95%: 1,1-1,3). Conclusiones: Los principales factores de riesgo de fracturas por fragilidad fueron la edad avanzada, el resultado de la densitometría y los antecedentes de fractura, aunque un 74% de las fracturas se produjeron con una densidad mineral ósea normal u osteopenia. Otros factores significativos fueron la artritis reumatoide y haber estado en tratamiento prolongado con corticosteroides.Introduction: Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD). Methods: A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model. Results: A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age > 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3). Conclusions: The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy.

BackgroundReduced muscle mass has been associated with increased treatment complications in several tumor types. We evaluated the impact of skeletal muscle index (SMI) on prognosis and immune-related adverse events (IrAEs) in a cohort of recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoints inhibitors (ICI).MethodsA single-institutional, retrospective study was performed including 61 consecutive patients of R/M HNSCC diagnosed between July 2015 and December 2018. SMI was quantified using a CT scan at L3 to evaluate body composition. Median baseline SMI was used to dichotomize patients in low and high SMI. Kaplan-Meier estimations were used to detect overall survival (OS) and progression-free survival (PFS). Toxicity was recorded using Common Terminology Criteria for Adverse Event v4.3.ResultsPatients were 52 men (85.2%) with mean of age 57.7 years (SD 9.62), mainly oral cavity (n = 21; 34.4%). Low SMI was an independent factor for OS in the univariate (HR, 2.06; 95% CI, 1.14–3.73, p = 0.017) and multivariate Cox analyses (HR, 2.99; 95% CI, 1.29–6.94; p = 0.011). PFS was also reduced in patients with low SMI (PFS HR, 1.84; 95% CI, 1.08–3.12; p = 0.025). IrAEs occurred in 29 (47.5%) patients. There was no association between low SMI and IrAEs at any grade (OR, 0.56; 95% CI, 0.20–1.54; p = 0.261). However, grades 3 to 4 IrAEs were developed in seven patients of whom three had low SMI.ConclusionsLow SMI before ICI treatment in R/M HNSCC patients had a negative impact on OS and PFS. Further prospective research is needed to confirm the role of body composition as a predictive biomarker in ICI treatment.