Risk of fracture among lung cancer survivors by cancer treatment modality: A population-based retrospective cohort study

Introduction Evidence on fracture incidence among lung cancer (LC) survivors remains limited. We assessed fracture risk in LC survivors who underwent curative-intent surgery, stratified by treatment modality and postoperative time. Methods This retrospective, population-based cohort study used the Korean National Health Insurance Service database (2009–2022), including LC survivors ( n = 33,292) and 1:3 age- and sex-matched controls ( n = 99,876). Competing risk analyses were performed with all-cause mortality as a competing risk. Results LC survivors had an elevated risk of fracture compared with non-cancer controls across the overall follow-up period. Vertebral fracture risk was most pronounced within the first year after surgery (cause-specific hazard ratios [csHRs] 1.81, 95% confidence interval [CI] 1.45–2.26). Hip fracture risk within the first year was similarly directed but did not reach significance in the overall cohort (csHR 1.40, 95% CI 0.98–1.98), whereas it was significantly elevated in the screening subgroup after additional adjustment for health behaviors and BMI (csHR 1.83, 95% CI 1.11–4.43). During the overall follow-up period, the risk of any fracture was elevated among LC survivors who received chemotherapy (csHR 1.32, 95% CI 1.21–1.45), radiation therapy (csHR 1.78, 95% CI 1.43–2.23), or chemoradiotherapy (csHR 1.73, 95% CI 1.50–1.99), compared with controls. Conclusion Compared with non-cancer controls, LC survivors had a generally higher risk of fracture at various sites, which varied by time since surgery and by cancer treatment modality. These findings suggest that osteoporosis screening and multimodal fracture prevention strategies should be considered for LC survivors.