Prevalence and fracture burden of osteoporosis among patients with colorectal cancer: A real-world analysis.

Abstract

11170 Background: Osteoporosis is a common age-related skeletal disorder that may be underrecognized among patients with colorectal cancer (CRC), despite shared risk factors including advanced age, systemic inflammation, nutritional deficiencies, and cancer-related treatments. Population-level data describing the prevalence, demographic distribution, and fracture burden of osteoporosis in CRC remain limited, particularly in real-world clinical settings. Methods: We conducted a retrospective, cross-sectional cohort study using the TriNetX Global Collaborative Network comprising over 180 million patients across 165 healthcare organizations using R. Adult patients aged 18–85 years with colorectal cancer were identified using ICD-10-CM codes C18–C20. Two cohorts were constructed: CRC patients with osteoporosis (defined by ICD-10-CM codes M80–M81) and CRC patients without osteoporosis. Osteoporosis subtypes were further categorized into osteoporosis with current pathological fracture (M80) and osteoporosis without current pathological fracture (M81). Cohorts were compared using aggregate-level demographic data, including age, sex, race, ethnicity, and fracture status. Results: Among 696,434 patients with colorectal cancer, 40,051 (5.7%) had a documented diagnosis of osteoporosis. CRC patients with osteoporosis were significantly older than those without osteoporosis (mean age 74 vs 68 years) and were predominantly female (79.2% vs 43.9%). Racial distribution among CRC patients with osteoporosis included White (56.7%), Black or African American (6.0%), Asian (6.8%), and other or unknown race (30.5%). Age-stratified analyses demonstrated a marked increase in osteoporosis prevalence with advancing age, particularly among patients aged ≥75 years. Among the CRC with osteoporosis cohort, 13% had documented osteoporosis with current pathological fracture (M80), while 87% had osteoporosis without fracture (M81), indicating a substantial fracture burden in this population. Age-related osteoporosis accounted for the majority of cases, with multiple fracture-related subcodes reflecting clinically significant skeletal fragility. Patient arrival rate analyses demonstrated sustained real-world healthcare utilization across participating institutions. Conclusions: In this large real-world cohort, osteoporosis was prevalent among patients with colorectal cancer and was strongly associated with advanced age and female sex. A clinically meaningful proportion of CRC patients with osteoporosis had documented pathological fractures, highlighting an underappreciated source of morbidity. These findings underscore the importance of routine bone health assessment and fracture risk evaluation in colorectal cancer care, particularly among older adults.