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Published in: Osteoporosis International 5/2007

01-05-2007 | Short Communication

The association between non-melanoma skin cancer and osteoporotic fractures—a population-based record linkage study

Authors: V. Srikanth, J. Fryer, A. Venn, L. Blizzard, L. Newman, H. Cooley, T. Albion, G. Jones

Published in: Osteoporosis International | Issue 5/2007

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Abstract

Summary

We studied the association between osteoporotic fractures and prior non-melanoma skin cancer (NMSC, a biomarker for cumulative sun exposure). The risk of prior NMSC in our fracture cohort was significantly reduced (standardised incidence ratio 0.69, 95% CI 0.61, 0.78). Adequate lifetime sun exposure may be necessary to protect against osteoporotic fractures in later life.

Introduction

The relationship between cumulative sun exposure and osteoporotic fractures is uncertain. We aimed to study the association between non-melanoma skin cancer (NMSC), a marker of cumulative sun exposure, and osteoporotic fractures in an older cohort.

Methods

A retrospective cohort study in southern Tasmania in people aged at least 50 years with incident radiographic fracture (n = 2,283) was carried out. By record linkage to the Tasmanian Cancer Registry the cohort was followed backwards through time until the occurrence of NMSC or end-of follow-up. Relative risk was estimated by the standardised incidence ratio (SIR) using sex-, age- and calendar year-specific cancer incidence rates in southern Tasmania as reference.

Results

The incidence of prior NMSC in the fracture cohort was 31% lower than for the general population (SIR 0.69, 95% CI 0.61, 0.78). This effect was significant for most fracture subtypes except pelvic and wrist fractures and observed for both NMSC subtypes, squamous cell carcinoma and basal cell carcinoma.

Conclusions

Older people with osteoporotic fractures may have had lifestyles linked to lower cumulative sunlight exposure. Achieving a balance between adequate lifetime sun exposure and protection against its adverse effects (such as fractures and skin cancer) may require assessment of individual risks.
Literature
1.
go back to reference Burge RT, King AB, Balda E, Worley D (2003) Methodology for estimating current and future burden of osteoporosis in state populations: application to Florida in 2000 through 2025. Value Health 6(5):574–583PubMedCrossRef Burge RT, King AB, Balda E, Worley D (2003) Methodology for estimating current and future burden of osteoporosis in state populations: application to Florida in 2000 through 2025. Value Health 6(5):574–583PubMedCrossRef
2.
go back to reference Gennari C (2001) Calcium and vitamin D nutrition and bone disease of the elderly. Public Health Nutr 4(2B):547–559PubMed Gennari C (2001) Calcium and vitamin D nutrition and bone disease of the elderly. Public Health Nutr 4(2B):547–559PubMed
3.
go back to reference Holick MF (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61 [3 Suppl]:638S–645SPubMed Holick MF (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61 [3 Suppl]:638S–645SPubMed
4.
go back to reference Lips P, van Ginkel FC, Jongen MJ, Rubertus F, van der Vijgh WJ, Netelenbos JC (1987) Determinants of vitamin D status in patients with hip fracture and in elderly control subjects. Am J Clin Nutr 46(6):1005–1010PubMed Lips P, van Ginkel FC, Jongen MJ, Rubertus F, van der Vijgh WJ, Netelenbos JC (1987) Determinants of vitamin D status in patients with hip fracture and in elderly control subjects. Am J Clin Nutr 46(6):1005–1010PubMed
5.
go back to reference Inderjeeth CA, Nicklason F, Al-Lahham Y et al (2000) Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non-institutionalised Southern Tasmanians. Aust N Z J Med 30(2):209–214PubMed Inderjeeth CA, Nicklason F, Al-Lahham Y et al (2000) Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non-institutionalised Southern Tasmanians. Aust N Z J Med 30(2):209–214PubMed
6.
go back to reference Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF (2004) Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Am J Clin Nutr 80(6):1645–1649PubMed Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF (2004) Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Am J Clin Nutr 80(6):1645–1649PubMed
7.
go back to reference Johnell O, Gullberg B, Kanis JA et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10(11):1802–1815PubMedCrossRef Johnell O, Gullberg B, Kanis JA et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10(11):1802–1815PubMedCrossRef
8.
go back to reference Kanis J, Johnell O, Gullberg B et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 9(1):45–54PubMedCrossRef Kanis J, Johnell O, Gullberg B et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 9(1):45–54PubMedCrossRef
9.
go back to reference English DR, Armstrong BK, Kricker A, Fleming C (1997) Sunlight and cancer. Cancer Causes Control 8(3):271–283PubMedCrossRef English DR, Armstrong BK, Kricker A, Fleming C (1997) Sunlight and cancer. Cancer Causes Control 8(3):271–283PubMedCrossRef
10.
go back to reference Kennedy C, Bajdik CD, Willemze R et al (2003) The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 120(6):1087–1093PubMedCrossRef Kennedy C, Bajdik CD, Willemze R et al (2003) The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 120(6):1087–1093PubMedCrossRef
11.
go back to reference ABS (2004) Estimated Resident Population of Tasmania. Canberra: Australian Bureau of Statistics ABS (2004) Estimated Resident Population of Tasmania. Canberra: Australian Bureau of Statistics
12.
go back to reference ABS (2004) Population by age and sex in Tasmania. Canberra: Australian Bureau of Statistics ABS (2004) Population by age and sex in Tasmania. Canberra: Australian Bureau of Statistics
13.
go back to reference Cooley H, Jones G (2001) A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int 12(2):124–130PubMedCrossRef Cooley H, Jones G (2001) A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int 12(2):124–130PubMedCrossRef
14.
go back to reference Holman CDJ (2001) The analysis of linked health data: principles and hands-on applications; short course workbook Holman CDJ (2001) The analysis of linked health data: principles and hands-on applications; short course workbook
15.
go back to reference Ulm K (1990) A simple method to calculate the confidence interval of a standardized mortality ratio (SMR). Am J Epidemiol 131(2):373–375PubMed Ulm K (1990) A simple method to calculate the confidence interval of a standardized mortality ratio (SMR). Am J Epidemiol 131(2):373–375PubMed
16.
go back to reference Dwyer T, Blizzard L, Ashbolt R, Plumb J, Berwick M, Stankovich JM (2002) Cutaneous melanin density of Caucasians measured by spectrophotometry and risk of malignant melanoma, basal cell carcinoma, and squamous cell carcinoma of the skin. Am J Epidemiol 155(7):614–621PubMedCrossRef Dwyer T, Blizzard L, Ashbolt R, Plumb J, Berwick M, Stankovich JM (2002) Cutaneous melanin density of Caucasians measured by spectrophotometry and risk of malignant melanoma, basal cell carcinoma, and squamous cell carcinoma of the skin. Am J Epidemiol 155(7):614–621PubMedCrossRef
17.
go back to reference Armstrong BK, Kricker A, English DR (1997) Sun exposure and skin cancer. Australas J Dermatol 38 [Suppl 1]:S1–S6PubMed Armstrong BK, Kricker A, English DR (1997) Sun exposure and skin cancer. Australas J Dermatol 38 [Suppl 1]:S1–S6PubMed
18.
go back to reference National Cancer Control Initiative 2003 (2003) The 2002 national non-melanoma skin cancer survey. NCCI, Melbourne National Cancer Control Initiative 2003 (2003) The 2002 national non-melanoma skin cancer survey. NCCI, Melbourne
19.
go back to reference Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T (1999) Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr 53(10):824–829PubMedCrossRef Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T (1999) Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr 53(10):824–829PubMedCrossRef
20.
go back to reference Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM (2005) Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int 16(6):636–641PubMedCrossRef Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM (2005) Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int 16(6):636–641PubMedCrossRef
21.
go back to reference Webb AR, Pilbeam C, Hanafin N et al (1990) An evaluation of the relative contributions of exposure to sunlight and of diet to the circulating concentrations of 25-hydroxyvitamin D in an elderly nursing home population in Boston. Am J Clin Nutr 51(6):1075–1081PubMed Webb AR, Pilbeam C, Hanafin N et al (1990) An evaluation of the relative contributions of exposure to sunlight and of diet to the circulating concentrations of 25-hydroxyvitamin D in an elderly nursing home population in Boston. Am J Clin Nutr 51(6):1075–1081PubMed
22.
go back to reference Rosen CJ, Morrison A, Zhou H et al (1994) Elderly women in northern New England exhibit seasonal changes in bone mineral density and calciotropic hormones. Bone Miner 25(2):83–92PubMedCrossRef Rosen CJ, Morrison A, Zhou H et al (1994) Elderly women in northern New England exhibit seasonal changes in bone mineral density and calciotropic hormones. Bone Miner 25(2):83–92PubMedCrossRef
23.
go back to reference Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22(2):142–146PubMed Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22(2):142–146PubMed
24.
go back to reference Dempster DW, Parisien M, Silverberg SJ et al (1999) On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism. J Clin Endocrinol Metab 84(5):1562–1566PubMedCrossRef Dempster DW, Parisien M, Silverberg SJ et al (1999) On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism. J Clin Endocrinol Metab 84(5):1562–1566PubMedCrossRef
25.
go back to reference Chapuy MC, Arlot ME, Duboeuf F et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef Chapuy MC, Arlot ME, Duboeuf F et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef
26.
go back to reference Grant AM, Avenell A, Campbell MK et al (2005) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365(9471):1621–1628PubMedCrossRef Grant AM, Avenell A, Campbell MK et al (2005) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365(9471):1621–1628PubMedCrossRef
27.
go back to reference Porthouse J, Cockayne S, King C et al (2005) Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 330(7498):1003PubMedCrossRef Porthouse J, Cockayne S, King C et al (2005) Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 330(7498):1003PubMedCrossRef
28.
go back to reference Goldacre MJ, Seagroatt V, Yeates D, Acheson ED (2004) Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health 58(2):142–144PubMedCrossRef Goldacre MJ, Seagroatt V, Yeates D, Acheson ED (2004) Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health 58(2):142–144PubMedCrossRef
29.
go back to reference Van der Mei IA, Ponsonby AL, Dwyer T et al (2003) Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 327(7410):316PubMedCrossRef Van der Mei IA, Ponsonby AL, Dwyer T et al (2003) Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 327(7410):316PubMedCrossRef
30.
go back to reference VanAmerongen BM, Dijkstra CD, Lips P, Polman CH (2004) Multiple sclerosis and vitamin D: an update. Eur J Clin Nutr 58(8):1095–1109CrossRef VanAmerongen BM, Dijkstra CD, Lips P, Polman CH (2004) Multiple sclerosis and vitamin D: an update. Eur J Clin Nutr 58(8):1095–1109CrossRef
31.
go back to reference Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K (2005) Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 16(11):1425–1431PubMedCrossRef Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K (2005) Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 16(11):1425–1431PubMedCrossRef
32.
go back to reference Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM (2005) Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int 16(6):636–641PubMedCrossRef Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM (2005) Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int 16(6):636–641PubMedCrossRef
33.
go back to reference Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16 [Suppl 2]:S3–S7PubMedCrossRef Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16 [Suppl 2]:S3–S7PubMedCrossRef
Metadata
Title
The association between non-melanoma skin cancer and osteoporotic fractures—a population-based record linkage study
Authors
V. Srikanth
J. Fryer
A. Venn
L. Blizzard
L. Newman
H. Cooley
T. Albion
G. Jones
Publication date
01-05-2007
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 5/2007
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0303-y

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