The risk of osteoporotic fracture in gastric cancer survivors: total gastrectomy versus subtotal gastrectomy versus endoscopic treatment

Hyun Jin Oh, Byung Ho Yoon, Jung Wee Park, Ye Jhin Jeon, Bit Na Yoo, Jean Kyung Bak, Yong Chan Ha, Young Kyun Lee

Research output: Contribution to journalArticlepeer-review


Purposes: Previous studies have suggested that there is an increased risk of osteoporotic fracture in gastric cancer survivors. However, the data was not classified according to surgery type. This study investigated the cumulative incidence osteoporotic fracture (OF) in gastric cancer survivors according to treatment modality. Methods: A total of 85,124 gastric cancer survivors during 2008–2016 were included. The type of surgery was classified as total gastrectomy (TG, n = 14,428)/subtotal gastrectomy (SG, n = 52,572)/endoscopic mucosal dissection and endoscopic mucosal resection (ESD/EMR, n = 18,125). The site of osteoporotic fractures included the spine, hip, wrist, and humerus. We examined cumulative incidence using Kaplan–Meier survivor analysis and cox proportional hazards regression analysis to determine the risk factor of OF. Results: The incidence of OF per 100,000 patient year was 2.6, 2.1, 1.8 in TG, SG, ESD/EMR group. The cumulative incidence rate was 2.3% at 3 years, 4.0% at 5 years, and 5.8% at 7 years in gastrectomy group, and 1.8% at 3 years, 3.3% at 5 years in the SG group, and 4.9% at 7 years postoperatively in ESD/EMR group. TG increased the risk of OF compared to patients who underwent SG (HR 1.75, 95% confidence interval [CI] 1.57–1.94), and ESD/EMR (hazard ratio [HR] 2.23, 95% CI 2.14–2.32). Conclusion: Gastric cancer survivors who underwent TG had an increased osteoporotic fracture risk than did SG or ESD/EMR in these patients. The amount of gastric resection and accompanying metabolic changes seemed to mediate such risk. Additional research is needed to establish an optimal strategy for each type of surgery.

Original languageEnglish
Pages (from-to)814-822
Number of pages9
JournalGastric Cancer
Issue number5
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.


  • Gastrectomy
  • Gastric cancer
  • Incidence
  • Korea
  • Osteoporotic fracture


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