ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Bone Research
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1570426
Association Between Endometrial Cancer and Subsequent Risk of Fracture：A National Cohort Study
Provisionally accepted
Wen Hsuan Tsai1*
Min-Shu Hsu1Chia-Sui Weng1
Hsin-Yin Hsu1Cheng-Tzu Hsieh2Tzu-Lin Yeh3
Kuo-Liong Chien4Chun-Chuan Lee1Ming-Nan Chien1Ming-Chieh Tsai1- 1Mackay Memorial Hospital, Taipei, Taiwan
- 2University of California, Los Angeles, California, United States
- 3Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
- 4National Taiwan University Hospital, Taipei, Taiwan
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Aims: Most endometrial cancer (EC) cases are estrogen-dependent, and some are associated with diabetes mellitus (DM). We aimed to estimate the risk of fracture among patients with EC and those with DM.Materials and methods: A total of 20814 patients with EC were identified from the Taiwan National Cancer Registry from 2007 to 2018, with the outcome ascertainment using the National Health Insurance Research Database from 2004 to 2019. This observational study investigated the hazard ratios (HRs) for fracture and mortality events using Cox proportional hazards regression, with 95% confidence intervals (CIs). We adjusted baseline comorbidities, cancer therapy, cancer staging and grade, and pathological status of estrogen receptor and progesterone receptor. Considering the competing death events, we estimated the subdistribution hazard model to predict the probability of the fracture risk in the competing risks context.Results: Among 15,505 EC patients, there were 3,044 patients with and 12,461 patients without DM. Patients with EC exhibited a no significant association of fracture when compared to the matched general population. EC patients with DM, compared to those without DM, had a significantly increased odds of osteoporotic fracture (HR 1.29 [95% CI 1.08–1.55]), hip fracture (HR 2.37 [95% CI 1.44–3.92]), and vertebral fracture (HR 1.71 [95% CI 1.06–2.74]). Patients with DM had a no significant association of upper extremity fracture (HR 1.33 [95% CI 0.95–1.87]) compared with those with EC but without DM.Conclusions: EC patients had a no significant association of fracture, while DM increased the fracture risk in EC patients.
Keywords: fracture, endometrial cancer, diabetes Wen-Hsuan Tsai: Conceptualization, methodology, data interpretation, draft manuscript. Min-Shu Hsu: Methodology, data analysis and interpretation Conceptualization, methodology, data interpretation. Kuo-Liong Chien, Chun-Chuan Lee, Ming-Nan Chien: Conceptualization, Data Interpretation, supervision. Ming-Chieh Tsai: Conceptualization, review
Received: 13 Feb 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Tsai, Hsu, Weng, Hsu, Hsieh, Yeh, Chien, Lee, Chien and Tsai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wen Hsuan Tsai, u9701003@cmu.edu.tw
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