(003) Age and sex-specific incidence of fracture events among persons with chronic lymphocytic leukemia

Background: There exists a growing body of empirical evidence suggesting that certain populations receiving treatment for hematologic malignancies such as chronic lymphocytic leukemia (CLL) may be more susceptible to bone fractures. However, evidence from real-world data remains limited.

Objectives: To characterize the age and sex-specific incidence of bone fracture events among persons with CLL in a real-world setting.

Methods: We examined the incidence of fracture events (including all fractures and hip and spine fractures separately) across four cohorts: 1) general population of all age, 2) general population of advanced age (≥65 years), 3) persons with CLL of all age, and 4) persons with CLL of advanced age (≥65 years) using data from five real-world databases: Optum’s de-identified Clinformatics® Data Mart Database (Clinformatics®), IBM MarketScan® Commercial Database, IBM MarketScan® Multi-State Medicaid Database, IBM MarketScan® Medicare Supplemental Database, and IQVIA Adjudicated Health Plan Claims Data (observation period 2012-2022). For each outcome and within each cohort, we calculated the crude incidence rate per 100 person-years (IRp100py) at risk and crude incidence proportion per 100 persons (IPp100p) at risk. The calculations were further stratified by sex.

Results: For the outcome of all fractures, in Clinformatics®, the IRp100py and IPp100p were lower in the general population cohort of all age (n=48,620,862, 3.64 and 7.79, respectively) compared with the advanced age cohort (n= 11,555,022, 6.04 and 15.57, respectively). The IRp100py and IPp100p were also found to be lower among males (2.97 and 6.65 in all age cohort, 4.18 and 11.45 in advanced age cohort) compared with females (4.27 and 8.89, 7.47 and 18.8, respectively). Among persons with CLL, the IRp100py and IPp100p were also lower in the all age cohort (n=110,837, 7.73 and 15.22, respectively) compared with the advanced age cohort (n=81,053, 8.69 and 17.40, respectively) and lower among males with CLL (5.87 and 12.13 in all age cohort, 6.48 and 13.66 in advanced age cohort) compared with females with CLL (10.0 and 19.22, 11.28 and 22.06, respectively). The incidence of fracture events varied considerably by databases, partly due to different population represented by each database. However, similar age and sex-related trends in incidence were observed for all fractures as well as hip and spine fracture separately in multiple databases.

Conclusions: These findings demonstrate important age and sex-related differences in the incidence of fracture events among persons with CLL in a real-world setting. Further investigation into the etiology, risk factors, and preventive strategies for this adverse event in persons with CLL is warranted.