Management of Bone Health Considerations in Patients with Cancer

Abstract

Background: Older adults with cancer are surviving longer due to earlier detection and more effective treatments for advanced stages. This population is at an elevated risk of osteoporosis due to age-related changes in bone density as well as the impact of cancer and cancer treatments on the skeletal system. Main Body: Cancer treatments are associated with increased bone loss and fracture risk via a variety of mechanisms. International guidelines recommend screening for cancer treatment-induced bone loss and provide treatment algorithms for pharmacological agents for those on hormonal therapy. There is a paucity of guidelines on bone health protection for those receiving intermittent glucocorticoid and newer immunotherapy regimes. Results: All patients receiving cancer treatment should undergo an individualised fracture risk assessment to optimise their bone health with regular review and reassessment of their risk profile. Dedicated bone health guidelines in cancer populations should be expanded to consider the impact of newer treatment modalities. All patients should receive education around non-pharmacological management and undergo a shared decision-making approach where there are indications for bone-targeted agents. Conclusions: Bone health assessment is an integral part of comprehensive geriatric assessment for older people with cancer. Strategies to minimise bone density loss and reduce fracture risk are an important consideration for cancer survivorship programmes for the majority of people and require a standardised approach.

Keywords: ageing; bone health; cancer treatment-related bone loss; fracture risk; geriatric oncology; osteoporosis; survivorship.

Figure 1

Clinical care algorithm for bone health in cancer.