Cancer and therapies used to treat it may raise a patient’s risk of osteoporosis. To address this risk in patients with nonmetastatic cancer, an American Society of Clinical Oncology (ASCO) expert panel recently developed a practice guideline for health care providers, which was recently published in the Journal of Clinical Oncology.
The guideline includes strategies to identify patients with nonmetastatic cancer who may be at a higher risk for osteoporotic fractures, how to screen these patients, and how to treat them in order to mitigate osteoporotic fracture risk.
In addition to risk factors for osteoporotic fracture that apply to the broader population, patients with nonmetastatic cancer may have additional risks based on the type of therapy used to treat their cancer. Such treatments include aromatase inhibitors, gonadotropin-releasing hormone agonists, antiandrogens, chemotherapy-induced ovarian failure, and oophorectomy.
The panel recommended using a risk assessment tool, such as the World Health Organization Fracture Risk Assessment Tool (FRAX), to establish a patient’s osteoporotic fracture risk, although with the caveat that no risk assessment tool has yet been validated for osteoporotic fracture risk in this population.
Screening for osteoporotic risk in this patient population, according to the guideline, optimally involves bone mineral density testing with central/axial dual-energy x-ray absorptiometry (DEXA) when possible. Other screening methods are also described in the guideline.
Lifestyle recommendations within the guideline include exercise, intake of sufficient calcium and vitamin D, and, when applicable, smoking cessation and reduced alcohol consumption.
The panel recommended considering bone-modifying treatments, such as bisphosphonates or denosumab, for those patients with osteoporosis or at an enhanced risk of osteoporotic fracture, defined as a 10-year FRAX-assessed 3% or higher probability of a hip fracture or 20% or higher probability of a major osteoporotic fracture.
“Management of bone health should be part of an overall survival plan, given the long period of risk for fracture,” wrote the authors of the report.
Shapiro CL, Van Poznak C, Lacchetti C, et al. Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO Clinical Practice Guideline [published online September 18, 2019]. J Clin Oncol. doi: 10.1200/JCO.19.01696