Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease

Published online September 18, 2019, doi: 10.1200/JCO.19.01696

Charles L. Shapiro, Catherine Van Poznak, Christina Lacchetti, Jeffrey Kirshner, Richard Eastell, Robert Gagel, Sean Smith, Beatrice J. Edwards, Elizabeth Frank, Gary H. Lyman, Matthew R. Smith, Rahul Mhaskar, Tara Henderson, and Joan Neuner

Purpose

The aim of this work is to provide evidence-based guidance on the management of osteoporosis in survivors of adult cancer.

Methods

ASCO convened a multidisciplinary Expert Panel to develop guideline recommendations based on a systematic review of the literature.

Results

The literature search of the 2018 systematic review by the US Preventive Services Task Force in the noncancer population was used as the evidentiary base upon which the Expert Panel based many of its recommendations. A total of 61 additional studies on topics and populations not covered in the US Preventive Services Task Force review were also included. Patients with cancer with metastatic disease and cancer survival outcomes related to bone-modifying agents are not included in this guideline.

Recommendations

Patients with nonmetastatic cancer maybe at risk for osteoporotic fractures due to baseline risks or due to the added risks that are associated with their cancer therapy. Clinicians are advised to assess fracture risk using established tools. For those patients with substantial risk of osteoporotic fracture, the clinician should obtain a bone mineral density test. The bone health of all patients may benefit from optimizing nutrition, exercise, and lifestyle. When a pharmacologic agent is indicated, bisphosphonates or denosumab at osteoporosis-indicated dosages are the preferred interventions.

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