- The American Society of Clinical Oncology (ASCO) has issued a clinical practice guideline (CPG) for osteoporosis screening and management in survivors of adult nonmetastatic cancers.
- Intravenous (IV) bisphosphonates or denosumab are recommended when a pharmacologic agent is indicated for patients with osteoporosis or a ≥20% probability of major osteoporotic fracture within 10 years.
Why this matters
- There are 32 million cancer survivors worldwide.
- Malignancy, and its treatment, may be associated with bone loss.
- Expert panel review of literature used in a 2018 systematic review of the noncancer population by the US Preventive Services Task Force plus 61 additional studies.
- Funding: ASCO.
- Patients with nonmetastatic cancer may be at increased risk for osteoporosis because of traditional risk factors (e.g., advanced age, current cigarette smoking) and risks conferred by cancer treatment (e.g., aromatase inhibitors, antiandrogens, gonadotropin-releasing hormone agonists, or chemotherapy-induced ovarian failure).
- Clinicians should quantify fracture risk using established tools (e.g., the WHO's Fracture Risk Assessment Tool).
- Bone mineral density testing is recommended for patients with ≥1 risk factors.
- Bisphosphonates or denosumab are recommended when a pharmacologic agent is indicated.
- Benefits of romosozumab or other new osteoporosis treatments not captured.