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      Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline

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          Abstract

          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 may be 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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          The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.

          Nicole C. Wright, Anne C Looker, Kenneth Saag … (2014)
          The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the noninstitutionalized population aged 50 years and older from the National Health and Nutrition Examination Survey 2005-2010 to 2010 US Census population counts to determine the total number of older US residents with osteoporosis and low bone mass. There were more than 99 million adults aged 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010, 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic white, 0.5 million non-Hispanic black, and 0.6 million Mexican American adults had osteoporosis, and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic white women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. © 2014 American Society for Bone and Mineral Research.
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            A meta-analysis of previous fracture and subsequent fracture risk.

            J Kanis, O. Johnell, C. de Laet … (2004)
            Previous fracture is a well-documented risk factor for future fracture. The aim of this study was to quantify this risk on an international basis and to explore the relationship of this risk with age, sex, and bone mineral density (BMD). We studied 15259 men and 44902 women from 11 cohorts comprising EVOS/EPOS, OFELY, CaMos, Rochester, Sheffield, Rotterdam, Kuopio, DOES, Hiroshima, and two cohorts from Gothenburg. Cohorts were followed for a total of 250000 person-years. The effect of a prior history of fracture on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson model for each sex from each cohort. Covariates examined were age, sex, and BMD. The results of the different studies were merged by using the weighted beta-coefficients. A previous fracture history was associated with a significantly increased risk of any fracture compared with individuals without a prior fracture (RR = 1.86; 95% CI = 1.75-1.98). The risk ratio was similar for the outcome of osteoporotic fracture or for hip fracture. There was no significant difference in risk ratio between men and women. Risk ratio (RR) was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any fracture (8%) and for hip fracture (22%). The risk ratio was stable with age except in the case of hip fracture outcome where the risk ratio decreased significantly with age. We conclude that previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by measurement of BMD. Its validation on an international basis permits the use of this risk factor in case finding strategies.
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              Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update

              Harold J Burstein, Christina Lacchetti, Holly Anderson … (2018)
              To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment.
              Article 0 comments Cited 210 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Journal of Clinical Oncology
                Abbreviated Title: JCO
                Publisher: American Society of Clinical Oncology (ASCO)
                ISSN (Print): 0732-183X
                ISSN (Electronic): 1527-7755
                Publication date Created: November 01 2019
                Publication date (Print): November 01 2019
                Volume: 37
                Issue: 31
                Pages: 2916-2946
                Affiliations
                [1 ]Mount Sinai Hospital, New York, NY
                [2 ]University of Michigan, Ann Arbor, MI
                [3 ]American Society of Clinical Oncology, Alexandria, VA
                [4 ]Hematology-Oncology Associates of Central New York, Syracuse, NY
                [5 ]The University of Sheffield, Sheffield, United Kingdom
                [6 ]MD Anderson Cancer Center, Houston, TX
                [7 ]University of Texas Dell Med School and Central Texas Veterans Healthcare System, Austin, TX
                [8 ]Dana-Farber Cancer Institute, Boston, MA
                [9 ]Fred Hutchinson Cancer Research Center, Seattle, WA
                [10 ]Massachusetts General Hospital Cancer Center, Boston, MA
                [11 ]University of South Florida Health, Tampa, FL
                [12 ]University of Chicago Medicine, Chicago, IL
                [13 ]Medical College of Wisconsin, Milwaukee, WI
                Article
                DOI: 10.1200/JCO.19.01696
                PubMed ID: 31532726
                SO-VID: 22f83126-48df-42d9-a28d-1ff0376349b4
                Copyright © © 2019
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