ASCO GUIDELINES Bundle

Osteoporosis in Survivors of Adult Cancers with Non-Metastatic Disease

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Key Points ➤ Patients with non-metastatic cancer may be at risk for osteoporotic fractures due to baseline risks or due to the added risks associated with their cancer therapy. ➤ Clinicians are advised to assess fracture risk using established tools. • For those with substantial risk of osteoporotic fracture the clinician should obtain a bone mineral density. ➤ 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. Risk ➤ Recommendation 1.1. It is recommended that patients with non-metastatic cancer who meet any of the following criteria should be considered at increased risk for developing osteoporotic fractures (Moderate Recommendation; EB-B-I): • advanced age • current cigarette smoking • excessive alcohol consumption • history of prior non-traumatic fractures in adulthood • hypogonadism • impaired mobility • increased risks for falls • long-term exposure to glucocorticoids • low body weight • parental history of hip fracture • postmenopausal status Qualifying Statement. Cutoffs used to define advanced age, excessive alcohol consumption, long-term glucocorticoid exposure and low body weight vary across studies and populations. The specifics around these continuous predictors and the thresholds most often associated with increased risk are described further within the supporting text. Assessment

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