Charles L Shapiro1, Catherine Van Poznak2, Christina Lacchetti3, Jeffrey Kirshner4, Richard Eastell5, Robert Gagel6, Sean Smith2, Beatrice J Edwards7, Elizabeth Frank8, Gary H Lyman9, Matthew R Smith10, Rahul Mhaskar11, Tara Henderson12, Joan Neuner13. 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.
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.
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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