Background:Older adults with cancer are surviving longer due to earlier detection and more effective treatments for advanced stages. This population is at an elevated risk of osteoporosis due to age-related changes in bone density as well as the impact of cancer and cancer treatments on the skeletal system.Main Body:Cancer treatments are associated with increased bone loss and fracture risk via a variety of mechanisms. International guidelines recommend screening for cancer treatment-induced bone loss and provide treatment algorithms for pharmacological agents for those on hormonal therapy. There is a paucity of guidelines on bone health protection for those receiving intermittent glucocorticoid and newer immunotherapy regimes.Results:All patients receiving cancer treatment should undergo an individualised fracture risk assessment to optimise their bone health with regular review and reassessment of their risk profile. Dedicated bone health guidelines in cancer populations should be expanded to consider the impact of newer treatment modalities. All patients should receive education around non-pharmacological management and undergo a shared decision-making approach where there are indications for bone-targeted agents.Conclusions:Bone health assessment is an integral part of comprehensive geriatric assessment for older people with cancer. Strategies to minimise bone density loss and reduce fracture risk are an important consideration for cancer survivorship programmes for the majority of people and require a standardised approach.
背景：由于早期发现及晚期癌症治疗手段的进步，老年癌症患者的生存期得以延长。该群体因年龄增长导致的骨密度变化，以及癌症本身及其治疗对骨骼系统的影响，面临更高的骨质疏松风险。 主体：癌症治疗通过多种机制加剧骨质流失和骨折风险。国际指南建议对癌症治疗引起的骨质流失进行筛查，并为接受激素治疗的患者提供药物治疗方案。然而，针对接受间歇性糖皮质激素治疗及新型免疫疗法患者的骨骼健康保护指南尚显不足。 结果：所有接受癌症治疗的患者均应进行个体化骨折风险评估，通过定期复查和风险状况再评估来优化骨骼健康管理。针对癌症人群的专项骨骼健康指南应拓展涵盖新型治疗模式的影响。所有患者都应接受非药物管理的健康教育，并在具备骨靶向药物使用指征时，通过共同决策制定治疗方案。 结论：骨骼健康评估是老年癌症患者综合老年评估的重要组成部分。对大多数患者而言，制定最小化骨密度流失、降低骨折风险的策略是癌症生存计划的重要考量，需要建立标准化实施路径。
Management of Bone Health Considerations in Patients with Cancer
肿瘤(癌症)患者之家