Bone health in the elderly cancer patient: A SIOG position paper |
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Institution: | 1. Department of Professional Practice and Education, City of Hope, Duarte, United States;2. Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia;3. Queensland University of Technology, Brisbane, Australia;4. Department of Health System Administration, The Ohio State University Health System, Columbus, United States;5. Department of Pharmacy Practice, Jefferson School of Pharmacy, Philadelphia, United States;6. Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore;7. Department of General Medical Oncology And Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium;1. Department of Oncology, Region Hospital West Jutland, Gl. Landevej 61, Herning, 7400, Denmark;2. Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA;3. Enrique Soto-Perez-de-Celis Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico;4. Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom;5. Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom;6. Division of Geriatrics/Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA;7. Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France;8. Gynaecology Unit, The Royal Marsden NHS Foundation Trust Sutton, United Kingdom;9. Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, NY, USA;1. Department of Surgery, University of Montreal, Montreal, Canada;2. Clinical and Health Informatics Research Group, McGill University, Montreal, Canada;3. Department of Surgery, City of hope, Duarte, CA, United States of America;4. Department of Medicine, McGill University, Montreal, Canada;5. Department of Epidemiology, Biostatistics and Occupational Therapy, McGill University, Montreal, Canada;6. School of Physical and Occupational Therapy, McGill University, Montreal, Canada;7. Department of Surgery, McGill University, Montreal, Canada;8. Department of Oncology, McGill University, Montreal, Canada |
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Abstract: | More than a third of cancers are diagnosed in people over the age of 75. Androgen deprivation for prostate cancer and aromatase inhibitors in breast cancer accelerate age-related bone loss and increase fracture rates. BMD should be checked by dual energy X-ray absorptiometry at baseline and, dependent on risk, every 12–24 months. Sufficient calcium, vitamin D and exercise are part of primary fracture prevention. Resistance exercise in particular may improve functional activity and bone density. In men at increased fracture risk and women with postmenopausal early breast cancer, antiresorptive treatment is warranted to reduce fracture rate and to increase overall survival in breast cancer. Bone metastases (BM) are common in breast and prostate cancer and lytic bone lesions typical of multiple myeloma. They can cause fractures, pain and spinal cord compression, require surgery or radiation for symptom relief, and lead to hypercalcaemia. Multidisciplinary working with patients and carers can improve quality of life for elderly patients with BM and mitigate the adverse consequences of therapy. Bisphosphonates and other osteoclast inhibitors such as denosumab reduce this morbidity, improve quality of life and reduce pain. Especially in the elderly, attention should be paid to renal function and to risk factors for osteonecrosis with bone-modifying agents. Attention should also be paid to hypocalcaemia risk, which can be considerable in elderly men with metastatic prostate cancer and vitamin D deficiency. We urgently need further research specifically directed at assessing risks and benefits of bone targeted treatments in the growing population of elderly cancer patients. |
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Keywords: | Breast cancer Prostate cancer Myeloma Bone health Bisphosphonates Denosumab |
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