Brennan Michelle, Kalsi Tania
Department of Geriatric Medicine, University Hospital Limerick, V94 F858 Limerick, Ireland.
Department of Ageing and Health, Geriatric Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK.
Cancers (Basel). 2025 Sep 1;17(17):2878. doi: 10.3390/cancers17172878.
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. 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. 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. 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.
由于早期检测以及对晚期更有效的治疗，老年癌症患者的生存期延长。由于与年龄相关的骨密度变化以及癌症和癌症治疗对骨骼系统的影响，这一人群患骨质疏松症的风险升高。癌症治疗通过多种机制导致骨质流失增加和骨折风险升高。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算法。对于接受间歇性糖皮质激素和新型免疫治疗方案的患者，关于骨骼健康保护的指南较少。所有接受癌症治疗的患者都应进行个体化骨折风险评估，通过定期复查和重新评估其风险状况来优化骨骼健康。癌症人群的专门骨骼健康指南应加以扩展，以考虑新型治疗方式的影响。所有患者都应接受非药物管理方面的教育，并在有使用骨靶向药物指征时采用共同决策方法。骨骼健康评估是老年癌症患者综合老年评估的一个组成部分。对于大多数人来说，尽量减少骨密度损失和降低骨折风险的策略是癌症幸存者计划的重要考虑因素，并且需要一种标准化方法。
