Preserving bone in cancers of the elderly: A necessity

• Published in: Joint, bone, spine : revue du rhumatisme Vol. 90; no. 4; p. 105549
• Main Authors: Bertrand, Nicolas, Bridoux, Marie, Gaxatte, Cédric, Abi Rached, Henry, Turpin, Anthony, Letarouilly, Jean-Guillaume, Vieillard, Marie-Hélène
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-07-2023; Elsevier Masson
• Subjects: Aged; Aging; Bone health; Bone metastases; Cancer; Comanagement; Geriatric oncology; Health pathway; Humans; Life Sciences; Medical Oncology; Multidisciplinarity; Neoplasms - epidemiology; Neoplasms - therapy; Older; Osteoporosis; Risk Assessment; Syndrome; Bone health; Osteoporosis; Comanagement; Multidisciplinarity; Health pathway; Geriatric oncology; Bone metastases; Older; Cancer
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2023.105549

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•Given the frequency and burden of bone events in elderly cancer patients, collaboration between rheumatologists, oncologists and geriatricians is essential.•Bone risk assessment is related to identification of geriatric syndromes during Comprehensive Geriatric Assessment (CGA) for frail patients, history, and cancer treatments.•Prevention of osteoporosis and skeletal-related events due to bone metastases, is based on drug and non-drug therapies related to geriatric interventions.•Management of fractures is based on the benefit-risk ratio of the intervention, but also the prognosis related to cancer and geriatric syndromes.
The occurrence of bone fractures is frequent in the elderly population, and in cancer patients, especially with bone metastases. The growing incidence of cancer associated with an aging population implies important health challenges, including bone health. Decisions on cancer care in older adults have to take into account older adults’ specificities. Screening tools as G8 or VES 13 and evaluating tools as comprehensive geriatric assessment (CGA) do not include bone-related items. Bone risk assessment is indicated according to identification of geriatric syndromes such as falls, history, and the oncology treatment plan. Some cancer treatments disrupt bone turnover and decrease bone mineral density. This is mainly caused by hypogonadism, induced by hormonal treatments and some chemotherapies. Treatments can also cause direct (i.e., chemotherapy, radiotherapy or glucocorticoids) or indirect toxicity through electrolyte disorders (i.e., some chemotherapies or tyrosine kinase inhibitors) on bone turnover. Bone risk prevention is multidisciplinary. Certain interventions proposed in the CGA aim to improve bone health and reduce the risk of falling. It is also based on the drug management of osteoporosis, and the prevention of complications from bone metastases. Management of fractures, related or not to bone metastases relates to the concept of orthogeriatrics. It is also based on the benefit-risk ratio of the operation, access to minimally invasive techniques, prehabilitation or rehabilitation, but also the prognosis related to cancer and geriatric syndromes. Bone health is essential in older cancer patient's care. Bone risk assessment should be part of CGA in routine use and specific decision-making tools should be developed. Bone event management must be integrated throughout the patient's care pathway and oncogeriatrics multidisciplinarity should include rheumatological expertise.