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Bone protection in older patients with cancer

Although anti-resorptive therapies are especially important for elderly patients with cancer, they are typically underutilised in this population, which also does not benefit from exercise and adequate calcium and vitamin D supplementation.
Older age is associated with increased risk for invasive malignancies, such as breast and prostate cancer, with a higher risk of bone metastasis. Underuse of antiresorptive therapies may be more detrimental in elderly patients compared with younger patients because of multiple fracture risk factors, including physiological decreases in BMD and increases in vertebral fracture rate with increasing age.

In addition to preventing SREs in the oncology setting, antiresorptive therapies are indicated for fracture risk reduction in elderly patients with osteoporosis. Although oral bisphosphonates such as risedronate and alendronate have demonstrated efficacy in the postmenopausal osteoporosis setting, their dosing schedule and strict dosing regimen can lead to poor patient compliance. Alternatively, i.v. bisphosphonates can be considered; a single annual infusion of zoledronic acid has proven effective for the treatment of postmenopausal osteoporosis. Denosumab has a broad indication in cancer and non-cancer patients at risk of bone-events. Thus far, no dose adjustments based on age have been suggested for denosumab, and this would be necessary only if safety issues (e.g. severe hypocalcemia) developed.

Aims
To revise and adapt the existing guidelines, like the recently published ESMO one, for the geriatric cancer population.
Special considerations should be made for elderly patients who may have renal impairment from hypertension or diabetes and are likely to be taking more concomitant medications due to comorbid conditions. Careful monitoring of such comorbidities is essential to ensure the safety and comfort of elderly patients, especially during chemotherapy.

Task Force Members

Moderators
Matti Aapro, Switzerland & Jean-Jacques Body, Belgium

Writing Committee
Rob Coleman, United Kingdom
Peyman Hadji, Germany
Evangelos Terpos, United Kingdom
Bertrand Tombal, Belgium
Annie Young, United Kingdom

Publication

2016
J.J. Body, E. Terpos, B. Tombal, P. Hadji, A. Arif, A. Young, M. Aapro, R. Coleman, Bone health in the elderly cancer patient: a SIOG Position Paper Cancer Treatment Reviews

This project was supported by an unrestricted grant from Amgen.