Bone health in patients with cancer: a SEOM-SEIOMM consensus review of risk factors, assessment strategies, and management approaches

Anticancer therapies frequently compromise skeletal health and increase fracture risk. This narrative review synthesizes information and provides guidance on assessment, prevention, and management of therapy-related bone loss in adults with cancer. Major contributors to bone loss in this population include aromatase inhibitors, androgen deprivation therapy, systemic glucocorticoids, chemotherapy, and selected targeted or immune agents. Recommended assessments include clinical evaluation, laboratory tests (calcium, vitamin D, and renal function), and bone mineral density by dual-energy X-ray absorptiometry with vertebral fracture assessment and, when acute vertebral fracture is suspected, magnetic resonance imaging. Prevention measures include exercise, adequate calcium and vitamin D intake, and fall-reduction strategies. Pharmacological treatment options include bisphosphonates and denosumab. Selection of treatment should consider skeletal efficacy and potential oncological benefits, while ongoing care includes repeat bone density testing at 12-24 months and vigilance for osteonecrosis of the jaw and atypical femoral fractures.