A multicenter prospective matched comparative study on osteoporosis risk in cancer patients receiving chemotherapy

Chemotherapy and cancer can worsen osteoporosis, a growing concern with improved cancer survival rates. This study aimed to assess osteoporosis risk in chemotherapy patients versus healthy individuals and identify predictive factors.

This multicenter prospective, cross-sectional study included 257 chemotherapy-treated cancer patients and 257 age- and gender-matched controls (1:1) using propensity score matching. Exclusions included recent alcohol use, severe organ impairments, endocrine disorders, specific treatments (estrogen, progesterone, glucocorticoids, bisphosphonates, calcium supplements), and cancer-related bone conditions. Bone mineral density (BMD) at the femur and lumbar spine was measured via DXA.

The study included 174 females and 83 males (median age 59) in both groups. Of cancer patients, 37.0% had osteopenia and 21.0% had osteoporosis in lumbar vertebrae, compared to 16.3% and 2.3% in controls (p < 0.001). For total femur, 32.3% had osteopenia and 5.8% had osteoporosis in cancer patients, versus 18.7% and 1.2% in controls (p < 0.001). Median lumbar BMD was 0.90 g/cm² in cancer patients and 1.22 g/cm² in controls (p < 0.001); median femur BMD was 0.89 g/cm² and 0.98 g/cm², respectively (p < 0.001). Breast cancer had the highest normal BMD (51.2%) but shared the highest osteoporosis rate (31.5%) with colorectal cancer. Gastric cancer showed the highest osteoporosis rate for femur BMD (33.3%, p = 0.024). Vitamin D deficiency (< 12 ng/mL) was more common in cancer patients (50.6% vs. 18.1%) and linked to reduced bone mineral density (p = 0.009). Serum creatinine, alkaline phosphatase, calcium, and phosphate levels were similar in groups, with no link to osteoporosis. Cancer increased osteoporosis risk 6.8-fold (p < 0.001, 95% CI: 4.024-11.494). BMI was protective, reducing odds by 4.5% per unit increase (p = 0.036, 95% CI: 0.915-0.997). Lumbar osteoporosis and osteopenia were 9.1 and 2.3 times more common in cancer patients, with lumbar and femur BMD reduced by 26.2% and 9.2%, respectively, compared to controls.

Addressing bone health in cancer patients is crucial for improving quality of life and reducing osteoporosis burdens.