Bone health in cancer survivors

Abstract

Background: To evaluate bone health in cancer survivors. Method(s): A total of 79 cancer survivors enrolled in prospective study evaluating bone health were included. Fracture risk of was evaluated by dual-energy X-ray absorptiometry densitometry (DEXA) scan. Parameters evaluated were T score, Z score, BMD and BMC. Risk of fracture was evaluated by age, height, body mass index, weight, type of cancer, treatment by chemotherapy, radiotherapy, hormonal therapy, exercise, per-formance status and ability to perform house hold activities. Pearson's chi-squared test was used to evaluate factors effecting osteoporosis. A p value of < 0.05 was considered significant. All analyses were performed using the IBM SPSS statistics version 22.0 software package (SPSS Inc., Chicago, IL, USA). Result(s): Median age was 53 yrs (range 26-79yrs). The study included 46 patients with gynecological malignancies and 23 patients with breast cancer. Eight two percent received chemotherapy, 89% were subjected to radiotherapy, 25% received hormonal therapy. Median BMI was 23.83kg/m2 (16.4-36.4 kg/m2), median weight was58Kg(35-83Kg), median height was 151 cms (131-166 cms). Median performance status was 80 (range 60-100). Brisk walking >30 minutes per day was done by 20%, 53% were actively performing house-hold work. T score spine median was-2.6 (range0 to-5.9), Z score spine median-1.5 (range 0.7 to-4.3), median BMD spine 0.76 (range 0.40-1.05) and median BMC spine was 39.02 (range 19.12-66.65). T score femur neck was median-1.4 (range 2.5 to-3.9), Z score femur neck median-0.6 (range 2.7 to-3.7), BMD femur neck median 0.72 (range 0.41-3.8) and median BMC femur neck was 3.64 (range 0.83-51.09). Sixty six per cent of cancer survivors had osteoporosis, 25% had osteopenia and 9% had normal bone health. Factors significantly associated with osteoporosis included weight <50kg (p = 0.001), age >60yrs (p =0.002), non breast cancer primary (p= 0.031). Conclusion(s): In the study 91% of patients had impaired bone health. Every 2 out of 3 survivors had osteoporosis and 1 out of 4 had osteopenia. Only 20% survivors were routinely brisk walking >30 minutes. Findings within our study lay emphasis on lifestyle modification, nutrition and pharmacological interventions to improve bone health in cancer survivors in this part of the subcontinent.