Osteoporosis, fractures, and risk of falls

• Published in: Oncology (Williston Park, N.Y.) Vol. 24; no. 8; p. 752
• Main Authors: Cohen, Melissa J, Naeim, Arash
• Format: Journal Article
• Language: English
• Published: United States Intellisphere, LLC 01.07.2010; MultiMedia Healthcare Inc
• Subjects: Accidental Falls - prevention & control; Aged; Aged patients; Antineoplastic Agents - adverse effects; Aromatase Inhibitors - adverse effects; Bone Density Conservation Agents - therapeutic use; Bone Remodeling - drug effects; Cancer; Chemotherapy; Complications and side effects; Female; Fractures; Fractures, Bone - etiology; Fractures, Bone - prevention & control; Geriatric Assessment; Health aspects; Humans; Male; Middle Aged; Osteoporosis; Osteoporosis - chemically induced; Osteoporosis - physiopathology; Osteoporosis - prevention & control; Risk Assessment; Risk factors; United States
• ISSN: 0890-9091

Morbidity associated with osteoporosis is due to fractures, therefore assessing risk of a fracture is important. Such assessment involves the identification and modification of clinical risk factors, in addition to measuring a person's bone density. The National Osteoporosis Foundation recommends a comprehensive approach to diagnosing osteoporosis including a detailed history and physical, medication assessment, and use of the Fracture Risk Assessment tool (FRAX). [2] The FRAX tool, developed by the World Health Organization (WHO), is an algorithm that estimates the 10-year probability of a hip fracture or osteoporotic fracture. Clinical features such as sex, weight, height, history of prior fracture, family history of hip fracture, smoking status, steroid use, rheumatoid arthritis diagnosis, and alcohol consumption are utilized. The tool was developed in population-based cohorts from Europe, North America, Australia, and Japan in subjects more than 50 years of age, and it has been demonstrated to be valid and reliable. A web-based version is available at http://www.shef.ac.uk/FRAX/. [3] It is well established that one-third of all community-dwelling individuals over the age of 65 years fall every year. [11,12] Cancer and its treatments can increase an elderly patient's risk for falling by contributing to muscle weakness, osteoporosis, neuropathy, and fatigue, all of which can be considered risk factors for falling and subsequent fractures. Therefore, it may be important for oncologists caring for elderly cancer patients to be aware of the risk factors associated with osteoporosis, fractures, and falls. There are many opportunities for further research in this area. Areas that would benefit from more focused research include the prevalence of osteoporosis, falls, and fractures in patients undergoing chemotherapy; effects of chemotherapy-induced menopause or hypogonadism on bone health and fracture-risk differences in bone density, fall risk, and subsequent fractures in patients who have bone metastases vs those who do not;