Management of bone health in cancer survivorship: a systematic review of clinical guidelines.

Abstract

Objective: Accelerated bone loss is a side effect of many anticancer treatments, posing significant health challenges for cancer survivors. The aim of this systematic review was to evaluate and synthesize recommendations for the management of bone health, specifically fracture and osteoporosis risk, in clinical guidelines for people with cancer. Method(s): Searches related to bone health clinical guidelines for cancer patients were conducted in four electronic databases (PubMed, EMBASE, CINAHL, and Scopus). Data extraction was performed independently by multiple authors. Quality appraisal was performed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidelines were categorized into three key focus areas (pharmacological interventions, screening, and lifestyle modifications) and compared across cancer types. Result(s): A total of sixty-five guidelines were included in the systematic review. Two-thirds of guidelines included recommendations related to lifestyle (most commonly vitamin D and calcium supplementation), 76% related to screening (mostly bone mineral density via DXA), and 89% related to pharmacological intervention (most commonly bisphosphonates and denosumab). Fifty-four percent included recommendations in all three domains. Using the AGREE II tool, 42 guidelines were rated moderate and 23 high with strong scoring in domains of Scope and Purpose, Clarity of Presentation and Editorial Independence. Conclusion(s): Findings highlight variations in guideline quality, with many lacking holistic, multidisciplinary recommendations for bone health management. Further development of guidelines supporting patients impacted by multiple risk factors, and the inclusion of management strategies to mitigate compounding effects of cancer-related bone loss and age-related bone degradation among cancer patients, is recommended.Copyright © The Author(s) 2026.