Delayed and selective bone health assessment following cancer diagnosis: a real-world gap in survivorship care.
6 affiliations
- 1Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky University Medical Center, Tel Aviv, Israel. [email protected].
- 2Gray School of Medicine, The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel. [email protected].
- 3Assuta Medical Centers, Tel Aviv, Israel. [email protected].
- 4Assuta Medical Centers, Tel Aviv, Israel.
- 5Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky University Medical Center, Tel Aviv, Israel.
- 6Gray School of Medicine, The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Abstract
Background
Cancer treatment-induced bone loss (CTIBL) is well-recognized in hormone-sensitive malignancies such as breast and prostate cancer but is less consistently implemented in patients with other solid tumors and hematologic malignancies. Furthermore, the long-term skeletal effects of newer systemic therapies, including immune checkpoint inhibitors and targeted agents, remain incompletely characterized. Although bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) is recommended for patients at increased skeletal risk, real-world utilization patterns remain poorly characterized.Objectives
To evaluate DXA utilization, timing, BMD results, and associated clinical characteristics following a new cancer diagnosis in a large real-world cohort.Methods
We conducted a retrospective cohort study using the MDClone platform, including adults with a first cancer diagnosis between January 1, 2015, and December 31, 2024, treated at Assuta Medical Centers in Israel. DXA completion, timing, BMD and T-scores, and prevalence of osteopenia and osteoporosis were analyzed.Results
Among 21,112 patients with newly diagnosed cancer (77.0% women; mean age 60.2 ± 13.1 years), 7496 (35.5%) underwent DXA at any time following diagnosis. DXA utilization was significantly lower in men than in women (15.0% vs. 41.7%). Early DXA assessment within 6 months of diagnosis was uncommon (1550 patients; 7.3% of the total cohort), and only 14.1% underwent DXA within the first 12 months. Median time from cancer diagnosis to DXA was 14.8 months. DXA utilization varied by cancer type and was highest in breast cancer (42.2%) and prostate cancer (30.0%), with substantially lower utilization among patients with other malignancies. Among patients with complete evaluable measurements, 40.2% had normal BMD, 45.2% had osteopenia, and 14.5% met criteria for osteoporosis.Conclusions
In our real-world experience within a large private healthcare network, DXA assessment after cancer diagnosis is infrequently performed and often delayed, with marked disparities by sex and cancer type. A substantial burden of low bone mass is already present at the time of evaluation, highlighting missed opportunities for early skeletal risk identification.
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BibTeX
@article{rouach2026delayed,
title = {{Delayed and selective bone health assessment following cancer diagnosis: a real-world gap in survivorship care.}},
author = {Vanessa Rouach and Ziv Versano and Meital Sasson and Yona Greenman and Arnon Makori},
journal = {Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer},
year = {2026},
month = oct,
doi = {10.1007/s00520-026-11340-3},
url = {https://europepmc.org/article/MED/42897399},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delayed and selective bone health assessment following cancer diagnosis: a real-world gap in survivorship care.
AU - Vanessa Rouach
AU - Ziv Versano
AU - Meital Sasson
AU - Yona Greenman
AU - Arnon Makori
PY - 2026
DA - 2026/10/19
JO - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
DO - 10.1007/s00520-026-11340-3
UR - https://europepmc.org/article/MED/42897399
AB - Background Cancer treatment-induced bone loss (CTIBL) is well-recognized in hormone-sensitive malignancies such as breast and prostate cancer but is less consistently implemented in patients with other solid tumors and hematologic malignancies. Furthermore, the long-term skeletal effects of newer systemic therapies, including immune checkpoint inhibitors and targeted agents, remain incompletely characterized. Although bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) is recommended for patients at increased skeletal risk, real-world utilization patterns remain poorly characterized.Objectives To evaluate DXA utilization, timing, BMD results, and associated clinical characteristics following a new cancer diagnosis in a large real-world cohort.Methods We conducted a retrospective cohort study using the MDClone platform, including adults with a first cancer diagnosis between January 1, 2015, and December 31, 2024, treated at Assuta Medical Centers in Israel. DXA completion, timing, BMD and T-scores, and prevalence of osteopenia and osteoporosis were analyzed.Results Among 21,112 patients with newly diagnosed cancer (77.0% women; mean age 60.2 ± 13.1 years), 7496 (35.5%) underwent DXA at any time following diagnosis. DXA utilization was significantly lower in men than in women (15.0% vs. 41.7%). Early DXA assessment within 6 months of diagnosis was uncommon (1550 patients; 7.3% of the total cohort), and only 14.1% underwent DXA within the first 12 months. Median time from cancer diagnosis to DXA was 14.8 months. DXA utilization varied by cancer type and was highest in breast cancer (42.2%) and prostate cancer (30.0%), with substantially lower utilization among patients with other malignancies. Among patients with complete evaluable measurements, 40.2% had normal BMD, 45.2% had osteopenia, and 14.5% met criteria for osteoporosis.Conclusions In our real-world experience within a large private healthcare network, DXA assessment after cancer diagnosis is infrequently performed and often delayed, with marked disparities by sex and cancer type. A substantial burden of low bone mass is already present at the time of evaluation, highlighting missed opportunities for early skeletal risk identification.
SN - 0941-4355
SN - 1433-7339
ER -