Clinical and geriatric factors associated with fracture risk in older adults with bone metastases: A prospective observational study
Supportive Care in Cancer, vol.34, no.6, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 34 Issue: 6
- Publication Date: 2026
- Doi Number: 10.1007/s00520-026-10859-9
- Journal Name: Supportive Care in Cancer
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Social Science Premium Collection (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest), Sociology Database (ProQuest)
- Keywords: Anticholinergic burden, Bone metastasis, Fractures, Frailty, Functional status, Malnutrition, Older adults
- Open Archive Collection: AVESIS Open Access Collection
- Hacettepe University Affiliated: Yes
Abstract
Purpose: Bone metastases frequently lead to fractures, causing substantial morbidity, impaired quality of life, and poor prognosis in older adults with cancer. This study aimed to evaluate fracture risk by integrating geriatric parameters with clinical and oncological factors in older patients with bone metastases. Methods: This prospective observational study included 55 patients aged ≥ 65 years with newly diagnosed bone metastases who initiated monthly parenteral antiresorptive therapy. Baseline evaluation included standard oncological variables and validated geriatric tools (ADL, MUST, mFI-5, and ACB). Fracture occurrence was monitored over a six-month follow-up period. Univariate Cox regression analyses were performed to identify fracture-associated factors, followed by a theoretically driven multivariable Cox regression model. Correlation analyses were used to assess associations among significant variables. Results: Fractures occurred in 21 patients (38.2%). Univariate analyses showed that poorer performance status (ECOG ≥ 1; HR = 19.92), moderate functional impairment (ADL 3–5; HR = 8.39), high frailty (mFI-5 ≥ 2; HR = 9.83), osteolytic lesions (HR = 4.87), high anticholinergic burden (ACB ≥ 3; HR = 4.56), malnutrition risk (MUST ≥ 2; HR = 4.30), post-study falls (HR = 4.22), and lung metastases (HR = 2.97) were associated with increased fracture risk. Multivariable analysis identified ECOG score of 1 (aHR = 20.62) and high ACB score (aHR = 5.70) as independent predictors. Reduced functional independence and poorer performance status showed the strongest correlations with fracture occurrence. Conclusion: Fracture risk in older adults with bone metastases is driven predominantly by functional impairment, frailty, and medication-related vulnerability rather than tumor-related factors alone. Integrating geriatric assessment into routine oncology practice may improve fracture risk stratification and supportive care outcomes.