Clinical and geriatric factors associated with fracture risk in older adults with bone metastases: A prospective observational study.

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.