Prevalence of osteopenia and incidence of fragility fracture in adult patients with gastrointestinal cancer: protocol for a systematic review and meta-analysis
Abstract
Introduction: Osteopenia, defined as a bone mineral density (BMD) T-score between -1.0 and -2.5, is a precursor to osteoporosis and fragility fracture which results in substantial morbidity. Patients with gastrointestinal (GI) cancer are particularly vulnerable due to disease-specific mechanisms of bone loss and treatment-related toxicities, which compound the risk of osteoporotic fractures and adverse oncological outcomes. Despite this, the global prevalence of osteopenia and incidence of osteoporotic fracture in GI cancer populations remains poorly quantified, limiting opportunities for targeted surveillance, preventive strategies and policy development.
Objective: This systematic review and meta-analysis will estimate the global prevalence of osteopenia and global incidence of osteoporotic fracture in cohorts of adults with non-metastatic GI cancer and explore variation across treatment type, cancer site, geographical region and diagnostic modality.
Methods and analysis: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidance. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, PubMed, Web of Science, Cochrane Central and ClinicalTrials.gov from 1994 to 2026. Eligible studies will include observational or interventional cohorts reporting prevalence of osteopenia, assessed using dual-energy X-ray absorptiometry (DXA) or CT scan, or incidence of fragility fracture, as determined by imaging…
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