Burden of comorbidities: Osteoporotic vertebral fracture during non-small cell lung cancer - the BONE study.

Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS). We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method. We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.

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Declaration of Competing Interest Valérie Gounant reports personal fees from Astra, BMS; personal fees and non- financial support from Janssen, Sanofi, Takeda, Pfizer, Roche; all outside the submitted work. Esther Ebstein reports personal fees from Galapagos, Novartis, Abbvie, UCB: all outside the submitted work. Marine Forien reports personal fees from Abbvie, Ucb, Galapagos BMS, Amgen: all outside the submitted work. Sébastien Ottaviani reports personal fees from BMS, Janssen, Chugai, MSD, Novartis, Boehringer: all outside the submitted work. Pierre Antoine Juge reports personal fees from Galapagos and Boehringer Ingelheim all outside the submitted work. Philippe Dieudé reports personal fees from Galapagos, BMS, Janssen, Abbvie, Pfizer, Novartis and Boehringer Ingelheim all outside the submitted work. Gérard Zalcman reports receiving grant support from Inventiva, Roche-France, and Takeda; personal fees from AstraZeneca, Bristol Myers Squibb, Da Volterra, Merck Sharp & Dohme, and Pfizer; and nonfinancial support from AbbVie and Inventiva: all outside the submitted work. Ghassen Soussi, Charles Vauchier, Antoine Khalil, Ralph Khoury, Bastien Léger, Pauline Brocard report no competing interest.