Evidence map›Paper›PMID 42392636›Full record

ArticleBMJ open2026

Prevalence of osteopenia and incidence of fragility fracture in adult patients with gastrointestinal cancer: protocol for a systematic review and meta-analysis.

Sara Bocchinfuso, Sheharzad Mahmood, Ka Yan Ip, Natasha Barone, Gianna Yau, Leonardo Brandão, William K Silverstein, Farhana Shariff, Teresa Tiano, Neill K J Adhikari and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Sara BocchinfusoInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada sara.bocchinfuso@mail.utoronto.ca.ORCID http://orcid.org/0009-0009-6518-7586
Sheharzad MahmoodInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Ka Yan IpClinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
Natasha BaroneInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Gianna YauClinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
Leonardo BrandãoInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
William K SilversteinInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Farhana ShariffDepartment of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Teresa TianoMyGutFeeling, Stomach Cancer Foundation of Canada, Toronto, Ontario, Canada.
Neill K J AdhikariInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.ORCID http://orcid.org/0000-0003-4038-5382
Natalie G CoburnInstitute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionOsteopenia, 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.

objectiveThis 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 findings, administrative codes or clinical history in cohorts of adult non-metastatic cancer populations. Five reviewers will independently and in pairs screen citations and full-text articles, extract data, and assess study quality using the Joanna Briggs Institute checklist for prevalence studies for each outcome. The primary outcome is the global pooled prevalence of osteopenia (diagnosed using DXA), calculated using a random-effect generalised linear mixed model. Secondary outcomes are the global pooled incidence rate of fragility fracture, and the pooled fragility fracture incidence rate ratio (IRR) comparing patients with GI cancer with the general population. All estimates will be presented with 95% confidence intervals. Heterogeneity will be assessed with I ETHICS AND DISSEMINATION: This study is a secondary analysis of aggregate, de-identified data extracted from previously published studies. As such, no new data were collected from human participants, and formal ethics board approval is not required. All aggregated data and analytical code used to complete this study will be made available on request to the corresponding author. The findings from this study will be disseminated through publication in a peer-reviewed scientific journal and presentation at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD420261286673.

Indexed as

Bone Diseases, MetabolicGastrointestinal NeoplasmsOsteoporotic FracturesAdultHumansIncidenceMeta-Analysis as TopicPrevalenceResearch DesignSystematic Reviews as TopicBone diseasesCancer SurvivorsFractures, BoneGastrointestinal tumoursMeta-AnalysisSystematic Review

Identifiers

PMID42392636
PMCPMC13330952

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.