Nutrition Education for Osteoporosis Prevention Among Cancer Survivors in Malaysia

Introduction

Osteoporosis and osteoporotic fractures are critical concerns for breast cancer survivors, significantly impacting their quality of life (Go et al., 2020). The non-ionizing radiation emitted by Radiofrequency Echographic Multi Spectrometry (REMS) makes it suitable for use in previously vulnerable groups, such as cancer survivors and enables more frequent monitoring of bone mineral density (BMD) (Fuggle et al., 2024). It is important to ensure adequate calcium intake among female cancer survivors (Zainordin et al., 2020) because cancer is a major risk factor for bone loss and fractures (Drake, 2013).

Problem Statement

Improved cancer survivorship means these patients may face chronic issues such as poor bone health (osteoporosis or osteopenia) and an increased risk of fractures (Wong and Chen, 2024) due to the long-term effects of cancer treatments such as chemotherapy, hormone therapy, or radiation (Rees-Punia et al., 2023). Despite the rising number of cancer survivors, awareness and implementation of bone health nutrition strategies remain limited. Without proper dietary knowledge and intervention, survivors are at higher risk for fractures, reduced mobility, and diminished quality of life. Therefore, targeted nutrition education is urgently needed to empower survivors with knowledge and skills to maintain bone health and prevent osteoporosis.

Objective

To evaluate the effectiveness of a nutrition education program in improving knowledge, dietary practices, and osteoporosis prevention behaviours among cancer survivors in Malaysia.

Methodology

Radiofrequency Echographic Multi Spectrometry (REMS)

Participants will lie on the provided bed. The avial site selection will be conducted to identify and prepare an appropriate anatomical location, ensuring optimal access, minimal discomfort, and reduced risk of complications. Following this, bone target visualization will be performed using REMS to accurately locate and identify the specific bone structure for osteoporosis diagnosis. The procedure for software-assisted ultrasound (US) acquisition will involve the use of specialized software to guide the capture, processing, and analysis of ultrasound images, ensuring precision and consistency in diagnostic imaging. Bone interface detection will be carried out through the calculation of Regions of Interest (ROIs), along with automatic signal and spectral analysis, to accurately identify and delineate the boundaries of bone structures. Finally, fragility score is a REMS measure of skeletal fragility (via bone microarchitecture and independent of BMD) at the spine and femoral neck and ranges from 0 (normal) to 100 (maximum fragility of the bone structure) (Fuggle et al., 2024). Figure 1 shows the REMS technology located in the subject preparation room at the Biomex Building, AMDI.

References

1. Go, J, Park, S, Sik Kim, K, Chang Kang, M, Hoon Ihn, M, Yun, S, Hyun Kim, S, Hoon Hong, S, Eun Lee, J, Wook Han, S, Yong Kim, S, Kim, Z, Mo Hur, S and Lee, J. (2020). Risk of osteoporosis and fracture in long-term breast cancer survivors. Korean J Clin Oncol. 2020 Jun 30;16(1):39–45. https://doi.org/10.14216/kjco.20007.   

2. Fuggle, NR, Reginster, J-Y, Al-Daghri, N, Bruyere, O, Burlet, N, Campusano, C, Cooper, C, Perez, AD, Halbout, P, Ghi, T, Kaufman, J-M, Kurt, A, Matijevic, R, Radermecker, RP, Tuzun, S, Veronese, N, Rizzoli, R, Harvey, NC, Brandi, ML and Brandi, M-L. (2024). Radiofrequency echographic multi spectrometry (REMS) in the diagnosis and management of osteoporosis: state of the art. Aging Clin Exp Res 36, 135 (2024). https://doi.org/10.1007/s40520-024-02784-w .

3. Zainordin NH, Abd Talib R, Shahril MR, Sulaiman S, A. and Karim N. Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia. Asian Pac J Cancer Prev. (2020) Dec 1;21(12):3689-3696. https://doi.org/10.31557/APJCP.2020.21.12.3689.

4. Drake MT. (2013). Osteoporosis and cancer. Curr Osteoporos Rep;11(3):163-70.  https://doi.org/10.1007/s11914-013-0154-3.

5. Wong PKK and Chen, W. 2024. Cancer survivorship and bone health. The Lancet Healthy Longevity. Volume 5, Issue 3e168-e169.

6. Rees-Punia, E., Newton, C. C., Patel, A. V., Corinne R. L., W. Ryan D., Amber C. G., Matthew M., Alpa V. P. and Lauren R. T. (2023). Fracture risk among older cancer survivors compared with older adults without a history of cancer. JAMA Oncology, 9(1), 79–87. https://doi.org/10.1001/jamaoncol.2022.5153