The prevalence of osteopenia in adult non-metastatic gastrointestinal cancer patients: A systematic review and meta-analysis.

e23187 Background: Improvements in survival among patients with gastrointestinal (GI) cancer have led to a shift in focus towards management of cancer-related sequelae, including osteopenia. We aimed to estimate the global prevalence of osteopenia in adults with non-metastatic GI cancer. Methods: We conducted a comprehensive search of MEDLINE, Embase, CINAHL, PubMed, Web of Science, Cochrane, and ClinicalTrials.gov from January 1, 1994 to October 2, 2025. Eligible studies measured bone mineral density (BMD) and reported the prevalence of osteopenia among patients diagnosed with non-metastatic GI cancer. Studies involving children (< 18 years) were excluded. Paired reviewers independently screened citations, selected studies, abstracted data, and assessed risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Pooled prevalence was estimated using a random effects generalized linear mixed model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results: 18 eligible studies (1635 patients), mostly prospective cohorts (10/18) measuring BMD following completion of cancer treatment (14/18), were included. The pooled prevalence of osteopenia was 40% (95% CI 33-48%; 95% PI 16-70%, I2= 88%; τ2= 0.39); certainty of evidence was moderate after downgrading for risk of bias. In a pre-specified subgroup analysis, osteopenia prevalence was higher in studies of gastric cancer (45%, 95% CI 39–50; 11 studies, 1,096 patients) than other GI cancers (30.6%, 95% CI 17.2–48.2; 7 studies, 539 patients; P = 0.08; low-credibility subgroup effect); however, comparisons are limited by small sample size. Prevalence was 40% in a sensitivity analysis limited to low risk of bias studies (95% CI 27-54; 9 studies, 957 patients). Conclusions: Moderate-certainty evidence suggests that the prevalence of osteopenia in adults with GI cancer is 40%. Our findings underscore the importance of bone health as a survivorship priority. Addressing this burden will require coordinated efforts in clinical practice, guideline development, and future research to improve screening, prevention, and management strategies for this vulnerable population.