Precision management of gastrointestinal tumor-associated osteoporosis driven by cutting-edge technologies: Current status, challenges, and future prospects

Abstract

Gastrointestinal tumor-associated osteoporosis (GTO) is defined as secondary osteoporosis in patients with gastrointestinal tumors caused by tumorderived factors, chemotherapy, surgery, or malabsorption; it is an underrecognized but clinically significant complication that adversely affects skeletal health, treatment adherence, quality of life, and longterm prognosis. Its pathogenesis is multifactorial and involves a metabolic imbalance in the tumor microenvironment, antitumor therapy-related bone toxicity, and nutrient malabsorption caused by gastrointestinal dysfunction. These factors collectively increase the risk of skeletal-related events and worsen clinical outcomes. The aim of this review is to systematically evaluate the methodological quality, clinical validity, and translational evidence of cutting-edge technologies in GTO precision management and to clarify key methodological gaps and standardized directions for future research. In recent years, emerging technologies such as artificial intelligence (AI), nanotargeted drug delivery systems, and multiomics approaches have provided new opportunities for the precision management of GTO. This review summarizes their current applications in AI-assisted early screening and risk prediction, nanoenabled targeted bone protection, and multiomics-based mechanistic exploration of the tumor-bone-gut axis. It also discusses major barriers to clinical translation, including limited AI generalizability, nanomedicine safety and manufacturing challenges, difficulties in multidimensional data integration and standardization, imperfect multidisciplinary collaboration, and ethical concerns. Overall, these technologies are expected to drive the transition of GTO management from empirical practice to precision medicine and ultimately improve long-term patient outcomes.

Keywords: Artificial intelligence; Bone-targeted drug delivery; Gastrointestinal tumor-associated osteoporosis; Gut-bone axis; Microbiome; Multidisciplinary management; Multi-omics; Nanomedicine; Precision medicine; Risk stratification

Core Tip: Gastrointestinal tumor-associated osteoporosis (GTO) is an underrecognized complication that compromises quality of life, treatment adherence, and long-term prognosis. This review highlights how artificial intelligence (AI), bone-targeted nanodelivery, and multiomics are reshaping GTO management from empirical intervention to precision medicine. AI enables opportunistic screening and risk stratification, nanotechnology improves targeted bone protection, and multiomics reveals mechanisms across the tumor-bone-gut axis. The article also addresses key translational barriers, including limited model generalizability, nanomedicine safety, data standardization, and multidisciplinary coordination, and outlines future directions for integrated precision management.