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

Table 1 Comparison between traditional management and precision management for gastrointestinal tumor-associated osteoporosis

Items (evaluation indicators)	Traditional management mode	Precision management mode (empowered by cutting-edge technologies)
Core concept	Empirical intervention, one-size-fits-all strategy	Precision medicine, based on individual characteristics (tumor biology, genetic background, bone metabolism status, etc.)
Screening method	Mainly dual-energy X-ray absorptiometry	AI-based opportunistic screening (based on routine imaging) + bone metabolism marker detection
Screening efficiency	Low, about 60% of GTO patients not identified early	High, significantly improved early recognition rate
Therapeutic strategy	Routine bone protectors (bisphosphonates, denosumab) applied uniformly based on guidelines	Nanoparticle-targeted drug delivery system + personalized scheme (combined with multiomics results)
Consideration of individual differences	Ignored (tumor stage, pathological type, treatment plan, genetic background, nutritional status not fully considered)	Fully considered, tailored to individual patient characteristics
Therapeutic effect	Poor in some patients (61.3% failure rate of bisphosphonates in postmenopausal osteoporotic vertebral fracture patients)	Significantly improved, targeted delivery enhances efficacy
Adverse reactions	High risk (atypical femoral fractures, osteonecrosis of the jaw from bisphosphonates; hypocalcemia from denosumab)	Reduced systemic adverse reactions (targeted delivery reduces nontarget organ exposure)
Mechanism understanding	Focus on single bone metabolism pathway (e.g., RANKL-RANK-OPG system)	In-depth analysis via multiomics technologies, clarifying “tumor-gastrointestinal-bone” multisystem interaction network
Management process	Discontinuous (screening → intervention, no closed-loop monitoring)	Whole-process closed-loop management (precision screening → precision assessment → precision intervention → precision monitoring)
Impact on patient compliance	Low (due to poor therapeutic effect and adverse reactions)	High (improved efficacy, reduced side effects, and personalized intervention)
Impact on prognosis	Limited improvement, failure to effectively reduce SREs and prolong survival	Significantly improves long-term prognosis, reduces SREs incidence, and enhances quality of life
Supporting technologies	Conventional detection and drug delivery technologies	AI, nanoparticle-targeted drug delivery system, multiomics (genomics, transcriptomics, metabolomics, microbiomics), MDT collaboration

GTO: Gastrointestinal tumor-associated osteoporosis; AI: Artificial intelligence; MDT: Multidisciplinary team; SRE: Skeletal-related event.

Table 2 Core challenges in the precision management of gastrointestinal tumor-associated osteoporosis

Category	Core challenges
Clinical translation barriers	AI models: Insufficient generalization, overfitting, poor interpretability, lack of multicenter validation. Nanodrugs: Unclear in vivo mechanism, long translation cycle, high cost, difficult quality control, biosafety risks, poor scenario adaptability
Data integration and standardization	Data islands among departments and institutions. Multisource heterogeneous data with poor interoperability. Nonuniform detection standards for bone metabolic markers. Ethical and privacy barriers restricting data sharing
Imperfect MDT cooperation	MDT is passive and delayed rather than proactive. Knowledge barriers between oncology, orthopedics, nutrition, etc. Lack of standardized GTO-specific guidelines and workflows
Ethical and safety risks	Data privacy and security issues in AI applications. “Black box” problem of AI leading to low clinical trust. Unknown long-term biosafety of nanomaterials. Individual heterogeneity and potential toxicity of nanodrugs

GTO: Gastrointestinal tumor-associated osteoporosis; AI: Artificial intelligence; MDT: Multidisciplinary team.

Table 3 Future perspectives for the precision management of gastrointestinal tumor-associated osteoporosis

Dimension	Future strategies
Construction of integrated precision system	Multitechnology fusion (AI, multiomics, nanomedicine, wearable sensors). Multicenter dataset and federated learning. Closed-loop management: Early warning, precise typing, intervention, monitoring
Accelerated clinical translation of nanotechnology	Optimize biocompatibility and administration routes (oral, enteric-coated). Conduct multicenter, randomized, controlled clinical trials. Scale production to reduce cost; develop multitarget synergistic nanosystems
Improved MDT and data standardization	Establish standardized, proactive MDT workflow. Define responsibilities of oncology, orthopedics, radiology, nutrition. Unify data standards and build regional data sharing platform. Develop GTO-specific clinical guidelines
Ethical supervision and technical regulation	Improve data privacy protection and encryption technology. Establish clinical access and postmarketing surveillance system. Define AI as an auxiliary tool; strengthen manual review. Standardize clinical application and risk control of new technologies

GTO: Gastrointestinal tumor-associated osteoporosis; AI: Artificial intelligence; MDT: Multidisciplinary team.