In Reply We thank Zhang and Xu and Lien et al for their thoughtful comments on our recent article examining fracture risk prediction in individuals with cancer. Cancer therapies and outcomes have indeed evolved over the observation period of our study. Although stratifying our analysis for different time periods would be interesting, performing validation studies of 10-year fracture risk requires 10 years of observation after the index date. Thus the most recent index time that we could study was, by definition, 10 years in the past. The largest advancement in cancer therapies in the past 10 years is the rapid adoption of immune checkpoint inhibitor (ICI) therapy. There is increasing evidence that ICI drugs could have adverse effects on bone, and whether or not the fracture risk associated with this new class of drugs will be captured by the Fracture Risk Assessment Tool (FRAX) remains unknown.