Cancer treatment-related bone disease

Abstract

Bone health may be impaired in many patients being treated for cancer. Primary tumors that reside in or form metastases to bone can result in compromised skeletal integrity. It has also been increasingly recognized that patients undergoing therapies for treatment of cancer are at higher risk of bone loss. These include androgen-deprivation therapy for prostate cancer and aromatase inhibitor therapy for breast cancer, among others. Hypogonadism induced by many of these cancer treatments results in bone loss and increases the risk of osteoporosis and fractures. Progress has been made in identifying the role of oral and intravenous bisphosphonates to prevent bone loss in these patients. This review discusses bone loss associated with cancer treatments, with a focus on breast cancer, prostate cancer, and survivors of childhood malignancies.

Figure 1

Bone mineral density loss with cancer therapies. Cancer treatment induced bone loss after 1 year often exceeds that seen in normal men and postmenopausal women. BMD=bone mineral density; AI=aromatase inhibitor. Data from Hirbe et al. (1), adapted and reprinted with permission from American Association for Cancer Research, Inc.