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Practice Guideline
. 2009 Jun;7 Suppl 3(Suppl 3):S1-32; quiz S33-5.
doi: 10.6004/jnccn.2009.0076.

NCCN Task Force Report: Bone Health in Cancer Care

Julie R Gralow  1 , J Sybil Biermann, Azeez Farooki, Monica N Fornier, Robert F Gagel, Rashmi N Kumar, Charles L Shapiro, Andrew Shields, Matthew R Smith, Sandy Srinivas, Catherine H Van Poznak
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Practice Guideline

NCCN Task Force Report: Bone Health in Cancer Care

Julie R Gralow et al. J Natl Compr Canc Netw. 2009 Jun.

Abstract

Bone health and maintenance of bone integrity are important components of comprehensive cancer care in both early and late stages of disease. Risk factors for osteoporosis are increased in patients with cancer, including women with chemotherapy-induced ovarian failure, those treated with aromatase inhibitors for breast cancer, men receiving androgen-deprivation therapy for prostate cancer, and patients undergoing glucocorticoid therapy. The skeleton is a common site of metastatic cancer recurrence, and skeletal-related events are the cause of significant morbidity. The National Comprehensive Cancer Network (NCCN) convened a multidisciplinary task force on Bone Health in Cancer Care to discuss the progress made in identifying effective screening and therapeutic options for management of treatment-related bone loss; understanding the factors that result in bone metastases; managing skeletal metastases; and evolving strategies to reduce bone recurrences. This report summarizes presentations made at the meeting.

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Figures

Figure 1
Figure 1
Example (reproduction) fracture risk analysis results for a white woman in the United States using the FRAX™ online tool. This algorithm incorporates bone density and other risk factors into a comprehensive estimate of fracture risk. The tool is available at www.shef.ac.uk/FRAX/. Abbreviations: BMD, bone mineral density; FRAX™, Fracture Risk Assessment Algorithm.
Figure 2
Figure 2
Algorithm for management of bone health of cancer patients in the United States. Abbreviations: 25(OH), serum hydroxy; BMD, bone mineral density; DEXA, dual-energy x-ray absorptiometry; FRAX™, Fracture Risk Assessment Algorithm. *See section on “Screening and Detection of Osteoporosis” for FRAX™ algorithm. †See section on “Update on Treatment Options for Osteoporosis” for lifestyle modifications and calcium and vitamin D repletion. ‡See section on “Update on Treatment Options for Osteoporosis” to correct vitamin D deficiency. §In selected cases, longer or shorter intervals may be considered. If a major change in patient risk factors or a major intervention occurs, repeating DEXA scan at one year is reasonable. Note: In addition to monitoring changes in BMD, the oncologist should obtain a lateral thoracic and lumbar x-ray of the spine to determine if vertebral compression deformities are present if there is: 1) a historical height loss > 4 cm (1.6 in) or a prospective height loss > 2 cm (0.8 in), or 2) complaint of acute back pain. Consider referral to a bone health specialist if loss of vertebral height > 20% is present.
Figure 3
Figure 3
Prevalence of skeletal-related events in patients with metastatic bone disease not treated with a bisphosphonate. The data are obtained from 4 major trials of placebo versus an intravenous bisphosphonate in different tumor types.,,, Abbreviation: NSCLC, non–small cell lung cancer.
Figure 4
Figure 4
Algorithm for imaging for cancer patients in the United States. Modified from Hamaoka T, Madewell JE, Podoloff DA, et al. Bone imaging in metastatic breast cancer. J Clin Oncol 2004;22:2942–2953
See this image and copyright information in PMC

References

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