Osteoporosis and cancer

Abstract

Cancer is a major risk factor for bone loss and fractures. This is due both to direct effects of cancer cells on the skeleton and to deleterious effects of cancer-specific therapies on bone cells. Marked improvements in survival for many cancers mean that strategies to limit bone loss and reduce fracture risk must be incorporated into the care plans for nearly all patients with cancer. The vast majority of effort thus far has focused on bone loss in patients with breast and prostate cancers, with comparatively few studies in other malignancies. Antiresorptive therapies have proven nearly universally effective for limiting bone loss in cancer patients, although few studies have been powered sufficiently to include fractures as primary endpoints, and patients are frequently neither identified nor treated according to published guidelines. Nonpharmacologic approaches to limit falls, particularly in elderly patients, are also likely important adjunctive measures for most cancer patients.

Figure 1

Comparison of annualized lumbar spine bone mineral density (BMD) losses associated with normal aging (top; solid bars) to BMD losses associated with different cancer therapies (bottom; hatched bars). AI indicates aromatase inhibitor; GnRH, gonadotropin-releasing hormone. Adapted from Postgraduate Institute for Medicine and Interlink Healthcare Communications, joint sponsors of the CME Lecture Series entitled Skeletal Complications Across the Cancer Continuum Slide/Lecture Kit. Released June 2005. Used with permission from Postgraduate Institute for Medicine.