Cancer Treatment and Bone Health

Abstract

Considerable advances in oncology over recent decades have led to improved survival, while raising concerns about long-term consequences of anticancer treatments. In patients with breast or prostate malignancies, bone health is a major issue due to the high risk of bone metastases and the frequent prolonged use of hormone therapies that alter physiological bone turnover, leading to increased fracture risk. Thus, the onset of cancer treatment-induced bone loss (CTIBL) should be considered by clinicians and recent guidelines should be routinely applied to these patients. In particular, baseline and periodic follow-up evaluations of bone health parameters enable the identification of patients at high risk of osteoporosis and fractures, which can be prevented by the use of bone-targeting agents (BTAs), calcium and vitamin D supplementation and modifications of lifestyle. This review will focus upon the pathophysiology of breast and prostate cancer treatment-induced bone loss and the most recent evidence about effective preventive and therapeutic strategies.

Keywords: BMD; Breast cancer; Cancer treatment; Osteoporosis; Prostate cancer.

Fig. 1

Algorithm for the assessment and management of cancer treatment-induced bone loss [70]. a Aromatase inhibitors and ovarian suppression therapy/oophorectomy for BC and androgen deprivation therapy for prostate cancer. b If patients experience an annual decrease in BMD of ≥ 10% (or ≥ 4–5% in patients who were osteopenic at baseline) using the same DXA machine, secondary causes of bone loss such as vitamin D deficiency should be evaluated and antiresorptive therapy initiated. Use lowest t score from spine and hip. c Six monthly intravenous zoledronate, weekly oral alendronate or risedronate or monthly oral ibandronate acceptable. d Denosumab may be a potential treatment option in some patients. e Although osteonecrosis of the jaw is a very rare event with bone protection doses of antiresorptives, regular dental care and attention to oral health are advisable. BMD bone mineral density, BMI body mass index, DXA dual-energy X-ray absorptiometry