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Review
. 2023 Oct;25(10):1141-1152.
doi: 10.1007/s11912-023-01447-9. Epub 2023 Aug 25.

Role of Body Composition in the Prediction of Skeletal Fragility Induced by Hormone Deprivation Therapies in Cancer Patients

Alberto Dalla Volta  1 , Irene Caramella  2 , Pierluigi Di Mauro  1 , Marco Bergamini  1 , Deborah Cosentini  1 , Francesca Valcamonico  1 , Carlo Cappelli  3 , Marta Laganà  1 , Nunzia Di Meo  4 , Davide Farina  4 , Rebecca Pedersini  1   5 , Gherardo Mazziotti  6   7 , Alfredo Berruti  1
Affiliations
Review

Role of Body Composition in the Prediction of Skeletal Fragility Induced by Hormone Deprivation Therapies in Cancer Patients

Alberto Dalla Volta et al. Curr Oncol Rep. 2023 Oct.

Abstract

Purpose of review: This review paper is intended to show that changes in body composition are key in the pathogenesis of bone fragility amongst patients with breast and prostate cancer receiving hormone deprivation therapies (HDTs) and that the mechanism is based on the development of alterations in bone quality rather than in bone quantity.

Recent findings: Preclinical and clinical data suggest a tight connection amongst bone, adipose and muscular tissues by means of several soluble mediators, potentially leading to (1) bone resorption and bone quality deterioration in sarcopenic obese subjects, (2) bone mineral deposition in healthy trained subjects. Cancer patients treated with HDTs frequently fall into the first condition, named osteosarcopenic obesity. Current clinical guidelines for the prevention of treatment-induced osteoporosis focus on bone mineral density (BMD) as a main predictive factor for fracture risk; however, the pathophysiology underlying HDT-induced bone fragility differs from that of primary and postmenopausal osteoporosis, suggesting a prevalent role for bone quality alterations. Focusing on available data from clinical trials, in our review we suggest osteosarcopenic obesity as a common target for the prevention and treatment of HDTs-related metabolic and skeletal complications, beyond a BMD-centred approach.

Keywords: Body composition; Bone health; Breast cancer; Hormonal deprivation; Prostate cancer; Sarcopenic obesity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The complex interplay between muscle, fat and bone. BMAT bone marrow adipose tissue
Fig. 2
Fig. 2
A In hormone deprivation therapies-naive subjects, fat mass counterbalances and usually overcomes the deleterious effect of adiposity on bone quality by means of preserved/increased bone mineral density through the increase in circulating levels of oestrogens. B As a result of hormonal deprivation therapies administration to obese patients, bone mineral density reduction adds to bone quality impairment causing a substantial increase in bone fragility. HDTs hormonal deprivation therapies, TNF-α tumour necrosis factor alpha, PPAR-γ peroxisome proliferator-activated receptor gamma, BMAT bone marrow adipose tissue
Fig. 3
Fig. 3
The vicious circle between muscle and fat, enhanced by hormonal deprivation therapies, results in bone quality and bone mineral density alterations, leading to the so-called osteosarcopenic obesity. HDTs hormonal deprivation therapies
See this image and copyright information in PMC

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