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Symptom Management and Supportive Care

Bone Loss and Fracture Risk Associated with Cancer Therapy

Department of Medicine, University of Virginia, Charlottesville, Virginia, USA

Key Words. Bisphosphonates • Osteoporosis • Fracture • Cancer • Chemotherapy • Hormonal antineoplastic agents

Correspondence: Theresa A. Guise, M.D., Division of Endocrinology and Metabolism, Department of Medicine, P.O. Box 801419, University of Virginia, Charlottesville, Virginia 22908, USA. Telephone: 434-243-0305; Fax: 434-982-3314; e-mail: tag4n{at}Virginia.edu

Background. Cancer patients experience osteoporosis resulting from accelerated loss of bone mineral density (BMD) caused by their treatment. Such bone loss greatly increases the risk for fracture and can have other serious effects on quality of life.

Methods. In the current report, the author focuses on studies of cancer therapy-associated bone loss, its prevalence and pathogenesis, and resulting clinical impact. Options for management and prevention are also reviewed, including treatment guidelines where available.

Results. A variety of cancer therapies, including hormonal therapy, chemotherapy, and glucocorticoids, affect gonadal hormone production, which increases bone resorption and decreases BMD. Such bone loss occurs more rapidly and to a greater degree than normal age-related osteoporosis, increases the risk for fracture and other morbidities, and decreases survival. Regular BMD screening and early intervention can prevent further decline in bone density and bone quality. Pharmacologic therapy with oral and i.v. bisphosphonates has been shown to slow bone loss in patients receiving cancer therapy, and the i.v. bisphosphonate zoledronic acid can increase BMD in patients with cancer treatment-related bone loss. Lifestyle changes, including supplementation with calcium and vitamin D, diet, and proper exercise, can also slow the rate of bone loss.

Conclusions. Bone loss associated with various cancer therapies significantly affects bone health. Early initiation of bisphosphonates, when indicated, and lifestyle modification can improve patient outcomes. Education of patients and health care professionals regarding the importance of this complication and effective treatment options is essential.

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