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The Oncologist, Vol. 13, No. 2, 187-195, February 2008; doi:10.1634/theoncologist.2007-0152
© 2008 AlphaMed Press

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Symptom Management and Supportive Care

Cancer Treatment-Induced Bone Loss: Pathophysiology and Clinical Perspectives

Adam M. Brufsky

University of Pittsburgh School of Medicine, Magee-Women's Hospital, Pittsburgh, Pennsylvania, USA

Key Words. Androgen deprivation therapy • Aromatase inhibitor • Bisphosphonate • Bone loss • Osteoporosis Zoledronic acid

Correspondence: Adam M. Brufsky, M.D., Ph.D., University of Pittsburgh School of Medicine, Magee-Women's Hospital, Suite 4628, Pittsburgh, Pennsylvania 15213, USA. Telephone: 412-641-6500; Fax: 412-641-2296; e-mail: brufskyam{at}upmc.edu

Disclosure: A.M.B. has participated in the speakers bureau for Novartis Pharmaceuticals. Funding for medical editorial assistance was provided by Novartis Pharmaceuticals Corporation. No other potential conflicts of interest were reported by the author, planners, reviewers, or staff managers of this article.

Hormone-ablative therapies for breast or prostate cancer can cause marked and rapid reductions in circulating estrogen or testosterone levels, resulting in significant effects on bone metabolism and cancer treatment–induced bone loss (CTIBL). Most patients with cancer are over the age of 65 and are already at risk for osteoporosis. Thus, accelerated bone loss from CTIBL is especially concerning in this population. Although there are currently no approved therapies for the treatment or prevention of CTIBL, oral bisphosphonates have been used in settings other than oncology to treat bone loss. New-generation i.v. bisphosphonates have demonstrated promising activity in preventing CTIBL in patients receiving hormonal therapy for breast or prostate cancer. In particular, zoledronic acid not only prevents CTIBL in both breast and prostate cancer patients but also increases bone mineral density above baseline. Such agents have the potential to delay or prevent CTIBL in patients receiving hormonal therapies.




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T. Van den Wyngaert, M. T. Huizing, E. Fossion, and J. B. Vermorken
Bisphosphonates in Oncology: Rising Stars or Fallen Heroes
Oncologist, February 1, 2009; 14(2): 181 - 191.
[Abstract] [Full Text] [PDF]


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