Cancer Treatment Related Bone Loss

Abstract

Cancer therapy can result in significant bone loss and increased risk of fragility fracture. Chemotherapy, aromatase inhibitors and GnRH analogues contribute to increases in the rate of bone remodeling and decrease bone mineral density. Patients with prostate cancer on androgen deprivation therapy experience increases in the risk of fracture. New research has demonstrated the key role played by bisphosphonates in preventing reductions in bone density and increases in bone remodeling. Novel antiresorptive agents targeting receptor activator of nuclear factor-kappa B ligand (RANKL) inhibition have great potential in skeletal protection and prevention of cancer therapy-related bone loss. Early assessment of skeletal health followed by initiation of calcium, vitamin D and an exercise program are valuable in the prevention and treatment of osteoporosis. In addition, those at an increased risk for fracture should be offered antiresorptive therapy. Early data has demonstrated that bisphosphonates are able to prevent the bone loss and increased bone remodeling associated with cancer therapy including aromatase inhibition and androgen deprivation therapy. This paper reviews the new research and advances in the management of bone loss associated with cancer therapy as well as estrogen deficiency in the postmenopausal female.