Skeletal sequelae of cancer and cancer treatment

J Cancer Surviv. 2009 Jun;3(2):75-88. doi: 10.1007/s11764-009-0083-4. Epub 2009 May 2.


Introduction: Survivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of skeletal disorders.

Methods: We performed a comprehensive search, using various Internet-based medical search engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of cancer and cancer therapies.

Results: One-hundred-forty-two publications, including journal articles, books, and book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate, platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A, NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and described. Skeletal effects of hyperparathyroidism, vitamin D deficiency, gastrectomy, hypophosphatemia, and hyperprolactinemia resulting from cancer therapies were also described.

Discussion/conclusions: The publications researched during this review both highlight and emphasize the association between cancer therapies, including chemotherapy and radiotherapy, and skeletal dysfunction.

Implications for cancer survivors: These studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer. Further studies are needed to better address the skeletal needs of cancer survivors.

Publication types

  • Review

MeSH terms

  • Androgen Antagonists / adverse effects
  • Androgen Antagonists / therapeutic use
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Protocols*
  • Bone Diseases / etiology*
  • Gastrectomy / adverse effects
  • Gastrectomy / rehabilitation
  • Humans
  • Hyperparathyroidism, Secondary / etiology
  • Hypophosphatemia / etiology
  • Neoplasms / complications*
  • Neoplasms / therapy*
  • Vitamin D Deficiency / etiology


  • Androgen Antagonists
  • Antineoplastic Agents