Cancer treatment-induced bone loss

Korean J Intern Med. 2024 Sep;39(5):731-745. doi: 10.3904/kjim.2023.386. Epub 2024 Mar 5.

Abstract

Cancer treatment-induced bone loss (CTBL) is associated with anti-tumor treatments, including endocrine therapies, chemotherapeutic treatments, radiotherapy, glucocorticoids, and tyrosine kinase inhibitors. Osteoporosis, characterized by the loss of bone mass, can increase the risk of fractures, leading to mortality and long-term disability, even after cancer remission. Cancer and osteoporosis have marked clinical and pathogenetic similarities. Both have a multifactorial etiology, affect the geriatric population, and markedly influence quality of life. Lifestyle management, including calcium and vitamin D supplementation, is recommended but the supporting evidence is limited. Oral and injectable bisphosphonates are effective for osteoporosis and malignant bone disease. Bisphosphonates increase bone mineral density (BMD) in patients with CTBL. Denosumab is also used in the management of CTBL; in clinical trials, it improved BMD and reduced the risk of fracture. Currently, there are no bone anabolic therapies for patients with cancer. Appropriate therapies are necessary to maintain optimal bone health, particularly in patients at heightened risk.

Keywords: Bisphosphonate; Bone; Cancer; Denosumab; Osteoporosis.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents* / adverse effects
  • Bone Density Conservation Agents* / therapeutic use
  • Bone Density* / drug effects
  • Denosumab / adverse effects
  • Denosumab / therapeutic use
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use
  • Humans
  • Neoplasms* / drug therapy
  • Osteoporosis* / chemically induced
  • Osteoporosis* / therapy
  • Risk Factors

Substances

  • Bone Density Conservation Agents
  • Antineoplastic Agents
  • Diphosphonates
  • Denosumab