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Effects of Drug Treatment for Malignancy on Skeletal Health of Cancer Survivors
 

Clinical Review in Bone and Mineral Metabolism  

June 2004, vol. 2, no. 2,  
pp. 103-114(12)
 
Heras-Herzig A.; Guise T.A.
 
Abstract:
Cancer treatment has advanced and survivorship is increasing. As
such, a new skeletal complication of malignancy, cancer treatment-induced
bone loss, has emerged and is likely to be the most common skeletal complication
of malignancy in years to come. Therapy for the most common cancers, breast
and prostate, often results in sex-steroid deficiency and subsequent bone
loss. A significant portion of breast cancers express estrogen receptors,
and estrogen stimulates tumor growth. Therapy directed against estrogen action
or to reduce estrogen production results in significant survival advantage
in women with estrogen receptor-positive breast cancer. This hormonal therapy
represents the mainstay of breast cancer treatment and is highly effective.
Many breast cancers are also treated with chemotherapy, which often induces
transient or permanent ovarian failure. However, estrogen is a critical factor
for maintaining bone health and normal bone mineral density. As such, all
of these breast cancer therapies may induce bone loss, mainly by reducing
estrogen or its action on bone. Aromatase inhibitors fall into this category;
its efficacy dictates that it will become first-line therapy for most hormone-sensitive
breast cancers. Theoretically, chemotherapy may have direct effects on bone
that are independent of the effects of estrogen deficiency, but evidence
is lacking. Limited clinical experience indicate that bisphosphonates are
effective in preventing bone loss owing to cancer treatment. This article
focuses on therapy for breast cancer and other malignancies and the respective
contributions of such therapy to bone loss.
 
Keywords: Bone; malignancy; antineoplastic
drugs; bone loss; skeletal health; osteoporosis
 
Document Type:
Miscellaneous ISSN: 1534-8644

Publisher:

Humana Press