Cancer Treatment-Induced Bone Loss: Pathophysiology and Clinical Perspectives

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Discuss the incidence of CTIBL in patients undergoing therapy for breast cancer and prostate cancer.Describe the pathogenesis of CTIBL in patients undergoing therapy for breast cancer and prostate cancer.Describe the current role of and indications for bisphosphonate therapy in the treatment of CTIBL. CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com 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.