Recent Advances in Management of Cancer Treatment-induced Bone Loss (CTIBL) in Patients with Breast or Prostate Cancer

Soo Hyun Kim; Seongbin Hong; Youngkyu Song; Hosook Song

doi:10.5388/aon.2013.13.3.103

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Kim, Hong, Song, and Song: Recent Advances in Management of Cancer Treatment-induced Bone Loss (CTIBL) in Patients with Breast or Prostate Cancer

Review Article

Asian Oncology Nursing 2013; 13(3): 103-112.

Published online: 30 September 2013

DOI: https://doi.org/10.5388/aon.2013.13.3.103

Recent Advances in Management of Cancer Treatment-induced Bone Loss (CTIBL) in Patients with Breast or Prostate Cancer

Soo Hyun Kim¹, Seongbin Hong², Youngkyu Song³, Hosook Song⁴

¹Department of Nursing, Inha University, Incheon, Korea.

²Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

³Graduate School, Catholic University, Seoul, Korea.

⁴Department of Urology, Inha University Hospital, Incheon · Graduate School, College of Nursing, Ajou University, Suwon, Korea.

Address reprint requests to: Kim, Soo Hyun. Department of Nursing, Inha University, 253 Yonghyun-dong, Nam-gu, Incheon 402-751, Korea. Tel: +82-32-860-8213, Fax: +82-32-874-5880, soohyun@inha.ac.kr

Received 31 July 2013 Accepted 7 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Bone loss resulting from cancer treatment is an emerging problem among cancer survivors. However, the mechanism and treatment of cancer treatment-induced bone loss (CTIBL) is not fully understood. The purpose of this article was to review the recent advances in CTIBL.

Methods

A comprehensive review of the literature was conducted.

Results

Risk factors for CTIBL that are unique to or commonly found in cancer survivors include chemotherapy-induced menopause, anti-estrogen and anti-androgen therapies, gonadotropin-releasing hormone suppression of gonadal function, and use of glucocorticoids. Assessment of CTIBL is performed using dual X-ray absorptiometry testing for measurement of BMD levels, Fracture Risk Assessment Tool, and bone turnover markers. Initial strategies for prevention of CTIBL include lifestyle modifications such as exercise, an adequate intake of calcium and vitamin D, avoiding tobacco use, and limiting alcohol intake. Pharmacologic therapy should be considered for patients at high risk for bone loss or fracture.

Conclusions

Prevention of CTIBL may be the best way to decrease morbidity and financial costs associated with osteoporosis and/or fractures. Oncology nurses should be well prepared to identify cancer survivors at risk of CTIBL, and to provide them with education regarding prevention and treatment of CTIBL.

Keywords: Osteoporosis, Bone Fractures, Breast Neoplasms, Prostatic Neoplasms, Health Promotion

Figures and Tables

Fig. 1

Algorithm for management of bone health of cancer patients in the United States

Reprinted with premission: Gralow JR, Biermann JS, Farooki A, Fornier MN, Gagel RF, Kumar RN, et al. NCCN task force report: Bone health in cancer care. J Natl Compr Canc Netw. 2009;3:S1-32.

Table 1

Risk Factors of CTIBL

ASCO=American Society of Clinical Oncology; ESMO=European Society of Medical Oncology; NCCN=National Comprehensive Cancer Network; NOF=National Osteoporosis Foundation.

Table 2

Diagnostic Criteria for Osteoporosis based on Dual X-ray Absorptiometry Testing

Table 3

Medications for Osteoporosis Prevention and Treatment

Notes

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (Grant No, 1220160)

References

1. Gralow JR, Biermann JS, Farooki A, Fornier MN, Gagel RF, Kumar RN, et al. NCCN task force report: bone health in cancer care. J Natl Compr Canc Netw. 2009; 7:S1–S32.

2. National Cancer Information Center. Cancer Facts and Figures 2010. Accessed July 25, 2013. http://www.cancer.go.kr.

3. Michaud LB, Goodin S. Cancer-treatment-induced bone loss, part 1. Am J Health Syst Pharm. 2006; 63:419–430.

4. Kanis JA, McCloskey EV, Powles T, Paterson AH, Ashley S, Spector T. A high incidence of vertebral fracture in women with breast cancer. Br J Cancer. 1999; 79:1179–1181.

5. Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, et al. Fracture risk among breast cancer survivors: results from the women's health initiative observational study. Arch Intern Med. 2005; 165:552–558.

6. Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM. Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab. 2005; 90:6410–6417.

7. Higano CS. Androgen-deprivation-therapy-induced fractures in men with nonmetastatic prostate cancer: what do we really know? Nat Clin Pract Urol. 2008; 5:24–34.

8. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med. 2005; 352:154–164.

9. Hillner BE, Ingle JN, Chlebowski RT, Gralow J, Yee GC, Janjan NA, et al. American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol. 2003; 21:4042–4057.

10. Hadji P, Body JJ, Aapro MS, Brufsky A, Coleman RE, Guise T, et al. Practical guidance for the management of aromatase inhibitor-associated bone loss. Ann Oncol. 2008; 19:1407–1416.

11. Korean Society of Bone Metabolism. Physician's guide for diagnosis and treatment of osteoporosis. Seoul: Minkum;2011.

12. Pfeilschifter J, Diel I. Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol. 2000; 18:1570–1593.

13. Lønning PE, Geisler J, Krag LE, Erikstein B, Bremnes Y, Hagen AI, et al. Effects of exemestane administered for 2 years versus placebo on bone mineral density, bone biomarkers, and plasma lipids in patients with surgically resected early breast cancer. J Clin Oncol. 2005; 23:5126–5137.

14. Yamamoto DS, Viale PH. Update on identifying and managing osteoporosis in women with breast cancer. Clin J Oncol Nurs. 2009; 13:E18–E29.

15. Pandya N, Morris GJ. Toxicity of aromatase inhibitors. Semin Oncol. 2006; 33:688–695.

16. Chien AJ, Goss PE. Aromatase inhibitors and bone health in women with breast cancer. J Clin Oncol. 2006; 24:5305–5312.

17. Hawkins B, Campos M, Fessels K. Got bones? It takes more than milk to preserve skeletal health in oncology patients. Pittsburgh, PA: Oncology Nursing Society;2005.

18. Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol. 2001; 19:3306–3311.

19. Kim SH, Cho YU, Kim SJ, Lee JE, Kim JH. Low bone density in breast cancer survivors in Korea: prevalence, risk factors and associations with health-related quality of life. Eur J Oncol Nurs. 2013; 17:196–203.

20. National Cancer Information Center. Treatment of prostate cancer. Accessed May 2, 2013. http://www.cancer.go.kr.

21. Finkelstein JS. Osteoporosis. In : Goldman L, Bennett JC, editors. Cecil textbook of medicine. 21st ed. Philadelphia: W.B. Saunders;2000. p. 1366–1373.

22. Oefelein MG, Ricchuiti V, Conrad W, Seftel A, Bodner D, Goldman H, et al. Skeletal fracture associated with and drogen suppression induced osteoporosis: the clinical incidence and risk factors for patients with prostate cancer. J Urol. 2001; 166:1724–1728.

23. Hatano T, Oishi Y, Furuta A, Iwamuro S, Tashiro K. Incidence of bone fracture in patients receiving luteinizing hormone-releasing agonists for prostate cancer. BJU Int. 2000; 86:449–452.

24. Lee SJ, Lee DG, Park JH, Kim JH, Song KH, Park JW, et al. Bone mineral density changes during androgen deprivation therapy for patients with prostate cancer. Korean J Bone Metab. 2009; 16:79–85.

25. Gass M, Dawson-Hughes B. Preventing osteoporosis-related fractures: An overview. Am J Med. 2006; 119:S3–S11.

26. Hadji P, Aapro MS, Body JJ, Bundred NJ, Brufsky A, Coleman RE, et al. Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol. 2011; 22:2546–2555.

27. Diamond TH, Higano CS, Smith MR, Guise TA, Singer FR. Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies. Cancer. 2004; 100:892–899.

28. Winters-Stone KM, Schwartz A, Nail LM. A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Surviv. 2010; 4:187–201.

29. Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JM, Abbott TA, et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc. 2006; 81:1013–1022.

30. Gómez Font R, Garcia MLM, Martinez JMO. Osteochemonecrosis of the jaws due to bisphosphonate treatment. Med Oral Patol Oral Cir Bucal. 2008; 13:E318–E324.

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