Originally published as JCO Early Release 10.1200/JCO.2008.18.4184 on October 27 2008

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Cancer Treatment–Induced Bone Loss in Breast and Prostate Cancer

Fred Saad, Jonathan D. Adachi, Jacques P. Brown, Leah A. Canning, Karen A. Gelmon, Robert G. Josse, Kathleen I. Pritchard

From the Department of Surgery/Urology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal; Department of Rheumatology, University of Laval, Sainte-Foy, Quebec; Department of Medicine, St. Joseph's Healthcare, McMaster University, Hamilton; Kaleidoscope Strategic Inc; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital; Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario; British Columbia Cancer Agency; Vancouver Cancer Centre; and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Corresponding author: Kathleen I. Pritchard, MD, Sunnybrook Odette Cancer Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; e-mail: kathy.pritchard{at}sunnybrook.ca

Purpose Bone loss resulting from the treatment of breast and prostate cancer is an emerging problem. Bisphosphonates have a potential role in the prevention of this cancer treatment–induced bone loss (CTIBL).

Methods Studies evaluating the incidence and prevalence of CTIBL in early breast and prostate cancer patients and trials evaluating the preventative role of bisphosphonates were identified by a search of the PubMed and Cochrane Library databases through the end of March 2008. Reference lists from retrieved articles were cross referenced, and further information was obtained from relevant scientific meetings.

Results Several therapies commonly used in the treatment of women and men with breast and prostate cancers, in particular the aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, are associated with significant bone loss and with an increase in fracture risk. The use of bisphosphonates seems to attenuate the bone loss, although the long-term impact remains unclear because of insufficient follow-up.

Conclusion Adjuvant endocrine therapy with an AI or androgen deprivation can be considered a risk factor for the development of osteopenia, osteoporosis, and bone fracture, which can be mitigated by appropriate bisphosphonate therapy. Clear identification of risk factors for osteoporosis in individual patients should aid treatment decisions about whether to use bisphosphonates when starting or switching to an AI or ADT. Patients need to be educated about this risk and other measures to avoid this complication, including lifestyle modifications that may benefit their general and bone health.

published online ahead of print at www.jco.org on October 27, 2008

Supported in part by Sanofi-aventis.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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