Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
This narrative review outlines how common anticancer treatments adversely affect bone health and provides practical guidance for evaluation and management of therapy‑related bone loss in adult cancer patients.
Key points:
- Therapies driving bone loss: Major contributors include aromatase inhibitors, androgen deprivation therapy, systemic glucocorticoids, conventional chemotherapy, and several targeted or immune therapies.
- Recommended assessment strategy:
- Clinical evaluation for fracture risk and symptoms.
- Basic labs: serum calcium, vitamin D, and renal function.
- Bone mineral density measurement with DXA, incorporating vertebral fracture assessment.
- MRI when an acute vertebral fracture is suspected.
- Prevention measures:
- Regular weight‑bearing and resistance exercise as tolerated.
- Adequate calcium and vitamin D intake.
- Fall-prevention strategies (home safety, vision, medications, balance training).
- Pharmacologic management:
- Bisphosphonates and denosumab are the primary options.
- Choice of agent should consider both skeletal protection and any potential oncologic benefit of the drug.
- Ongoing monitoring and safety:
- Repeat DXA every 12–24 months to track bone density.
- Ongoing surveillance for osteonecrosis of the jaw and atypical femoral fractures in patients receiving antiresorptive therapy.
Overall, the article emphasizes proactive identification and management of cancer therapy–induced bone loss as an integral component of comprehensive oncologic care.