Cancer therapy-induced bone loss (CTIBL) is a form of secondary
osteoporosis associated with systemic
chemotherapy and hormonal ablation
therapy. The monitoring and treatment of CTIBL is an important component of comprehensive
cancer care, especially for patients with curable disease and long life expectancies. Whereas oral
bisphosphonates remain the most commonly used therapeutic option for CTIBL, additional treatment options may be required for patients who do not respond adequately or are intolerant to
bisphosphonates, have
renal insufficiency, or are receiving treatment with nephrotoxic medications. For these patients,
denosumab, a
monoclonal antibody targeting the receptor activator of nuclear factor-κB
ligand (RANKL), offers an effective and well-tolerated alternative. Several recent randomized trials have examined the use of
denosumab as treatment for CTIBL associated with
hormone ablation
therapy for breast and
prostate cancer. Recent data suggest a possible role for RANKL inhibitors in both
chemoprevention and the prevention of
cancer recurrence through direct effects on breast tissue and
breast cancer stem cells. The outcomes of several international Phase III clinical trials currently underway will help clarify the role of
denosumab in patients undergoing
cancer therapy.