The survival prospects for many patients with
cancer are steadily improving. As a result, survivorship issues are of increasing importance as attempts are made to minimize the
long-term adverse effects of
cancer treatments.
Cancer therapies can adversely affect bone health, particularly in women with
breast cancer and men with
prostate cancer. Strategies for screening patients at increased risk for fragility fracture, and treatment algorithms using both bone-targeted treatments and other therapeutic interventions, are being developed. Both
bisphosphonates and
denosumab have been evaluated as treatments to prevent or reverse the bone loss associated with
cancer treatments.
Zoledronic acid is the most extensively assessed agent and has been shown to prevent bone loss in patients with
breast cancer experiencing a
premature menopause, in postmenopausal women receiving an
aromatase inhibitor and in patients with
prostate cancer undergoing
androgen deprivation
therapy (ADT). To date, the improvements in bone mineral density have not translated into a reduced fracture rate. However, in a large phase III trial,
denosumab has been shown to reduce vertebral fractures in men receiving ADT for
prostate cancer. These bone-targeted treatments have also been shown to modify the course of the underlying
cancer and prevent
metastasis, although the beneficial effects are confined to patients with low levels of circulating reproductive
hormones.