Cancer-associated bone disease

Abstract

Bone is commonly affected in cancer. Cancer-induced bone disease results from the primary disease, or from therapies against the primary condition, causing bone fragility. Bone-modifying agents, such as bisphosphonates and denosumab, are efficacious in preventing and delaying cancer-related bone disease. With evidence-based care pathways, guidelines assist physicians in clinical decision-making. Of the 57 million deaths in 2008 worldwide, almost two thirds were due to non-communicable diseases, led by cardiovascular diseases and cancers. Bone is a commonly affected organ in cancer, and although the incidence of metastatic bone disease is not well defined, it is estimated that around half of patients who die from cancer in the USA each year have bone involvement. Furthermore, cancer-induced bone disease can result from the primary disease itself, either due to circulating bone resorbing substances or metastatic bone disease, such as commonly occurs with breast, lung and prostate cancer, or from therapies administered to treat the primary condition thus causing bone loss and fractures. Treatment-induced osteoporosis may occur in the setting of glucocorticoid therapy or oestrogen deprivation therapy, chemotherapy-induced ovarian failure and androgen deprivation therapy. Tumour skeletal-related events include pathologic fractures, spinal cord compression, surgery and radiotherapy to bone and may or may not include hypercalcaemia of malignancy while skeletal complication refers to pain and other symptoms. Some evidence demonstrates the efficacy of various interventions including bone-modifying agents, such as bisphosphonates and denosumab, in preventing or delaying cancer-related bone disease. The latter includes treatment of patients with metastatic skeletal lesions in general, adjuvant treatment of breast and prostate cancer in particular, and the prevention of cancerassociated bone disease. This has led to the development of guidelines by several societies and working groups to assist physicians in clinical decision making, providing them with evidencebased care pathways to prevent skeletal-related events and bone loss. The goal of this paper is to put forth an IOF position paper addressing bone diseases and cancer and summarizing the position papers of other organizations. Epidemiology of cancer-associated bone disease Bone metastasisCancer affects nearly 12.7 million people and is associated with over 7 million deaths in 2008 [1]. Cancer is a rising global health burden and it is estimated that in 2030, cancer deaths will be tallied at over 13 million (World Health Organization (WHO) 2010 Global Status Report [2]). Addressing the morbidity and mortality of cancer is an important public health concern. On purpose, we are limiting our analysis to cancer bone involvement in adults and do not discuss cancer in children.Metastases from cancer are associated with 90 % of cancer deaths [3]. It was estimated that one half of people who die from cancer in the USA have bone involvement [4][5][6]. Different tumou...

Guidelines for the diagnosis, prevention and management of osteoporosis

“…Aminobisphosphonates and denosumab are the first line drugs for the management of bone health in breast and prostate cancer, being able to prevent BMD loss during adjuvant hormonal therapy. The bisphosphonates alendronate, risedronate and ibandronate have been used in both men and women, at the same doses used for fracture risk reduction in postmenopausal osteoporosis (58,59). Zoledronic acid has been used at doses double those used in postmenopausal osteoporosis (4 mg every 6 months) on average, with effects similar to those achieved in postmenopausal os- only the treatment effect on BMD has been evaluated.…”

“…There is no international consensus on the intervention threshold for the prevention of CTIBL and CTIBL-related fractures. Over time, an increasingly conservative threshold has been considered, up to nearnormal, especially in the presence of other independent risk factors (58,59). However, based on the following factors: i) the lack of evidence for a validated Tscore threshold (only based on expert opinion) and the uncertainty on the predictive value of BMD for fracture risk in this patient population; ii) a particularly fast rate of bone loss in all forms of osteoporosis induced by adjuvant hormonal therapy, as an independent risk factor; iii) a very high prevalence of osteoporosis/fractures and/or other risk factors for fracture in patients with breast or prostate cancer; iv) the strong evidence that treatment with antiresorptives is more effective when used before than after a fracture or BMD loss has occurred, in both men and women (either pre-or post-menopausal) (60,63); v) the evidence that fracture risk reduction (with denosumab) is independent of BMD values at initiation of antiresorptive therapy (61).…”

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

“…In 2013, the IOF Committee of Scientific Advisors (CSA) Working Group on Cancer-induced Bone Disease published a position paper on cancerassociated bone disease [98]. In relation to prostate cancer, the pathophysiology and epidemiology of ADT-induced osteoporosis was reviewed.…”

Остеопонтин Та Остеокальцин При Раку Легенів

“…Необходимо отметить, что поражение костной тка-ни в виде вторичного остеопороза и метастазов встре-чается у каждого второго больного РЛ [14]. В этих про-цессах C. Ostheimer et al [12] придают особое значение остеопонтину (ОР) -провоспалительному цитокину (богатому аспарагиновой и глутаминовой кислотами гликопротеину), относящемуся к классу матриксно-клеточных белков, который участвует в процессах реконструкции костной ткани [8,20].…”