Effect of Chemotherapy on Skeletal Health in Male Survivors from Testicular Cancer and Lymphoma

Abstract

Purpose: There are concerns over the late effects of cancer therapy, including accelerated bone loss leading to increased risk of osteoporosis. Treatment-related bone loss is well recognized in breast and prostate cancer, due to overt hypogonadism, but there has been little evaluation of the skeletal effects of chemotherapy alone in adults. This study assesses the extent of bone loss due to previous chemotherapy in men. Experimental Design: The bone mineral density (BMD) of men who had received previously chemotherapy with curative intent for lymphoma or testicular cancers was compared with that of an age-matched population of men from a cancer control population that had not received chemotherapy. BMD was measured by dual-energy X-ray scanning. Additionally, measurement of sex hormones and the bone turnover markers N-telopeptide fragment of type I collagen and bone-specific alkaline phosphatase were done. All statistical tests were two sided. Results: One hundred fifteen chemotherapy-treated patients and 102 cancer controls were recruited. There was no statistical difference in BMD between the chemotherapy and control groups at either spine or hip and the mean BMD values in both groups were no lower than that of a reference population. There were no significant differences in estradiol, luteinizing hormone, and testosterone, but follicle-stimulating hormone values were significantly higher in the chemotherapy group (P = 0.011). The mean values of NH 2 -terminal telopeptide fragment of type I collagen and bone-specific alkaline phosphatase were within the reference ranges. Conclusions: The absence of accelerated bone loss following chemotherapy is reassuring and suggests that standard dose cytotoxic chemotherapy has no lasting clinically important direct effects on bone metabolism.

Long-term follow-up of testicular cancer patients shows no predisposition to osteoporosis

“…This study used a similar methodology to our work. These papers compliment one another in that the work by Brown et al [8] is relatively large, but the follow-up is comparatively short (4 years), while the work presented here has smaller numbers but longer follow-up. Moreover, the work presented here investigates other factors which could potentially predispose to bone loss such as vitamin D levels.…”

Adverse skeletal effects of drugs – beyond Glucocorticoids

“…Men treated with combination chemotherapy for Hodgkin's lymphoma and haematologic malignancy had reduced BMD; however, some had evidence of mild hypogonadism. In another study, men who had previously received chemotherapy for lymphoma or testicular cancers did not have reduced BMD . There are no fracture data for any of these populations.…”

“…In another study, men who had previously received chemotherapy for lymphoma or testicular cancers did not have reduced BMD. 59 There are no fracture data for any of these populations. Currently, there are no evidence-based protocols for managing bone health in patients undergoing chemotherapy.…”

Cancer Therapies and Bone Health

“…Ifosfamide, widely used in the treatment of solid tumors such as pediatric osteosarcoma, causes more sex hormoneindependent negative effects on bone than any alkylating agent [32]. At higher doses, alone or in combination with cisplatin, it causes injury to the proximal renal tubule and reduces the threshold for phosphate reabsorption.…”