Effects of Radiation on Bone
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Ionizing radiation produces its deleterious biologic effects by both direct (DNA strand breaks) and indirect processes (formation of free oxygen radicals). Mitotically active cells are more susceptible to the detrimental effects of ionizing radiation. These effects are most severe locally within the treatment field but can also occur systemically, possibly reflecting hormonal influences and inflammatory cytokine mediators. Specific bone complications of radiation include osteopenia, growth arrest, fracture and malignancy. Some of these complications, such as osteopenia, are reversible and severity is dose dependent. Insufficiency fractures are a common complication after radiation therapy and generally affect those bones under most physiologic stress and with the highest ratio of trabecular to cortical bone. Familiarity with the radiographic appearance of irradiated bone, including computed tomography (CT) and magnetic resonance imaging (MRI), will improve image interpretation and facilitate accurate diagnosis.
- Bushberg JT, Siebert JA, Leidholdt EM, et al. The essential physics of medical imaging. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002.
- •• Huda W. Review of radiologic physics. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2010. This is an excellent reference addressing all aspects of radiation physics spanning the creation of x-rays to radiation biology.
- Robbins ME, Zhao W. Chronic oxidative stress and radiation-induced late normal tissue injury: a review. Int J Radiat Biol. 2004;80(4):251–9. CrossRef
- Knopse WH, Blom J, Crosby WH. Regeneration of locally irradiated bone marrow. I. Dose dependent, long-term changes in the rat, with particular emphasis upon vascular and stromal reaction. Blood. 1966;28(3):398–415.
- Fajardo LF, Berthrong M, Anderson RE. Radiation pathology. NYC, NY: Oxford Press Inc.; 2001.
- Pitkanen MA, Hopewell JW. Functional changes in the vascularity of the irradiated rat femur. Implications for late effects. Acta Radiol Oncol. 1983;22(3):253–6. CrossRef
- Lam J, Takeshita S, Barker JE, et al. TNF-α induces osteoclastogenesis by direct stimulation of macrophages exposed to permissive levels of RANK ligand. J Clin Invest. 2000;106(12):1481–8. CrossRef
- Zaidi M, Blair HC, Moonga BS, et al. Osteoclastogenesis, bone resorption, and osteoclast-based therapeutics. J Bone Min Res. 2003;18(4):599–609. CrossRef
- • Hui SK, Sharkey L, Kidder LS, et al. The influence of therapeutic radiation on the patterns of bone marrow in ovary-intact and ovariectomized mice. PLoS One. 2012;7(8):e42668. doi:10.1371/journal.pone.0042668. This article describes current research regarding the pathophysiology of bone marrow suppression post radiation therapy and further investigates the role of cytokines affecting osteoclast and osteoblast function. CrossRef
- Helms CA, Major NM, Anderson MW, et al. Musculoskeletal MRI. 2nd ed. Philadelphia: Saunders; 2009.
- King MA, Casarett GW, Weber DA. A study of irradiated bone: I. Histologic and physiologic changes. J Nucl Med. 1979;20(11):1142–9.
- Bell EG, McAffee JG, Constable WC. Local radiation damage to bone and marrow demonstrated by radioisotopic imaging. Radiology. 1969;92(5):1083–8.
- Fliedner TM, Nothdurft W, Calvo W. The development of radiation late effects to the bone marrow after single and chronic exposure. Int J Radiat Biol Relat Stud Phys Chem Med. 1986;49(1):35–46. CrossRef
- Eifel PJ, Donaldson SS, Thomas PR. Response of growing bone to irradiation: a proposed late effects scoring system. Int J Radiat Oncol Biol Phys. 1995;31(5):1301–7. CrossRef
- Knopse WH, Rayudu VM, Cardello M, et al. Bone marrow scanning with 52 iron (Fe): regeneration and extension of marrow after ablative doses of radiotherapy. Cancer. 1976;37(3):1432–42. CrossRef
- Horton JA, Margulies BS, Strauss JA, et al. Restoration of growth plate function following radiotherapy is driven by increased proliferative and synthetic activity of expansions of chondrocytic clones. J Orthop Res. 2006;24(10):1945–56. CrossRef
- Damron TA, Mathur S, Horton JA, et al. Temporal changes in PTHrP, Bcl-2, Bax, Caspase, TGF-, and FGF-2 expression following growth plate irradiation with or without radioprotectant. J Histochem Cytochem. 2004;52(2):157–67. CrossRef
- Bluemke DA, Fishman EK, Scott WW. Skeletal complications of radiation therapy. Radiographics. 1994;14(1):111–21. CrossRef
- • Sawhney R, Ducic Y. Management of pathologic fractures of the mandible secondary to osteoradionecrosis. Otolaryngol Head Neck Surg. 2013;148(1):54–8. Current research, which both discusses and investigates factors resulting in pathologic mandibular fracture after radiation therapy including dose and suspected likelihood of occurrence after radiation therapy. CrossRef
- Blomlie V, Rofstad EK, Talle K, et al. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. Am J Roetgenol. 1996;167(5):1205–10. CrossRef
- Kwon JW, Huh SJ, Yoon YC, et al. Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. Am J Roetgenol. 2008;191(4):987–94. CrossRef
- van der Linden JC, Homminga J, Verhaar JA, et al. Mechanical consequences of bone loss in cancellous bone. J Bone Min Res. 2001;16(3):457–65. CrossRef
- Dempster DW. Anatomy and functions of the adult skeleton. In: Favus MJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. 6th ed. Washington, DC: American Society for Bone and Mineral Research; 2006.
- Khuarana JS. Bone pathology. 2nd ed. New York: Human Press; 2009. CrossRef
- • Hui SK, Fairchild GR, Kidder LS, et al. The influence of therapeutic radiation on the patterns of bone remodeling in ovary-intact and ovariectomized mice. Calcif Tissue Int. 2013;92:372–84. As in reference 9, this further investigates the role of hormones and cytokines resulting in increased bone resorption status post radiation therapy. CrossRef
- Imai Y, Youn MY, Kondoh S, et al. Estrogens maintain bone mass by regulating expression of genes controlling function and life span in mature osteoclasts. Ann NY Acad Sci. 2009;1173(s1):E31–9. CrossRef
- Masiukiewicz US, Mitnick M, Grey AB, et al. Estrogen modulates parathyroid hormone-induced interleukin-6 production in vivo and in vitro. Endocrinology. 2000;141(7):2526–31. CrossRef
- Yankelevitz DF, Henschke CI, Knapp PH, et al. Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. Am J Roetgenol. 1991;157(1):87–92. CrossRef
- Love C, Din AS, Tomas MB, et al. Radionuclide bone imaging: an illustrative review. Radiographics. 2003;23(2):341–58. CrossRef
- Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–93. CrossRef
- Effects of Radiation on Bone
Current Osteoporosis Reports
Volume 11, Issue 4 , pp 299-304
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Ionizing radiation
- Particle radiation
- Bone metabolism
- Cortical bone
- Trabecular bone
- Fracture risk
- Industry Sectors