Osteoporosis International

, Volume 24, Issue 12, pp 2929–2953

Cancer-associated bone disease

  • R. Rizzoli
  • J.-J. Body
  • M.-L. Brandi
  • J. Cannata-Andia
  • D. Chappard
  • A. El Maghraoui
  • C. C. Glüer
  • D. Kendler
  • N. Napoli
  • A. Papaioannou
  • D. D. Pierroz
  • M. Rahme
  • C. H. Van Poznak
  • T. J. de Villiers
  • G. El Hajj Fuleihan
  • for the International Osteoporosis Foundation Committee of Scientific Advisors Working Group on Cancer-Induced Bone Disease
Position Paper

DOI: 10.1007/s00198-013-2530-3

Cite this article as:
Rizzoli, R., Body, JJ., Brandi, ML. et al. Osteoporos Int (2013) 24: 2929. doi:10.1007/s00198-013-2530-3

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 cancer-associated 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 evidence-based 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.

Keywords

BoneCancerIOFSkeletal-related events

Abbreviations

ABCSG

Austrian Breast & Colorectal Cancer Study Group

ADT

Androgen deprivation therapy

AI

Aromatase inhibitor

ALP

Alkaline phosphatase

ASCO

American Society of Clinical Oncology

ATAC

Arimidex, Tamoxifen Alone or in Combination

AZURE

Adjuvant Zoledronic Acid to Reduce Recurrence

BTM

Bone turnover marker

BMD

Bone mineral density

CI

Confidence interval

CMF

Cyclophosphamide–methotrexate–5 fluorouracil

CT

Computed tomography

CTX

Cross-linked terminal telopeptide

DKK1

Dickkopf-related protein

DXA

Dual-energy X-ray absorptiometry

ER

Estrogen receptor

ET

Endothelin

ESCEO

European Society for Clinical and Economical Aspects of Osteoporosis and Osteoarthritis

FAC

5-Fluorouracil–doxorubicin–cyclophosphamide

FDG

Fluorodeoxyglucose

FGF

Fibroblast growth factor

FRAX

WHO fracture risk assessment tool

GnRH

Gonadotropin-releasing hormone

HR

Hazard ratio

IGF

Insulin-like growth factor

IES

Intergroup Exemestane Study

IL

Interleukin

IV

Intravenous

MRI

Magnetic resonance imaging

NCCN

National Comprehensive Cancer Network

NTX

N-terminal telopeptide

ONJ

Osteonecrosis of the jaw

OPG

Osteoprotegerin

PDGF-BB

Platelet-derived growth factor-BB

PET

Positron emission tomography

PSA

Prostate-specific antigen

PTHrP

Parathyroid hormone-related protein

RANK

Receptor activator of nuclear factor kappa-B

RANKL

Receptor activator of nuclear factor kappa-B ligand

RCT

Randomized controlled trial

RR

Relative risk

SABRE

Study of Anastrozole with the Bisphosphonate Risedronate

SERM

Selective oestrogen receptor modulator

sFRP

Secreted frizzled-related protein

SRE

Skeletal-related event

TGF-β

Transforming growth factor-beta

TNF-α

Tumour necrosis factor-alpha

TRAcP

Tartrate-resistant acid phosphatase

TSH

Thyroid-stimulating hormone

VEGF

Vascular endothelial growth factor

VFA

Vertebral fracture assessment

WHO

World Health Organization

Z-Fast and ZO-Fast

Zometa-Femara Adjuvant Synergy Trials

αCTX

Alpha cross-linked telopeptides type

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • R. Rizzoli
    • 1
  • J.-J. Body
    • 2
  • M.-L. Brandi
    • 3
  • J. Cannata-Andia
    • 4
  • D. Chappard
    • 5
  • A. El Maghraoui
    • 6
  • C. C. Glüer
    • 7
  • D. Kendler
    • 8
  • N. Napoli
    • 9
  • A. Papaioannou
    • 10
  • D. D. Pierroz
    • 11
  • M. Rahme
    • 12
  • C. H. Van Poznak
    • 13
  • T. J. de Villiers
    • 14
  • G. El Hajj Fuleihan
    • 12
  • for the International Osteoporosis Foundation Committee of Scientific Advisors Working Group on Cancer-Induced Bone Disease
  1. 1.Division of Bone DiseasesGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  2. 2.Department of Medicine, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
  3. 3.Department of Internal MedicineUniversity of FlorenceFlorenceItaly
  4. 4.Bone and Mineral Research Unit, Instituto Reina Sofía, REDinREN, ISCIII, Hospital Universario Central de AsturiasUniversidad de OviedoOviedoSpain
  5. 5.GEROM-Research Group on Bone Remodeling and bioMaterialsLUNAM UniversityAngersFrance
  6. 6.Rheumatology DepartmentMilitary Hospital Mohammed VRabatMorocco
  7. 7.Sektion Biomedizinische Bildgebung, Klinik für Diagnostische RadiologieUniversitätsklinikum Schleswig-HolsteinKielGermany
  8. 8.Department of MedicineUniversity of British ColumbiaVancouverCanada
  9. 9.Division of EndocrinologyUniversity Campus Bio-MedicoRomeItaly
  10. 10.Department of MedicineMcMaster UniversityHamiltonCanada
  11. 11.International Osteoporosis Foundation (IOF)NyonSwitzerland
  12. 12.Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Osteoporosis and Metabolic Bone DisordersAmerican University of Beirut Medical CenterBeirutLebanon
  13. 13.University of MichiganAnn ArborUSA
  14. 14.Panorama MediClinic and Department of Gynaecology, Faculty of Health SciencesStellenbosch UniversityCape TownSouth Africa