Position Paper

Osteoporosis International

, Volume 24, Issue 12, pp 2929-2953

First online:

Cancer-associated bone disease

  • R. RizzoliAffiliated withDivision of Bone Diseases, Geneva University Hospitals and Faculty of Medicine Email author 
  • , J.-J. BodyAffiliated withDepartment of Medicine, CHU Brugmann, Université Libre de Bruxelles
  • , M.-L. BrandiAffiliated withDepartment of Internal Medicine, University of Florence
  • , J. Cannata-AndiaAffiliated withBone and Mineral Research Unit, Instituto Reina Sofía, REDinREN, ISCIII, Hospital Universario Central de Asturias, Universidad de Oviedo
  • , D. ChappardAffiliated withGEROM-Research Group on Bone Remodeling and bioMaterials, LUNAM University
  • , A. El MaghraouiAffiliated withRheumatology Department, Military Hospital Mohammed V
  • , C. C. GlüerAffiliated withSektion Biomedizinische Bildgebung, Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein
  • , D. KendlerAffiliated withDepartment of Medicine, University of British Columbia
  • , N. NapoliAffiliated withDivision of Endocrinology, University Campus Bio-Medico
    • , A. PapaioannouAffiliated withDepartment of Medicine, McMaster University
    • , D. D. PierrozAffiliated withInternational Osteoporosis Foundation (IOF)
    • , M. RahmeAffiliated withCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Osteoporosis and Metabolic Bone Disorders, American University of Beirut Medical Center
    • , C. H. Van PoznakAffiliated withUniversity of Michigan
    • , T. J. de VilliersAffiliated withPanorama MediClinic and Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University
    • , G. El Hajj FuleihanAffiliated withCalcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Osteoporosis and Metabolic Bone Disorders, American University of Beirut Medical Center
    • , for the International Osteoporosis Foundation Committee of Scientific Advisors Working Group on Cancer-Induced Bone Disease

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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.


Bone Cancer IOF Skeletal-related events