Skip to main content

Advertisement

SpringerLink
Log in

Bone loss in patients with breast or prostate cancer

  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Cancers of the breast and prostate are very common in the general population, with breast cancer accounting worldwide for 23% of cancer cases in women and prostate cancer accounting for 12% of cases in men. During the past decade, the survival rates of patients with estrogen-dependent breast cancer and testoster-one-dependent prostate cancer have improved. This improvement has been possible thanks to the introduction of hormone treatments that suppress the synthesis or antagonize the actions of gonadal steroids. However, estrogen and testosterone deficiencies are associated with excessive bone resorption that translates into damage of the bone microarchitecture, loss of bone mineral density, and predisposition to osteoporosis and fractures. Herein, we review the mechanisms of bone loss in breast and prostate cancer survivors, their clinical implications, and different available therapeutic modalities that may help to correct the damage of bone and prevent the development of fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. American Cancer Society: Cancer Facts & Figures 2007. Available at http://www.cancer.org/downloads/STT/CAFF-2007PWSecured.pdf. Accessed June 2007.

  2. Shapiro CL, Manola J, Leboff M: Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Clin Oncol 2001, 19:3306–3311.

    PubMed  CAS  Google Scholar 

  3. Kanis JA, McCloskey EV, Powles T, et al.: A high incidence of vertebral fracture in women with breast cancer. Br J Cancer 1999, 79:1179–1181.

    Article  PubMed  CAS  Google Scholar 

  4. Chen Z, Maricic M, Bassford TL, et al.: Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 2005, 165:552–558.

    Article  PubMed  Google Scholar 

  5. Mittan D, Lee S, Miller E, et al.: Bone loss following hypogonadism in men with prostate cancer treated with GnRH analogs. J Clin Endocrinol Metab 2002, 87:3656–3661.

    Article  PubMed  CAS  Google Scholar 

  6. Melton LJ, Alothman KI, Khosla S, et al.: Fracture risk following bilateral orchiectomy. J Urol 2003, 169:1747–1750.

    Article  PubMed  Google Scholar 

  7. Janssens K, ten Dijke P, Janssens S, Van Hul W: Transforming growth factor-beta1 to the bone. Endocr Rev 2005, 26:743–774.

    Article  PubMed  CAS  Google Scholar 

  8. Hofbauer LC, Khosla S, Dunstan CR, et al.: Estrogen stimulates gene expression and protein production of osteoprotegerin in human osteoblastic cells. Endocrinology 1999, 140:4367–4370.

    Article  PubMed  CAS  Google Scholar 

  9. Benito M, Gomberg B, Wehrli FW, et al.: Deterioration of trabecular architecture in hypogonadal men. J Clin Endocrinol Metab 2003, 88:1497–1502.

    Article  PubMed  CAS  Google Scholar 

  10. Guise TA: Bone loss and fracture risk associated with cancer therapy. Oncologist 2006, 11:1121–1131.

    Article  PubMed  CAS  Google Scholar 

  11. Osborne CK: Tamoxifen in the treatment of breast cancer. N Engl J Med 1998, 339:1609–1618.

    Article  PubMed  CAS  Google Scholar 

  12. Vogel VG, Costantino JP, Wickerham DL, et al.: Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006, 295:2727–2741.

    Article  PubMed  CAS  Google Scholar 

  13. Vehmanen L, Elomaa I, Blomqvist C, Saarto T: Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status. J Clin Oncol 2006, 24:675–680.

    Article  PubMed  CAS  Google Scholar 

  14. Resch A, Biber E, Siefert M, Resch H: Evidence that tamoxifen preserves bone density in late postmenopausal women with breast cancer. Acta Oncol 1998, 37:661–664.

    Article  PubMed  CAS  Google Scholar 

  15. Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 2005, 97:1652–1662.

    Article  PubMed  CAS  Google Scholar 

  16. Howell A, Cuzick J, Baum M, et al.: Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 2005, 365:60–62.

    Article  PubMed  CAS  Google Scholar 

  17. Coates A, Keshaviah A, Thurlimann B, et al.: Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. J Clin Oncol 2007, 25:486–492.

    Article  PubMed  CAS  Google Scholar 

  18. Coombes RC, Kilbum LS, Snowdon CF, et al.: Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 2007, 369:559–570.

    Article  PubMed  CAS  Google Scholar 

  19. Winer EP, Hudis C, Burstein HJ, et al.: American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 2005, 23:619–629.

    Article  PubMed  CAS  Google Scholar 

  20. Eastell R, Hannon RA, Cuzick J, et al.: Effect of an aromatase inhibitor on BMD and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) trial (18233230). J Bone Miner Res 2006, 21:1215–1223.

    Article  PubMed  CAS  Google Scholar 

  21. The Arimidex, Tamoxifen, Alone or in Combination Trialists’ Group, Buzdar A, Howell A, et al.: Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol 2006, 7:633–743.

    Article  PubMed  CAS  Google Scholar 

  22. Perez EA, Josse RG, Pritchard KI, et al.: Effect of letrozole versus placebo on bone mineral density in women with primary breast cancer completing 5 or more years of adjuvant tamoxifen: a companion study to NCIC CTG MA.17. J Clin Oncol 2006, 24:3629–3635.

    Article  PubMed  CAS  Google Scholar 

  23. Goss PE, Qi S, Cheung AM, et al.: Effects of the steroidal aromatase inhibitor exemestane and the nonsteroidal aromatase inhibitor letrozole on bone and lipid metabolism in ovariectomized rats. Clin Cancer Res 2004, 10:5717–5723.

    Article  PubMed  CAS  Google Scholar 

  24. Coleman RE, Banks LM, Girgis SI, et al.: Skeletal effects of exemestane on bone-mineral density, bone biomarkers, and fracture incidence in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES): a randomised controlled study. Lancet Oncol 2007, 8:119–127.

    Article  PubMed  CAS  Google Scholar 

  25. Pritchard K, Whelan T: Clinical trial update: National Cancer Institute of Canada. Breast Cancer Res 2005, 7:48–51.

    Article  PubMed  Google Scholar 

  26. Sverrisdottir A, Fornander T, Jacobsson H, et al.: Bone mineral density among premenopausal women with early breast cancer in a randomized trial of adjuvant endocrine therapy. J Clin Oncol 2004, 22:3694–3699.

    Article  PubMed  CAS  Google Scholar 

  27. Bines J, Oleske DM, Cobleigh MA: Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1996, 14:1718–1729.

    PubMed  CAS  Google Scholar 

  28. Headley JA, Theriault RL, LeBlanc AD, et al.: Pilot study of bone mineral density in breast cancer patients treated with adjuvant chemotherapy. Cancer Invest 1998, 16:6–11.

    Article  PubMed  CAS  Google Scholar 

  29. Pierce SM, Recht A, Lingos TI, et al.: Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992, 23:915–923.

    PubMed  CAS  Google Scholar 

  30. Jia D, O’Brien CA, Stewart SA, et al.: Glucocorticoids act directly on osteoclasts to increase their life span and reduce bone density. Endocrinology 2006, 147:5592–5599.

    Article  PubMed  CAS  Google Scholar 

  31. LeBoff MS, Kohlmeier L, Hurwitz S, et al.: Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 1999, 281:1505–1511.

    Article  PubMed  CAS  Google Scholar 

  32. Chapuy MC, Arlot ME, Duboeuf F, et al.: Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992, 327:1637–1642.

    PubMed  CAS  Google Scholar 

  33. Hillner BE, Ingle JN, Chlebowski RT, et al.: American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol 2003, 21:4042–4057.

    Article  PubMed  CAS  Google Scholar 

  34. Vehmanen L, Saarto T, Risteli J, et al.: Short-term intermittent intravenous clodronate in the prevention of bone loss related to chemotherapy-induced ovarian failure. Breast Cancer Res Treat 2004, 87:181–188.

    Article  PubMed  CAS  Google Scholar 

  35. Fuleihan GH, Salamoun M, Mourad YA, et al.: Pamidronate in the prevention of chemotherapy-induced bone loss in premenopausal women with breast cancer: a randomized controlled trial. J Clin Endocrinol Metab 2005, 90:3209–3214.

    Article  CAS  Google Scholar 

  36. Saarto T, Blomqvist C, Valimaki M, et al.: Chemical castration induced by adjuvant cyclophosphamide, methotrexate, and fluorouracil chemotherapy causes rapid bone loss that is reduced by clodronate: a randomized study in premenopausal breast cancer patients. J Clin Oncol 1997, 15:1341–1347.

    PubMed  CAS  Google Scholar 

  37. Powles TJ, McCloskey E, Paterson AH, et al.: Oral clodronate and reduction in loss of bone mineral density in women with operable primary breast cancer. J Natl Cancer Inst 1998, 90:704–708.

    Article  PubMed  CAS  Google Scholar 

  38. Delmas PD, Balena R, Confravreaux E, et al.: Bisphosphonate risedronate prevents bone loss in women with artificial menopause due to chemotherapy of breast cancer: a double-blind, placebo-controlled study. J Clin Oncol 1997, 15:955–962.

    PubMed  CAS  Google Scholar 

  39. Greenspan SL, Bhattacharya RK, Seeika SM, et al.: Prevention of bone loss in survivors of breast cancer: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab 2007, 92:131–136.

    Article  PubMed  CAS  Google Scholar 

  40. Gnant MF, Mlineritsch B, Luschin-Ebengreuth G, et al.: Zoledronic acid prevents cancer treatment-induced bone loss in premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer: a report from the Austrian Breast and Colorectal Cancer Study Group. J Clin Oncol 2007, 25:820–828.

    Article  PubMed  CAS  Google Scholar 

  41. Eriksson S, Eriksson A, Stege R, Carlström K: Bone mineral density in patients with prostatic cancer treated with orchiectomy and with estrogens. Calcif Tissue Int 1995, 57:97–99.

    Article  PubMed  CAS  Google Scholar 

  42. Daniell HW: Osteoporosis after orchiectomy for prostate cancer. J Urol 1997, 157:439–444.

    Article  PubMed  CAS  Google Scholar 

  43. Smith MR, McGovern FJ, Fallon MA, et al.: Low bone mineral density in hormone-naive men with prostate carcinoma. Cancer 2001, 91:2238–2245.

    Article  PubMed  CAS  Google Scholar 

  44. Diamond TH, Higano CS, Smith MR, et al.: Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies. Cancer 2004, 100:892–899.

    Article  PubMed  Google Scholar 

  45. Maillefert JF, Sibilia J, Michel F, et al.: Bone mineral density in men treated with synthetic gonadotropin-releasing hormone agonists for prostatic carcinoma. J Urol 1999, 161:1219–1222.

    Article  PubMed  CAS  Google Scholar 

  46. Oefelein MG, Ricchiuti V, Conrad W, Resnick MI: Skeletal fractures negatively correlate with overall survival in men with prostate cancer. J Urol 2002, 168:1005–1007.

    Article  PubMed  Google Scholar 

  47. Smith MR, McGovern FJ, Zietman AL, et al.: Pamidronate to prevent bone loss during androgen-deprivation therapy for prostate cancer. N Engl J Med 2001, 345:948–955.

    Article  PubMed  CAS  Google Scholar 

  48. Smith MR, Eastham J, Gleason DM, et al.: Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. J Urol 2003, 169:2008–2012.

    Article  PubMed  CAS  Google Scholar 

  49. Greenspan SL, Nelson JB, Trump DL, Resnick NM: Effect of once-weekly oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer: a randomized trial. Ann Intern Med 2007, 146:416–424.

    PubMed  Google Scholar 

  50. Smith MR, Fallon MA, Lee H, Finkelstein JS: Raloxifene to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer: a randomized controlled trial. J Clin Endocrinol Metab 2004, 89:3841–3846.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrine Neoplasia, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 435, Houston, TX, 77030, USA

    Camilo Jimenez

Authors
  1. Mimi I. Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert F. Gagel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camilo Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Camilo Jimenez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hu, M.I., Gagel, R.F. & Jimenez, C. Bone loss in patients with breast or prostate cancer. Curr Osteoporos Rep 5, 170–178 (2007). https://doi.org/10.1007/s11914-007-0013-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-007-0013-1

Keywords

Search

Navigation