The science and practice of bone health in oncology: managing bone loss and metastasis in patients with solid tumors.
Cancer and its treatment can compromise bone health, leading to fracture, pain, loss of mobility, and hypercalcemia of malignancy. Bone metastasis occurs frequently in advanced prostate and breast cancers, and bony manifestations are commonplace in multiple myeloma. Osteoporosis and osteopenia may be consequences of androgen-deprivation therapy for prostate cancer, aromatase inhibition for breast cancer, or chemotherapy-induced ovarian failure. Osteoporotic bone loss and bone metastasis ultimately share a pathophysiologic pathway that stimulates bone resorption by increasing the formation and activity of osteoclasts. Important mediators of pathologic bone metabolism include substances produced by osteoblasts, such as RANKL, the receptor activator of nuclear factor kappa B ligand, which spurs osteoclast differentiation from myeloid cells. Available therapies are targeted to various steps in cascade of bone metastasis.
Lipton
Allan
A
Milton S. Hershey Medical Center, Penn State University, Hershey, PA, USA.
Uzzo
Robert
R
Amato
Robert J
RJ
Ellis
Georgiana K
GK
Hakimian
Behrooz
B
Roodman
G David
GD
Smith
Matthew R
MR
D000970:Antineoplastic Agents / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D001943:Breast Neoplasms; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control*; D011471:Prostatic Neoplasms
D000970:Antineoplastic Agents; D015415:Biomarkers; D050071:Bone Density Conservation Agents