Cancer patients and survivors who have received treatments such as aromatase inhibitors, chemotherapy, hormone therapy like Tamoxifen or a combination of these, are at an increased risk of osteoporosis, a condition which reduces the bone density, making it fragile. Hence, designing a comprehensive treatment plan including optimum management of skeletal health of the cancer patients is inevitable.
The recent advancements in cancer research have helped in increasing the number of cancer survivors across the world. However, despite all the advances in the cancer therapies, most of the cancer survivors end up dealing with different side effects of these treatments. Osteoporosis is one such long-term side effect seen in cancer patients and survivors who have received treatments like chemotherapy and hormone therapy. Osteoporosis is the medical condition in which the bone density is decreased, making the bone weak and brittle. Many studies show that patients and survivors of cancer types like breast cancer, prostate cancer and lymphoma are at an increased risk of osteoporosis.
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Studies highlighting the Risk of Osteoporosis in Cancer Survivors
In a study led by the researchers from Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, they evaluated the frequency of incidence of osteoporosis and another bone-loss condition called osteopenia in 211 breast cancer survivors who were diagnosed with the cancer at a mean age of 47 years, and compared the data with 567 cancer-free women. (Cody Ramin et al, Breast Cancer Research, 2018) The data used for this analysis was obtained from the BOSS Study (Breast and Ovarian Surveillance Service study) and included data of women who had information on bone-loss tests. 66% of breast cancer survivors and 53% of cancer-free women had undergone a bone-loss test during a follow-up period averaging 5.8 years and a total of 112 incidences of osteopenia and/or osteoporosis were reported. The researchers found that there was 68% higher risk of bone-loss conditions in breast cancer survivors as compared to cancer-free women. Additionally, researchers also reported the following key findings of the study:
- Breast cancer survivors diagnosed at age ≤ 50 years had 1.98 folds increased risk of osteopenia and osteoporosis compared with cancer-free women.
- Women with ER-positive (estrogen receptor positive) tumors had 2.1 folds increased risk of bone-loss conditions compared with cancer-free women.
- Breast cancer survivors treated with a standard combination of chemotherapy and hormone therapy had 2.7 folds increased risk of osteopenia and osteoporosis compared with cancer-free women.
- Women who were diagnosed with breast cancer and treated with a combination of chemotherapy and tamoxifen, a widely used hormone therapy for breast cancer, had 2.48 folds increased risk of bone-loss conditions compared with cancer-free women.
- Breast cancer survivors treated with aromatase inhibitors which reduces estrogen production, had 2.72 and 3.83 folds increased risk of osteopenia and osteoporosis when treated alone or in combination with chemotherapy, respectively, compared with cancer-free women.
In short, the study concluded that there was an increased risk of bone-loss conditions in breast cancer survivors who were younger, had ER(estrogen receptor)-positive tumors, were treated with aromatase inhibitors alone, or a combination of chemotherapy and aromatase inhibitors or tamoxifen. (Cody Ramin et al, Breast Cancer Research, 2018)
In another clinical study, data from 2589 Danish patients, who were diagnosed with diffuse large B-cell lymphoma or follicular lymphoma, commonly treated with steroids like prednisolone, between 2000 and 2012 and 12,945 control subjects were analyzed for incidences of bone-loss conditions. Results showed that lymphoma patients had an increased risk of bone-loss conditions compared to control, with the 5-year and 10-year cumulative risks reported as 10.0% and 16.3% for lymphoma patients compared to 6.8% and 13.5% for control. (Baech J et al, Leuk Lymphoma., 2020)
All these studies support the fact that there is an increased risk of osteoporosis in cancer patients and survivors following different cancer treatments. Cancer therapies are often chosen with the intention of improving the survival rates, without giving importance to their deleterious impact on the skeletal health. The bottom line is, before initiating the therapy, it is important to educate cancer patients on the possible adverse effects of these treatments on their skeletal health and include a comprehensive cancer treatment plan which also covers optimum management of the skeletal health of cancer patients.
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