BONE COMPLICATIONS IN EARLY DISEASE

Recent advances in adjuvant therapy for early-stage cancer present new challenges in the management of bone health in cancer patients. For example, in breast cancer, aromatase inhibitors (AIs) have demonstrated superior efficacy over tamoxifen. However, the use of an AI is associated with increased bone loss and incidence of fracture. Similarly in prostate cancer, androgen deprivation therapy (ADT), through surgical castration or with the use of gonadotropin-releasing hormone (GnRH) analogs, has been shown to correlate with a fall in bone mineral density (BMD) and an increased fracture rate. Thus, as these therapies become more commonly used for patients with early-stage disease, preservation of bone health with bisphosphonates and other bone-targeted agents may play a key role in overall disease management for patients receiving adjuvant therapy.

BONE LOSS AND FRACTURE RISK

The rate of bone loss naturally increases with age, with one in three women over the age of fifty years sustaining an osteoporotic fracture of the wrist, hip, or vertebrae. However, although the absolute risk of an osteoporotic fracture increases with decreasing BMD, an analysis of nearly 150,000 healthy postmenopausal women found that 82 percent of fractures occurred in nonosteoporotic women (T-score ≥2.5). As a result, the World Heath Organization (WHO) working group has identified risk factors other than low BMD for osteoporotic fracture; these include increasing age, female sex, smoking, personal history of fracture over the age of fifty years, a parental history of hip fracture, a low body mass index (<20 mg/m2), consumption of more than three units of alcohol per day, corticosteroid use, and other diseases such as rheumatoid arthritis.