The number of cancer survivors is increasing, soon to be as many of 13 million of us in the world! Bones are often affected in cancer survivors, usually a result of bone metastases, or of anti-cancer therapies which can contribute to bone loss and fragility.
Bone disease in cancer survivors can result both from the primary disease itself, either due to circulating bone-resorbing substances, or like in prostate cancer from bone metastasis. Additionally, the therapy itself can cause bone loss and fractures – especially in the case of glucocorticoid or estrogen deprivation therapy, chemotherapy and as in prostate cancer androgen deprivation therapy (ADT).
As we survive longer, which was are doing, cancer related bone disease and its treatment becomes an important health issue that needs to be addressed. Men with prostate cancer are at particularly high risk of osteoporosis and fracture due in part to ADT treatment. It is not unheard that rates of bone mineral density decrease can be as high as 3 to 5.6% within the first year of ADT treatment alone!
Early evaluation and treatment for osteoporosis is critical to good treatment. Survivors, along with their doctors must make concerted efforts to prevent bone loss and fractures. Fragility fractures due to osteoporosis can have serious repercussions, including severe pain, immobility, and accompanying loss of quality of life.
Survivors must make an effort to increase their exercise patterns and include regular weight bearing exercises. Physicians should be aware that that bone-modifying agents, such as bisphosphonates and denosumab, are effective in preventing and delaying cancer-related bone disease.
Joel T. Nowak, M.A., M.S.W.