Osteoporosis is a common problem for survivors of several types of cancer syndromes, including: Lymphoma and Leukemia, Breast, Prostate, and Children
Contributing Factors to Bone Loss
Factors contributing to bone loss in Leukemia / Lymphoma
- Involvement of bone marrow by cancer cells, which produce activators of bone breakdown, causes bone loss
- Many treatment programs include cortisone-like drugs which cause bone loss
- Patients are living longer!
Factors contributing to bone loss after Breast Cancer
- Chemotherapy for premenopausal women often results in early menopause
- Estrogen replacement is generally omitted
- Improved diagnosis and therapy results in prolonged survival and women are living longer in the post-menopausal state
Factors contributing to bone loss in Prostate Cancer
- Involvement of bone by cancer cells
- Treatment strategies frequently include reduction or blockade of testosterone effects.
- Testosterone deficiency increases bone loss
- Prostate cancer frequently affects older patients who may already have low bone mass
Osteopenia in Young Adult Survivors of Childhood Cancer
Improved survival of children with malignant diseases is, in part, due to the application of intensive, multimodality therapies including radiotherapy, surgery, glucocorticoids and cytotoxic agents. Such interventions have the potential to induce complex hormonal, metabolic and nutritional effects which may interfere with skeletal mass acquisition during childhood cancer survivors may therefore reach adulthood with diminished peak bone mass and be at increased risk for clinically significant osteoporosis later in their life.
Osteopenia is a prominent finding in young adults who are survivors of childhood cancers; it is likely that antineoplastic treatments during childhood and adolescence, impede peak bone mass acquisition. Bone mineral density is lower than age and gender averages. Bone mineral density is especially decreased in cancer survivors with history of cranial irradiation.
We suggest that systematic attention to this potential complication is needed in order to identify what subgroups of children may require regular surveillance and what interventions are required for its prevention or treatment.
Questions for future analysis:
- prevalence and severity of Osteopenia
- influence of underlying disease category
- impact of age at time of treatment
- role of irradiation, steroids, chemotherapy, endocrine deficiencies
- skeletal recovery potential, peak bone mass
- what is appropriate ERT dose in adolescence
- role of gender (testosterone replacement)
- role of GH deficiency, impact of replacement
- surveillance and intervention strategies
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