Arthritis und Rheuma 2012; 32(06): 385-390
DOI: 10.1055/s-0037-1618149
Sekundäre Formen der Osteoporose
Schattauer GmbH

Osteoporose bei Krebserkrankungen

Osteoporosis in cancer patients
J. Weiß
1   Klinik am Kurpark, Fachklinik für Rheumatologie und Onkologie, Bad Kissingen
,
M. A. Reuss-Borst
1   Klinik am Kurpark, Fachklinik für Rheumatologie und Onkologie, Bad Kissingen
› Author Affiliations
Further Information

Publication History

Publication Date:
23 December 2017 (online)

Zusammenfassung

Patienten mit Krebserkrankungen haben ein deutlich erhöhtes Risiko für eine Osteoporose. Epidemiologische Daten hierzu sind vor allem für Deutschland recht knapp. Grund der Osteoporose ist neben direkten knochentoxischen Effekten von Tumorzytokinen und Chemotherapeutika meist ein therapieinduzierter Hypogonadismus, weshalb vorwiegend Patienten mit Mamma- und Prostatakarzinom betroffen sind. Bei anderen Tumorarten spielen unter anderem steroidhaltige Behandlungsregimes eine ätiologische Rolle. Therapeutisch kommen neben Basismaßnahmen wie einer „knochengesunden Lebensweise“ und der Gabe von Kalzium und Vitamin D vor allem Bisphosphonate zum Einsatz. Auch für den monoklonalen Antikörper Denosumab, einen RANKL-Inhibitor, liegen erste positive Ergebnisse vor.

Summary

In cancer patients, the risk for osteoporosis is increased considerably. Epidemiological data concerning that topic are scarce, especially in Germany. Besides direct bone-toxic effects of tumor-cytokines and chemotherapy, the source of osteoporosis mostly is a hypogonadism induced by therapy. Therefore, mainly patients with breast and prostatic cancer may develop osteoporosis. In other types of cancer, therapy regimens containing steroids play an etiological role. Besides basic measures like a bone-healthy lifestyle and substitution of calcium and cholecalciferol, bisphosphonates are mainly used for treatment. Denosumab, a monoclonal antibody and inhibitor of RANKL, demonstrated first positive results in several trials.

 
  • Literatur

  • 1 Arts J, Kuiper GG, Janssen JM. et al. Differential expression of estrogen receptors alpha and beta mRNA during differentiation of human osteoblast SV-HFO cells. Enocrinology 1997; 138: 5067-5070.
  • 2 Brown SA, Guise TA. Cancer-associated bone disease. Curr Osteoporos Rep 2007; 5: 120-127.
  • 3 Brown SA, Guise TA. Cancer treatment-related bone disease. Crit Rev Eukaryot Gene Expr 2009; 19: 47-60.
  • 4 Brufsky A, Bundred N, Coleman R. et al. An integrated analysis of zoledronic acid (ZA) for prevention of aromatase inhibitor associated bone loss (AIBL) in postmenopausal women (PMW) with early breast cancer (BCa) receiving adjuvant letrozole (LET). Breast Cancer Res Treat 2006; 100: S25 (Abstract 107).
  • 5 Brufsky A. Management of cancer-treatment-induced bone loss on postmenopausal women undergoing adjuvant breast cancer therapy: a Z-FAST update. Semin Oncol 2006; 33: S13-S17.
  • 6 Brufsky AM. Cancer treatment-induced bone loss: Pathophysiology and clinical perspectives. Oncologist 2008; 13: 187-195.
  • 7 Brufsky AM, Harker WG, Beck JT. et al. Final 5-year results of Z-FAST trial: adjuvant zoledronic acid maintains bone mass in post menopausal breast cancer patients receiving letrozole. Cancer 2012; 118: 1192-1201.
  • 8 Carani C, Qin K, Simoni M. et al. Effect of testosterone and estradiol in a man with aromatase deficiency. N Engl J Med 1997; 337: 91-95.
  • 9 Conde FA, Sarna L, Oka RK. et al. Age, body mass index and serum prostate-specific antigen correlate with bone loss in men with prostate cancer not receiving androgen deprivation therapy. Urology 2004; 64: 335-340.
  • 10 Confavreux CB, Fontana A, Guastalla JP. et al. Estrogen-dependend increase in bone turnover and bone loss in postmenopausal women treated with anastrozole. Prevention with biphosphonates. Bone 2007; 41: 346-352.
  • 11 Dachverband Osteologie e. V. DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen. Osteologie 2009; 18: 304-328.
  • 12 Deroo BJ, Korach KS. Estrogen receptors and human disease. J Clin Invest 2006; 116: 561-570.
  • 13 Diamond TH, Higano CS, Smith MR. et al. Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy. Cancer 2004; 100: 892-899.
  • 14 Eastell R, Hannon RA, Cuzick J et al.. ATAC Trialists’ group. Effect of an aromatase inhibitor on BMD and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) trial (18233230). J Bone Miner Res 2006; 21: 1215-1223.
  • 15 Ellis GK, Bone HG, Chlebowski R. et al. Randomized trial of denosumab in patients receiving adjuvant aromatase inhibitors for nonmetastatic breast cancer. J Clin Oncol 2008; 26: 4875-4882.
  • 16 Eriksson S, Eriksson A, Stege R, Carlstrom K. Bone mineral density in patients with prostatic cancer treated with orchidectomy and with estrogens. Calif Tissue Int 1995; 57: 97-99.
  • 17 Feng JQ, Ward LM, Liu S. et al. Loss of DMP1 causes rickets and osteomalacia and identifies a role for osteocytes in mineral metabolism. Nat Genet 2006; 38: 1310-1315.
  • 18 Ganz PA. Survivorship: adult cancer survivors. Prim Care 2009; 36: 721-741.
  • 19 Greendale GA, Edelstein S, Barrett-Connor E. Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study. J Bone Miner Res 1997; 12: 1833-1843.
  • 20 Guise TA. Bone loss and fracture risk associated with cancer therapy. Oncologist 2006; 11: 1121-1131.
  • 21 Hadji P, Body JJ, Aapro MS. et al. Practical guidance for the management of aromatase inhibitorassociated bone loss. Ann Oncol 2008; 19: 1407-1416.
  • 22 Hadji P, Aapro MS, Body JJ. et al. Management of aroomatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 2011; 22: 2546-2555.
  • 23 Hadji P, Asmar L, van Nes JG. et al. The effect of exemestan and tamoxifen on bone health within the Tamoxifen Exemestan Adjuvant Multinational (TEAM) trial: a meta-analysis of th US, German, Netherlands, and Belgium sub-studies. J Cancer Res Clin Oncol 2011; 137: 1015-1025.
  • 24 Häussler B, Gothe H, Göl D. et al. Epidemiology, treatment and costs of osteoporosis in Germany – the BoneEVA Study. Osteoporosis Int 2007; 18: 77-84.
  • 25 Hirbe A, Morgan EA, Uluckan O, Weilbaecher K. Skeletal complications of breast cancer therapies. Clin Cancer Res 2006; 12: 6309s-6314s.
  • 26 Ito K, Elkin EB, Girotra M, Morris M. Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer. Ann Intern Med 2010; 152: 621-629.
  • 27 Kanis JA, Burlet N, Cooper C. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int 2008; 19: 399-428.
  • 28 Kaptoge S, da Silva JA, Brixen K. et al. Geographical variation in DXA bone mineral density in young European men and women. Results from the Network in Europe on Male Osteoporosis (NEMO) study. Bone 2008; 43: 332-339.
  • 29 Krebs in Deutschland 2007/2008. 8. Ausgabe.. Robert Koch-Institut und Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V.. Hrsg. Berlin: 2012
  • 30 Krum SA, Miranda-Carboni GA, Hauschka PV. et al. Estrogen protects bone by inducing Fas ligand in osteoblasts to regulate osteoclast survival. EMBO J 2008; 27: 535-545.
  • 31 Krupski TL, Smith MR, Lee WC. et al. Natural history of bone complications in men with prostate carcinoma initiating androgen deprivation therapy. Cancer 2004; 101: 541-549.
  • 32 Lee JS, Lacroix AZ, Wu L. et al. Associations of sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women. J Clin Endocrinol Metab 2008; 93: 1796-1803.
  • 33 Mann GB, Kang YC, Brand C. et al. Secondary causes of low bone mass in patients with breast cancer: a need for greater vigilance. J Clin Oncol 2009; 27: 3605-3610.
  • 34 Markopoulos C, Tzoracoleftherakis E, Polychronis A. et al. Management of anastrozole-induced bone loss in breast cancer patients with oral risedronat: results from the ARBI prospective trial. Breast Cancer Res 2010; 12: R24.
  • 35 Markopoulos C, Tzoracoleftherakis E, Koukouras D. et al. Age effect on bone mineral density changes in breast cancer patients receiving anastrozole: results from the ARBI prospective clinical trial. J Cancer Res Clin Oncol. 2012 May 3. [Epub ahead of print]
  • 36 Meier C, Nguyen TV, Handelsman DJ. et al. Endogenous sex hormones and inciedent fracture risk in older men: the Dubbo Osteoporosis Epidemiology Study. Arch Intern Med 2008; 168: 47-54.
  • 37 Michaud LB, Goodin S. Cancer-treatment-induced bone loss, part 1. Am J Health-Syst Pharm 2006; 63: 419-430.
  • 38 Michaud LB. Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer. Am J Health Syst Pharm 2010; 67: S20-S30.
  • 39 Morandi P, Rouzier R, Altundag K. et al. The role of aromatase inhibitors in the adjuvant treatment of breast carcinoma: the M. D. Anderson Cancer Center evidence-based approach. Cancer 2004; 101: 1482-1489.
  • 40 Morote J, Morin JP, Orsola A. et al. Prevalence of osteoporosis during long-term androgen deprivation therapy in patients with prostate cancer. Urology 2007; 69: 500-504.
  • 41 Murthy RK, Morrow PK, Theriault RL. Bone biology and the role of the RANK ligand pathway. Oncology 2010; 23: 9-15.
  • 42 Nakamura T, Imai Y, Matsumoto T. et al. Estrogen prevents bone loss via estrogen receptor alpha and induction of Fas ligand in osteoclasts. Cell 2007; 130: 811-823.
  • 43 Pfeilschifter J, Diel IJ. Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol 2000; 18: 1570-1593.
  • 44 Powles TJ, Hickish T, Kanis JA. et al. Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol 1996; 14: 78-84.
  • 45 Reuss-Borst M, Hartmann U, Scheede C, Weiß J. Prevalence of osteoporosis among cancer patients in Germany. Osteoporosis Int 2012; 23: 1437-1444.
  • 46 Sala A, Barr RD. Osteopenia and cancer in children and adolescents. Cancer 2007; 109: 1420-1431.
  • 47 Sambrook P, Cooper C. Osteoporosis. Lancet 2006; 367: 2010-2018.
  • 48 Serpa Neto A, Tobias-Machado M, Esteves MAP. et al. A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma. BMC Urology 2010; 10: 9.
  • 49 Serpa Neto A, Tobias-Machado M, Esteves MAP. et al. Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer. Prostate Cancer Prostatic Dis 2012; 15: 36-44.
  • 50 Siebler T, Shalet SM, Robson H. Effects of chemotherapy on bone metabolism and skeletal growth. Horm Res 2002; 58: 80-85.
  • 51 Smith EP, Boyd J, Frank GR. et al. Estrogen resistance caused by a mutation in the estrogen-receptor gene in man. N Engl J Med 1994; 331: 1056-1061.
  • 52 Smith MR, Eegerdie B, Hernandez Toris N. et al. Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 2009; 361: 745-755.
  • 53 Spanik S, Spanikova B. Bone mineral density in early breast cancer patients. Bratist Lek Listy 2010; 111: 27-32.
  • 54 Stava CJ, Jimenez C, Hu Mi, Vassilopoulou-Sellin R. Skeletal sequelae of cancer and cancer treatment. J Cancer Surviv 2009; 3: 75-88.
  • 55 Theriault RL, Biermann JS, Brown E. et al. NCCN Task Force Report: Bone health and cancer care. J Natl Compr Cenc Netw 2006; 4: S1-S20.
  • 56 Ziaran S, Goncelves FM, Breza JS. Bone mineral density, pathological fractures and bisphosphonate therapy in prostate cancer patients on androgen deprivation therapy. Endocr Regul 2011; 45: 199-204.