Βone loss and hematological malignancies: Latest research adds new light
Bone loss and osteoporosis is a known consequence of diverse cancers and their treatments. Osteoporosis is a serious public health concern. It is estimated that approximately 30% of postmenopausal women in the USA and Europe have osteoporosis, and, at least 40% of those women and 10-30% of aging men will incur one or more osteoporotic fractures. Lifestyle issues, such as diet, physical activity, cigarette smoking, and excessive alcohol consumption are among the important prognostic factors for osteoporosis. Aging is one of the most significant predisposing factors for bone loss. In adult oncological patients, predisposing factors for bone loss and fractures are compounded by the direct effects of cancer cells on the skeleton, bony metastasis, and the deleterious effects of cancer-specific therapies on bone. Hormonal therapies used to treat patients with breast or prostate cancer can potentiate age-related bone loss. Treatments hindering bone growth in children and adolescents include chemotherapy, large doses of steroids, and radiotherapy, particularly cranial irradiation to the hypothalamic-pituitary axis.
In a pilot study, publishes in Supportive Care in Cancer , bone loss was evaluated in adults with hematological malignancies and aimed to identified which hematological diseases are associated with the highest prevalence and severity of osteoporosis. The study included 181 adult patients. A male predominance for most diseases was noted. Significant bone loss was found compared to normal population. Bone mineral density measurements were notably worse for patients with non-Hodgkin lymphoma than patients with chronic lymphocytic and small lymphocytic leukemia. Significant bone loss was already present at a short duration from diagnosis for patients with myelo-dysplastic syndrome.
In conclusion, there was ubiquitous and significant detection of bone loss among adult patients with hematological neoplasms, while specific groups were identified in terms of the type of the neoplasm. Larger studies are needed to substantiate the extensive implications. Prophylactic measures will be needed before, during and after therapy, including lifestyle changes, such as diet, behavior, and exercise. Follow up would be needed, possibly for years after therapy, with the ultimate long-term goal of preventing fractures and other skeletal morbidity and thus improve the patient’s quality of life.
Ruchlemer R et al. Bone loss and hematological malignancies in adults: a pilot study. Supportive Care in Cancer 2018;26:3013-3020.