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Year : 2009  |  Volume : 46  |  Issue : 4  |  Page : 331--334

Cancer chemotherapy-induced osteoporosis: How common is it among Saudi Arabian cancer survivors

Ali Al Amri1, Mir Sadat-Ali2,  
1 Department of Internal Medicine and Oncology, College of Medicine, King Faisal University Dammam and King Fahd University Hospital, Al-Khobar, 31952, Saudi Arabia
2 Department of Orthopaedic Surgery, College of Medicine, King Faisal University Dammam and King Fahd University Hospital, Al-Khobar, 31952, Saudi Arabia

Correspondence Address:
Mir Sadat-Ali
Department of Orthopaedic Surgery, College of Medicine, King Faisal University Dammam and King Fahd University Hospital, Al-Khobar, 31952
Saudi Arabia

Abstract

Objective: This study was done to assess the prevalence of cancer chemotherapy-induced osteoporosis among survivors of cancer in Saudi Arabia. Material and Methods: Patients who received chemotherapy due to malignant disease attending oncology and orthopedic clinics between June 1, 2006 and November 30, 2006, were the subjects. Age, sex, type of malignancy, last chemotherapy cycle and body mass index (BMI) of patients were entered in the database. Complete blood picture, serum calcium, phosphorous, renal function and liver function tests were done. Bone mineral density measurement of the hip and spine was done using Dual-Energy X-ray Absorptiometry. Results: We analyzed the data of 71 patients with an average age of 49.29 ± 8.24 years. Of these, 19 (25.8%) were osteoporotic and 33.87% were found to be osteopenic according to the BMD of the lumbar spine, 17 (22.6%) found to be osteoporotic and 29% found to be osteopenic per the BMD of the hip area. Patients whose BMD was normal had received their last chemotherapy cycle 48.68 ± 27.35 months earlier (P = 0.01). Osteopenia and osteoporosis were more common in patients in the age group of ≤50 years (65.6%) versus 56.4% in patients of ≥51 years (P = 0.001). Patients who received the last cycle of chemotherapy of less than 2 years were significantly more osteoporotic (81.5%-18.5%, P < 0.0001). Conclusions: Our study indicates a high prevalence of osteopenia and osteoporosis in patients who were younger than ≤50 years and who had received cancer chemotherapy. Second, bone loss continued for more than 2 years from the last cycle of chemotherapy.



How to cite this article:
Al Amri A, Sadat-Ali M. Cancer chemotherapy-induced osteoporosis: How common is it among Saudi Arabian cancer survivors.Indian J Cancer 2009;46:331-334


How to cite this URL:
Al Amri A, Sadat-Ali M. Cancer chemotherapy-induced osteoporosis: How common is it among Saudi Arabian cancer survivors. Indian J Cancer [serial online] 2009 [cited 2020 Aug 13 ];46:331-334
Available from: http://www.indianjcancer.com/text.asp?2009/46/4/331/55554


Full Text

 Introduction



Osteoporosis is characterized by reduction of the bone mass with distortion of the architecture, leading to fractures. Secondary osteoporosis occurs after adjuvant chemotherapy in two-thirds of men, more than half of premenopausal women and about one-fifth of postmenopausal women. [1] Patients with cancer are at increased risk of developing osteopenia and osteoporosis following adjuvant chemotherapy. Cancer Therapy-Induced Bone Loss (CTIBL) is an important cause of secondary osteoporosis, which cause bone fragility and an increased risk of fractures, decreased quality of life and increased mortality. [2],[3] It is estimated that bone loss after cancer chemotherapy can increase up to tenfold higher than normal. [4],[5],[6] With better management and newer drugs for chemotherapy, many patients survive from malignancy but they are faced with a more crippling secondary osteoporosis. [7],[8],[9] Osteopenia and osteoporosis continue to progress without being diagnosed in patients with cancer until a fracture occurs, which leads to increased morbidity and mortality.

There is little literature, if any, on the impact of chemotherapy on bone loss among survivors of cancer in Saudi Arabia. With the main objective to assess the prevalence of CTIBL, this retrospective study was conducted to assess the prevalence of bone loss in our patients who had received chemotherapy for cancer.

 Material and Methods



The subjects in this study included patients who had received chemotherapy due to a malignant condition in the last five years. Patients were attending the outpatient oncology and orthopedic clinics between June 1, 2006 and November 30, 2006, were included in the study. The importance of the study was explained to the patients who provided a verbal consent. Age, sex, type of malignancy, last chemotherapy cycle and body mass index (BMI) of patients was entered in the database. Complete blood picture, serum calcium, phosphorous, alkaline phosphatase, renal function tests and liver function tests were done. Bone mineral density (BMD) measurement of the hip and spine was done using Dual-Energy X-ray Absorptiometry (DEXA; Hologic Inc.). Osteopenia and osteoporosis were defined per the definition of World Health Organization. The data were entered in the database and analyzed using SPSS Inc version 14 (Chicago, Illinois). [10] Descriptive statistics are expressed as mean ± SD unless otherwise mentioned. Categorical data were analyzed using χ2 or Fisher's exact test, as appropriate. A value of P 50 years ( P = 0.001). Patients who received the last cycle of chemotherapy of less than 2 years were significantly more osteoporotic (81.5%-18.5%; P [11] It was little anticipated that patients who survive their ordeal of cancer and chemotherapy will face another serious debilitating condition such as secondary osteoporosis. [7],[9] Bone loss after cancer chemotherapy is more rapid in such patients than in normal population between 1% and 5% per year. [12] Bone loss due to cancer therapy should be prevented as bone once lost becomes difficult to regain. Twiss et al . (2001) [13] found that 80% of their patients with breast cancer had abnormal BMD indicating osteopenia or osteoporosis. In this study, we found that even after discontinuation of the chemotherapy 59.67% of patients had abnormal BMD, indicating either osteopenia or osteoporosis.

Early detection of osteopenia and osteoporosis by BMD measurement is essential. A recent survey reported that even in the developed countries, 3% to 32% of high-risk patients on cancer therapy had a BMD. [14],[15] In our own institution, a BMD was done in 4.22% of patients before this study was undertaken. It raises serious concern about physicians' apathy in regular evaluation of patients by BMD. This study shows that even after initial antiresorptive therapy, patients require regular follow-up and correction of their bone loss by multicomponent intervention for postcancer therapy osteoporosis with calcium and vitamin D [16] , physical exercise, lifestyle modification and drugs such as calcitonin, oral or intravenous bisphosphonates and selective estrogen-receptor modifiers (SERMS). [17]

Patients with osteoporosis and its related complications has become one of the major causes of morbidity and unprecedented increase in health care budgets in the Western world. The estimated life-time cost of a hip fracture is now increased to $81,300, with an annual budget in the United States increasing to $13 billion. [18] In developing countries, the economic expenses due to postmenopausal osteoporosis and the expenses of secondary osteoporosis such as CTIBL is still to be assessed. Our search of the English language literature did not reveal any reported studies on CTIBL from Gulf countries in general and Saudi Arabia specifically and this retrospective analysis has shown a high percentage of patients with cancer who suffer from osteoporosis due to the effects of their cancer chemotherapy. It will be a pity for these patients to get cured of their malignancies only to succumb to osteoporosis-related fractures with high morbidity and mortality.

In conclusion, we believe that patients in postcancer chemotherapy are at a significant risk of increased bone loss. Second, patients need to be monitored with regular BMD measurements to assess the effect of initial antiresorptive therapy. Our results indicate that after cancer chemotherapy not only women but men continued to suffer from osteoporosis. Special efforts are needed to formulate policies to diagnosis and proper treatment of osteoporosis secondary to cancer chemotherapy.

References

1Painter SE, Kleerekoper M, Camacho PM. Secondary osteoporosis: a review of the recent evidence. Endocr Pract 2006;12:436-45.
2Hoff AO, Gagel RF. Osteoporosis in breast and prostate cancer survivors. Oncology (Williston Park) 2005;19:651-8.
3Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med 1997;103:12S-7.
4Eastell R, Hannon RA, Cuzick J, Dowsett M, Clack G, Adams JE et al . Effect of anastrozole on bone density and bone turnover: results of the "Arimidex" (anastrozole), Tamoxifen. Alone or in combination (ATAC) trial. J Bone Miner Res 2006;21:1215-23.
5Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer. J Oncology 2001;19:3306-11.
6Higano CS. Understanding treatments for bone loss and bone metastatses in patients with prostatic cancer: a practical review and guide for clinicians. Urol Clin North Am 2004;31:331-52.
7Headley JA, Theriault RL, LeBlanc AD, Vassilopoulou-Sellin R, Hortobagyi GN. Pilot study of bone mineral density in breast cancer patients treated with adjuvant chemotherapy. Cancer Invest 1998;16:6-11.
8Lappe JM, Tinley ST. Prevention of osteoporosis in women treated for hereditary breast and ovarian carcinoma: a need that is overlooked. Cancer 1998;83:830-4.
9Mahon SM. Osteoporosis: A concern for cancer survivors. Oncol Nurs Forum 1998;25:843-51.
10SPSS, statistical software package, version 14.0. SPSS Inc. Chicago, Illinois, 2007.
11Eid HS, Arteh SO. Cancer incidence report on Saudi Arabia 1999-2000. Published by the main office, National Cancer Registry, under the Depository number at King Fahad National Library, 3480/22, date 6/9/1422H, ISSN:1658-0559, Riyadh May 2004, Page 22.
12Guise TA. Bone loss and fracture risk associated with cancer therapy.Oncologist 2006;11:1121-31.
13Twiss JJ, Waltman N, Ott CD, Gross GJ, Lindsey AM, Moore TE. Bone mineral density in postmenopausal breast cancer survivors. J Am Acad Nurse Pract 2001;13:276-84.
14Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, et al . Patterns of bone mineral density testing: current guidelines, testing rates, and Interventions. J Gen Intern Med 2004;19:783-90.
15Smith MD, Ross W, Ahern MJ. Missing a therapeutic window of opportunity: an audit of patients attending a tertiary teaching hospital with potentially osteoporotic hip and wrist fractures. J Rheumatol 2001;28:2504-8.
16Waltman NL, Twiss JJ, Ott CD, Gross GJ, Lindsey AM, Moore TE, et al . Testing an intervention for preventing osteoporosis in postmenopausal breast cancer survivors. J Nurs Scholarsh 2003;4:333-8.
17Michaud LB, Goodin S. Cancer-treatment-induced bone loss part2.Amer J Health Syst Pharm 2006;63:534-46.
18King AB, Saag KG, Burge RT, Pisu M, Goel N. Fracture reduction effects Medicare economics (FRAME): impact of increased osteoporosis diagnosis and treatment. Osteoporosis Inter 2005;16:1545-57.