Clin Osteol 2026; 31(1): 26-34 | DOI: 10.36290/clo.2026.004

Comprehensive overview of bone disease in oncology patientsMain theme

Beata Špániková
Osteocentrum pre vybrané onkologické diagnózy, Onkologický ústav sv. Alžbety, Bratislava

The issue of bone changes in cancer patients an interesting and important part of supportive care for cancer patients. The incidence of many cancers is increasing, thanks to advances in treatment options, many cancer patients are surviving for a long time. Decrease in bone density is often result of the cancer disease itself and/or adverse event of anticancer therapy. Therefore, solving this problem is of great importance for the quality of life of long-term survivors. In this article we present an overview of the most common skeletal complications, their underlying pathophysiological mechanisms, diagnostic and differential diagnostic and the therapeutic management options. Our Osteocenter for selected oncological diagnoses in OUSA Bratislava celebrates its twentieth anniversary. This is one of the reasons for writing this article as a summary of our results. It can be a solution guide at the same time to the approach to oncological patients at risk of BMD decrease or already developed osteoporosis

Keywords: bone mineral density, cancer, metastases, anticancer treatment, osteocenter.

Accepted: March 25, 2026; Published: March 30, 2026  Show citation

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Špániková B. Comprehensive overview of bone disease in oncology patients. Clinical Osteology. 2026;31(1):26-34. doi: 10.36290/clo.2026.004.
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References

  1. Prezentácia výstupov (4.4.0, rev.: 009c1b7 z 15.11.2022). Available from: https://iszi.nczisk.sk/nor.sr/.
  2. Ondrušová M, Kyselicová A, Suchanský M. Vybrané deskriptívne ukazovatele epidemiológie zhubných nádorov prostaty (C61) v SR. Bratislava: Pharm In; 2024. Elektronická publikácia. Available from: www.pharmin.sk.
  3. Ondrušová M, Suchanský M, Fajbiková A. Vybrané epidemiologické indikátory zhubných nádorov prsníka v SR. Bratislava: Pharm In; 2024. Elektronická publikácia.
  4. Riggs BL, Khosla S, Melton LJ 3rd. Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev. 2002;23(3):279.302. doi:10.1210/edrv.23.3.0465. Go to original source... Go to PubMed...
  5. Almeida M, Laurent MR, Dubois V, et al. Estrogens and androgens in skeletal physiology and pathophysiology. Physiol Rev. 2017;97(1):135-187. Go to original source... Go to PubMed...
  6. Armas LA, Recker RR. Pathophysiology of osteoporosis: new mechanistic insights. Endocrinol Metab Clin North Am. 2012;41(3):475.486. Go to original source... Go to PubMed...
  7. Khan MN, Khan AA Cancer treatment-related bone loss 2008: a review and synthesis of the literature. Curr Oncol. 2008 Jan;15(Suppl 1):S30-40. doi: 10.3747/co.2008.174. PMID: 18231646; PMCID: PMC2216420. Go to original source... Go to PubMed...
  8. Howell A, Cuzick J, Baum M, et al; ATAC Trialists' Group. Results of the ATAC trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 2005;365(9453):60-62. Go to original source... Go to PubMed...
  9. Coleman RE, Banks LM, Girgis SI, et al. Skeletal effects of exemestane in postmenopausal women with early breast cancer: Intergroup Exemestane Study. Lancet Oncol. 2007;8(2):119-127. Go to original source... Go to PubMed...
  10. Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350(16):1655-1664. Go to original source... Go to PubMed...
  11. Kanis JA. Diagnosis of osteoporosis. Osteoporos Int. 1997;7(Suppl 3):S108-S116. Go to original source... Go to PubMed...
  12. Eastell R, Hannon RA, Cuzick J, et al; ATAC Trialists' Group. Effect of an aromatase inhibitor on BMD and bone turnover: 2 year results of ATAC trial. J Bone Miner Res. 2006;21(8):1215-1223. Go to original source... Go to PubMed...
  13. Maillefert JF. Bone mineral density in men treated with GnRH agonists. J Urol. 1999;161(4):1219-1222. Go to original source...
  14. Shapiro CL, Manola J, Leboff M. Ovarian failure after adjuvant chemotherapy and bone loss. J Clin Oncol. 2001;19:3306-3311. Go to original source... Go to PubMed...
  15. Hopson MB, Onishi M, Awad D, et al. Changes in bone quality in premenopausal breast cancer patients receiving chemotherapy. Clin Breast Cancer. 2020;20(3):e327-e333. Go to original source... Go to PubMed...
  16. Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures after pelvic irradiation. JAMA. 2005;294(20):2587-2593. Go to original source... Go to PubMed...
  17. Ikushima H, Osaki K, Furutani S, et al. Pelvic insufficiency fractures after radiotherapy. Gynecol Oncol. 2006;103(3):1100-1104. Go to original source... Go to PubMed...
  18. Chatzimavridou Grigoriadou V, Barraclough LH, Kochhar R, et al. Radiotherapy related insufficiency fractures and BMD. Endocr Connect. 2023;12(7):e220328. Go to original source... Go to PubMed...
  19. Spanik S, Spanikova B. Bone mineral density in early breast cancer patients. Bratisl Lek Listy. 2010;111(1):27-32.
  20. Mittan D, Lee S, Miller E, et al. Bone loss after hypogonadism in prostate cancer treated with GnRH analogs. J Clin Endocrinol Metab. 2002;87(8):3656-3661. Go to original source... Go to PubMed...
  21. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation. N Engl J Med. 2005;352:154-164. Go to original source... Go to PubMed...
  22. Khosla S. New insights into androgen and estrogen receptor regulation. J Bone Miner Res. 2015;30(7):1134-1137. Go to original source... Go to PubMed...
  23. Vehmanen L, Sievänen H, Kellokumpu Lehtinen P, et al. Long term impact training and BMD in early breast cancer. Osteoporos Int. 2021;32:473-482. Go to original source... Go to PubMed...
  24. Zhang J, Quan Y, Wang X, et al. Global epidemiology of malnutrition in cancer patients. BMC Cancer. 2025;25:1191. Go to original source... Go to PubMed...
  25. Tisdale MJ. Cachexia in cancer. Nat Rev Cancer. 2002;2:862-871. Go to original source... Go to PubMed...
  26. Argilés JM, López Soriano FJ. Cancer associated cachexia. Nat Rev Clin Oncol. 2023;20(4):250-264. Go to original source... Go to PubMed...
  27. Nutricia s.r.o. Malnutrícia ako problém sprevádzajúci ochorenia. Bratislava: Nutricia; 2025. Available from: https://www.e.nutricia.sk/clanek/podvyziva-ako-problem-sprevadzajuci-mnoho-ochoreni/85.
  28. Arends J. Malnutrition in cancer patients. Eur J Surg Oncol. 2024;50(5):107074. Go to original source... Go to PubMed...
  29. Karpouzos A, Diamantis E, Farmaki P, et al. Nutritional aspects of bone health. J Osteoporos. 2017;2017:4218472. Go to original source... Go to PubMed...
  30. Rizzoli R. Nutritional aspects of bone health. Best Pract Res Clin Endocrinol Metab. 2014;28(6):795-808. Go to original source... Go to PubMed...
  31. Villareal DT, Fontana L, Weiss EP, et al. BMD response to caloric restriction or exercise. Arch Intern Med. 2006;166:2502-2510. Go to original source... Go to PubMed...
  32. Kim HJ, Lee YM, Ko BS, et al. Vitamin D deficiency and prognosis in breast cancer. Ann Surg Oncol. 2011;18(7):1830-1836. Go to original source... Go to PubMed...
  33. Ness RA, Duane D, Miller DD, et al. Vitamin D in cancer prevention. Chin J Nat Med. 2015;13(7):481-497. Go to original source... Go to PubMed...
  34. Vieth R, Bischoff Ferrari H, Boucher BJ, et al. Need for effective vitamin D intake. Am J Clin Nutr. 2007;85:649.650. Go to original source... Go to PubMed...
  35. Body JJ, Bergmann P, Boonen S, et al. Extraskeletal benefits of vitamin D. Osteoporos Int. 2012;23(Suppl):S1.S23. Go to original source... Go to PubMed...
  36. Krishnan AV, Swami S, Feldman D. Vitamin D and breast cancer signaling. J Steroid Biochem Mol Biol. 2010;121:343-348. Go to original source... Go to PubMed...
  37. Krajewski W, Dziegala M, Dembowski J, et al. Vitamin D and urologic cancers. Cent European J Urol. 2016;69(2):139-147.
  38. Holtzman B, Popp KL, Tenforde AS, et al. Low energy availability and BMD. Bone. 2022;14(5):587. Go to original source... Go to PubMed...
  39. Kanis JA, Oden A, Johnell O, et al. Burden of osteoporotic fractures. Osteoporos Int. 2001;12(5):417. Go to original source... Go to PubMed...
  40. Ministerstvo zdravotníctva SR. Usmernenie o diagnostike a liečbe osteoporózy u onkologických pacientov. Vestník MZ SR. 2014;62:27-32.
  41. Pienta KJ, Robertson BA, Coffey DS, et al. Cancer diaspora. Clin Cancer Res. 2013;19(21):5849-5855. Go to original source... Go to PubMed...
  42. Clézardin P, Coleman R, Puppo M, et al. Bone metastasis mechanisms. Physiol Rev. 2021;101:797-855. Go to original source... Go to PubMed...
  43. Coleman RE, Croucher PI, Padhani AR, et al. Bone metastases. Nat Rev Dis Primers. 2020;6:83. Go to original source... Go to PubMed...
  44. Hiraga T. Targeted agents for bone metastases. Expert Opin Investig Drugs. 2016;25(3):319-334. Go to original source... Go to PubMed...
  45. Yu HM, Hoffe SE. Bone metastasis: epidemiology and diagnosis. Uptodate. 2025.
  46. Horiguchi T, Tachikawa S, Kondo R, et al. ICTP as marker for lung cancer bone metastasis. Jpn J Clin Oncol. 2000;30(4):174-179. Go to original source... Go to PubMed...
  47. Koga H, Naito S, Koto S, et al. ICTP in prostate cancer bone metastasis. Prostate. 1999;39(1):1-7. Go to original source...
  48. Vani SA, Ananthanarayanan PH, Nandeesha H, et al. Vitamin D and calcium supplementation in letrozole therapy. Clin Chim Acta. 2016;459:53-56. Go to original source... Go to PubMed...
  49. Coleman RE. Clinical features of metastatic bone disease. Clin Cancer Res. 2006;12:6243s. Go to original source... Go to PubMed...
  50. Hadji P, Aapro M, Al Dagri N, et al. AIBL management: updated statement. J Bone Oncol. 2025;53:100694. Go to original source... Go to PubMed...
  51. Coleman R, Body JJ, Aapro M, et al. Bone health in cancer patients: ESMO guidelines. Ann Oncol. 2014;25(Suppl 3):iii124-iii137. Go to original source... Go to PubMed...
  52. Coleman R, Hadji P, Body JJ, et al. ESMO Bone health guidelines (2020). Ann Oncol. 2020;31(12):1650-1663. Go to original source...
  53. Hadji P, Aapro MS, Body JJ, et al. Management of AI associated bone loss. Ann Oncol. 2011;22(12):2546-2555. Go to original source... Go to PubMed...
  54. Waqas K, Lima Ferreira J, Tsourdi E, et al. CTIBL management guidance. J Bone Oncol. 2021;28:100355. Go to original source... Go to PubMed...
  55. Gnant MF, Mineritsch B, Luschin Enengreuth G, et al. Zoledronic acid in endocrine therapy induced bone loss. J Clin Oncol. 2007;25:820. Go to original source... Go to PubMed...
  56. Coleman R, Finkelstein DM, Barrios C, et al. D CARE denosumab study. Lancet Oncol. 2020;21:60-72. Go to original source... Go to PubMed...
  57. Khan MI. Managing endocrine therapy induced bone loss. Osteoporos Int. 2023;34:671-680. Go to original source... Go to PubMed...
  58. Eisen A, Somerfield MR, Accordino MK, et al. Adjuvant bisphosphonates in breast cancer. J Clin Oncol. 2022. doi:10.1200/JCO.21.02647 Go to original source... Go to PubMed...
  59. Ministerstvo zdravotníctva SR. Diagnostika a liečba osteoporózy u onkologických pacientov. Vestník MZ SR. 2014;62:27-32.
  60. Coleman R, Hadji P, Body JJ, et al. ESMO Bone health guidelines (2020). Ann Oncol. 2020;31(12):1650-1663. Go to original source...
  61. Coleman R, Hadji P, Body JJ, et al. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1650 1663. Go to original source... Go to PubMed...
  62. Hadji P, Coleman R, Wilson C, et al. Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel. Ann Oncol. 2016;27(3):379 390. Go to original source... Go to PubMed...
  63. Novartis Pharmaceuticals. Zometa (zoledronic acid). Summary of Product Characteristics.
  64. Amgen. Xgeva/Prolia (denosumab). Summary of Product Characteristics.




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