Module Abstract

Breast Cancer and Bone Health: New and Emerging Treatment Options

Abstract

A substantial proportion of the morbidity from breast cancer can be attributed to bone disease resulting from both the disease and its treatment. Issues surrounding bone health in breast cancer patients are particularly pressing in postmenopausal women, who may begin to develop osteoporosis because of natural ovarian failure. Optimal bone health depends on a balanced cycle of bone turnover and remodeling. Bone metastases in patients with breast cancer produce an imbalance in bone homeostasis, which can lead to increased risk of fracture and spinal cord compression as well as the need for surgery and/or radiotherapy. Localized, nonmetastatic breast cancer also increases the risk of osteoporosis and fracture. Bone metastases are present in up to 70% of breast cancer patients in postmortem analyses. During a 2-year period, approximately two thirds of breast cancer patients with metastatic bone disease will experience at least 1 skeletal-related event such as bone pain, pathological fractures, hypercalcemia, or spinal cord compression because of bone involvement. Treating breast cancer patients with bone metastases involves a comprehensive multidisciplinary approach that includes standard anticancer agents in conjunction with supportive and palliative therapies. As a more detailed understanding develops of the mechanisms underlying bone disease and repair, treatments are being designed that target cellular pathways, and treatment strategies can be tailored to individual patients. In metastatic bone disease, measurement of markers of bone turnover is being used with increasing frequency to evaluate prognosis and risk of skeletal morbidity. Incorporating strategies to minimize bone loss in the clinical management of breast cancer patients can be facilitated by national and international guidelines regarding bone health.