Bone Health in Cancer Patients
- Written by N. Simon Tchekmedyian, MD
- Category: Prostate Cancer
Did you know? We have done a lot of work over many years to develop new treatments to enhance bone health in patients with cancer. Here are some examples:
Working together with doctors in the US, Canada and Brazil as well as Novartis Pharmaceuticals, we conducted a clinical trial of Zoledronic acid in patients with hormone refractory metastatic prostate cancer. The results, published in the Journal of the National Cancer Institute (J Natl Cancer Inst 2002;94:1458-68)*, showed that Zoledronic acid reduced skeletal-related events (meaning complications such as bone fractures, need for surgery to bone, need for radiation therapy to bone, or need to change treatment to treat bone pain). This treatment is now standard therapy for patients with prostate cancer and bone metastases.
Working with doctors in Massachusetts, Louisiana, Arizona, and California, we conducted a study of Zoledronic acid to prevent bone loss in patients receiving androgen deprivation therapy for nonmetastatic prostate cancer. The results, published by the American Urological Association (Journal of Urology, Vol. 169, 2008-2012, June 2003)** showed that Zoledronic acid increases bone mineral density in the hip and spine during androgen deprivation therapy for nonmetastatic prostate cancer. This is now a good option of therapy for patients with prostate cancer on androgen deprivation therapy.
Working with doctors in the US, Canada, Australia and Poland, as well as Novartis pharmaceuticals, we conducted a study of Zoledronic acid for the treatment of bone metastases in patients with lung cancer and other solid tumors. The results, published in the Journal of Clinical Oncology (J Clin Oncol 21:3150-3157, 2003)***, showed that Zoledronic acid reduced skeletal complications in these patients (meaning complications such as bone fractures, need for surgery to bone, need for radiation therapy to bone, or spinal cord compression). This treatment is now a standard for patients with various cancers and bone metastases.
Would you like an explanation? Here is how Zoledronic acid works: it reduces bone destruction. Lack of testosterone in men or lack of estrogen in women, and or the presence of cancer in bones, accelerates the destruction of bones, causing thinning and leading to painful and severe fractures. Zoledronic acid, given by intravenous drip at various intervals depending on the condition, stops bone destruction.
Actually, used as a once a year dose, Zoledronic acid (also known by the brand name Reclast) is used to treat osteoporosis; the mechanism is the same, it stops bone destruction. People with osteoporosis face complications as they age, including loss of height and forward bending of the spine (due to vertebral compression fractures). In order to understand the process, imagine bones as being brick walls and 2 crews of workers: one crew takes the bricks and mortar out(destroys bones), and another places the bricks and mortar back in (makes bone). This is normal because bones are very much alive and are being constantly refurbished. In osteoporosis, the crew destroying bones works faster than the one making bones. Zoledronic acid stops the crew that destroys bones (in the body, the crew that destroys bones is made of cells called osteoclasts). One thing to remember is that the treatment does not increase the activity of the crew that makes bones (cells called osteoblasts). That is why we encourage physical activity with weight bearing exercises when feasible, because that is the best way to have your body make more good quality bone.
What to watch for? Zoledronic acid tends to send calcium back into bones, so patients generally need to take calcium supplements. Rarely, it can cause a complication known as osteonecrosis of the jaw (ONJ) which consists of a non healing area in the jaw bone inside the mouth especially after oral surgery. That is why we always ask if you are planning any oral surgery before we administer this medication. It can cause kidney problems in patients who have kidney disease. There are several alternatives to Zoledronic acid to treat cancer in bones or osteoporosis, so please discuss your individual situation with your doctor.
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