The International Osteoporosis Foundation (IOF) Bone and Cancer Working Group has released a comprehensive review detailing the often underrecognised impact of modern anti-cancer treatments on bone health.

Published in Calcified Tissue International, the article Bone Effects of Anti-Cancer Treatments in 2024 was conducted by an international team of 14 experts across Europe, Australia, Canada, South Africa, and the Middle East.

It highlights the pressing need to address cancer treatment-induced bone loss (CTIBL), including in patients undergoing cutting-edge therapies.

Professor Cyrille B.Confavreux, last and corresponding author of the review and member of the IOF Bone and Cancer Working Group, stated: “Significant advancements in cancer treatment have emerged over the past decade with the introduction of anti-cancer immunotherapies, such as immune checkpoint inhibitors, and targeted therapies, including tyrosine kinase inhibitors. Consequently, many patients experience long-lasting remissions and cures. This means more cancer patients are facing new long-term challenges—among them, bone fragility and the increased risk of fractures.”

The publication provides a concise review of the bone effects of major anti-cancer therapies currently in use, including newer agents, and discusses their known cellular impacts, effects on bone mineral density (BMD), and fracture incidence by drug category.

Among the key messages:

• Drugs such as glucocorticoids, hormone therapies, antiangiogenic drugs, and immune checkpoint inhibitors show varying degrees of detrimental effects on bone mineral density (BMD), fracture risk, or bone cell function. Some, like tyrosine kinase inhibitors (TKIs) or proteasome inhibitors, seem to be more protective for bone. 
• Even short-term or high-dose intermittent use of medications like dexamethasone can significantly weaken bones and significantly increase the risk of fracture, especially in vulnerable populations such as the elderly or paediatric cancer patients.
• Immunotherapies —heralded for their efficacy in treating previously untreatable cancers—are now linked to increased fracture rates and disruptions in bone remodelling. 
• The authors underscore the urgency for clinical trials dedicated to evaluating the bone safety profiles of new anti-cancer drugs, as human data on BMD or fracture risk are scarce or unknown.
• Anti-resorptive agents such as bisphosphonates and denosumab have shown promise in mitigating bone loss, yet are underutilised, particularly in men undergoing androgen deprivation therapy or women receiving aromatase inhibitors for breast cancer.

Professor René Rizzoli, Chair of the IOF Bone and Cancer Working Group, stated.

“While today’s cancer therapies have significantly improved survival, they come with a hidden cost—an increased risk of bone loss and life-altering fragility fractures.”

“For this reason, we strongly advocate for a multidisciplinary approach, bringing together oncologists, endocrinologists, and general practitioners to ensure early screening and proactive bone-protective strategies for patients at high risk of fracture.”

Source: International Osteoporosis Foundation