Certain Types of Cancer Linked to Higher Risk for Bone Fracture MONTREAL—Patients with primary bone cancer, multiple myeloma, and metastases to the bone are approximately three to five times more likely than others to suffer a fracture within 12 months of their diagnosis, according to a new Danish study. The investigators, who presented their findings at the American Society for Bone and Mineral Research 30th Annual Meeting, also found that patients with metastases to organs other than bone, as well as those with lung, liver, gallbladder, and pancreatic cancers were at elevated risk of fracture within 12 months of diagnosis. On the other hand, patients with breast cancer, skin cancer, and cancer of the colon or rectum were not found to be at elevated risk, said study investigator Lars Rejnmark, MD, who is an attending physician at Aarhus University Hospital, Denmark. He said these findings should be of special interest to oncology nurses because they suggest that patients at elevated risk should be managed more aggressively and
counseled thoroughly. “If fracture is a main feature of the cancer, then it needs to be prevented,” said Rejnmark in an interview with The Oncology Nurse. “Nurses are very important information providers on these types of findings. They are the ones who need to counsel the patients about healthy living and the importance of adequate vitamin D. I think vitamin D malabsorption may be playing a role in some of these cancer patients, and that is easily treated with supplementation of vitamin D, either through tablets or injections.” He advised that all patients with the types of cancer associated with elevated risk for fracture should not only be screened thoroughly for bone mineral density levels but also for serum vitamin D levels. Rejnmark noted that there have been few studies on the risk of fracture in patients with cancer and little is known on the mechanisms of fractures in patients with cancer. He and his col-
leagues studied the risk of fracture in almost 500,000 cancer patients. The case-control study included 124,655
“We found that with prostate cancer there was a difference. Patients with prostate cancer did not have any
If fracture is a main feature of the cancer, then it needs to be prevented. fracture cases and 373,962 age- and sexmatched controls. The investigators found that within 12 months of diagnosis, the risk for a fracture among primary bone cancer patients was 3.51 times greater than the controls, 5.21 times greater for patients with multiple myeloma, and 5.28 times greater for patients with metastases to the bone. In addition, the risk for fracture was elevated in patients with metastases to organs other than bone (1.85 times greater), in patients with lung cancer (1.90 times greater), and in patients with cancer of the liver, stomach, gallbladder, and pancreas (2.14 times greater).
BONE METASTASES
Bone Metastases
increased risk during the first 12 months after diagnosis. However, they did have an increased risk after the first year,” explained Rejnmark. He said all other types of cancer, including skin and breast, were not associated with an increased risk for fracture within 12 months after their cancer diagnosis. He said these findings are important because they suggest those patients with elevated risk should be selected for prevention strategies and that bone health needs to be addressed by both nurses and physicians earlier rather than later in the course of their treatment. —JS
MONTREAL—Preliminary data presented at the American Society for Bone and Mineral Research 30th Annual Meeting are suggesting that strength training exercises may help prevent bone loss in older women who have been treated for breast cancer. This is the first study of its kind, and while it is ongoing, the current results show that for the first time there may be a proactive, nonpharmacologic approach a breast cancer survivor can take to lower her risk for osteoporosis and subsequent fractures. “This is a big deal. Because of age, these women are at higher risk for osteoporosis and related fractures,” said lead study investigator Kerri Winters-Stone, PhD, associate professor and research scientist, School of Nursing at Oregon Health & Science University, Portland. “This is something they can do on their own. They can preserve their bone health so they may never be a candidate for medications for preventing bone loss.” Winters-Stone said that is a very important issue to breast cancer survivors. She said many do not want to take any more medications than they have to because they have suffered so many side effects from their breast December 2008
cancer treatments. Until now, few studies have focused on how different types of exercise interventions, particularly strength training, may benefit older patients with breast cancer. Winters-Stone and her colleagues conducted a 12-month randomized controlled trial of strength (STR) training versus flexibility (FLEX) training in early-stage, older breast cancer survivors. The mean age of the women was 63.7 years, and the majority had stage I (40%) or stage II (41%) disease. On average, all the women were 12.5 years past diagnosis. Among these women 78% had undergone radiation therapy, 74% were currently on hormone manipulation therapy, and 48% had received chemotherapy. Exercise training was done three times per week, with two onsite sessions and one at-home session. Each session was 60 minutes in duration. The STR group performed progressive lowerbody and upper-body strength training, and each woman did one to two sets of nine exercises. The FLEX group performed progressive flexibility and relaxation exercises. After 12 months, the researchers found that spine and hip bone mineral density (BMD) was maintained in
women who performed regular strength training exercises (0.3% and –0.8%, respectively). Conversely, BMD decreased at both sites in the control group that performed only flexibility exercise (–1.7% and –1.6% at the spine and hip, respectively). “So after 1 year of strength training, these older breast cancer survivors maintained bone at the spine and hip, in contrast to a group that performed flexibility exercises. They lost bone density over that same time period,” said Winters-Stone in an interview with The Oncology Nurse. “Regular strength training can help maintain bone health and possibly reduce the risk of fracture after the treatment of breast cancer. This is a nonpharmacologic strategy for reducing fracture, and that is important for a couple of reasons. Many women are looking for nonpharmacologic strategies because they get tired from the treatments. Another reason women may like this is that this is something they can do on their own.” She noted that breast cancer survivors overall may have higher risk for fracture and osteoporosis compared with similarly aged women with no breast cancer history. She cautioned, however, that these findings
©iStockphoto.com/Kikolay Mamluke
are preliminary, and the study is ongoing. Winters-Stone also said this study included only women who had normal to low bone mass, but no osteoporosis. —John Schieszer
G REEN H ILL H EALTHCARE C OMMUNICATIONS
19
BONE METASTASES
Strength Training May Help Prevent Bone Loss in Older Breast Cancer Patients