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Lymphomation.org > Side Effects > Bone Density Loss

Last update: 06/21/2014

TOPIC SEARCH:  PubMed

Premature bone density loss is associated with lymphoma, with standard treatment, and treatment-induced menopause.

Research strongly suggests that bone density screen should be routine for lymphoma patients as low bone marrow density is associated with lymphoma at baseline (before treatment) and can be made worse by standard treatments.

"In patients at least 50 years of age, 54% of men and 40% of women had baseline osteopenia.

Therapy of lymphoma with high-dose glucocorticoids and alkylating agents may result in premature bone loss, increasing the risk of vertebral and hip fractures. 

Surprisingly, stage and bone or marrow involvement were not relevant factors in the rates of osteopenia or osteoporosis in this study. Regardless, these findings suggest that older male patients with lymphomas may be at higher risk of osteopenia than older men in the general population."
http://1.usa.gov/1ij5SAW

Research News

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Zoledronic Acid for Prevention of Bone Loss in Patients Receiving Primary Therapy for Lymphomas: A Prospective, Randomized Controlled Phase III Trial http://1.usa.gov/1ij5SAW 

Therapy of lymphoma with high-dose glucocorticoids and alkylating agents may result in premature bone loss, increasing the risk of vertebral and hip fractures. Exogenous glucocorticoids result in an increased risk of osteoporosis-related fractures by increasing bone resorption and decreasing bone formation, calcium retention, muscle mass, and endocrine gonadal function.2–8 Brief high-dose exposure to corticosteroids results in a durable increased risk of fracture and potential for avascular necrosis.4,9 In addition, alkylating agent–induced endocrine gonadal damage is a common complication and affects both men and women.1,10–13

To date, the effect of ZA on bone health has not been evaluated in patients with previously untreated lymphomas. In this study, our objective was to determine the effect of ZA in prevention of bone loss for patients undergoing initial treatment for lymphomas.

In patients at least 50 years of age, 54% of men and 40% of women had baseline osteopenia. The screening failures and patients who were not evaluable had rates of baseline bone loss that were nearly identical to the evaluable group (Table 2). Neither disease stage nor bone or marrow involvement were significant factors for baseline osteopenia.

Survivorship issues for patients with lymphomas, including bone health, are of increasing importance as long-term outcomes continue to improve. Our results demonstrate that 2 doses of ZA along with calcium and vitamin D supplementation effectively prevents further bone loss in patients with newly diagnosed lymphoma. The mechanisms for the low BMD seen at diagnosis, which may worsen after lymphoma therapy, are unclear but are in agreement with previous findings of others.42,43

In comparison with community osteopenia rates, we found that men at least 50 years of age with newly diagnosed lymphomas had a higher rate of osteopenia (54% vs. 30%), whereas females at least 50 years of age with lymphomas had an equivalent rate (40% vs. 49%).44

The reasons for this sex difference are unclear but may include the small sample size of our population or lymphoma-induced hormonal or cytokine-related bone changes.1

Surprisingly, stage and bone or marrow involvement were not relevant factors in the rates of osteopenia or osteoporosis in this study. Regardless, these findings suggest that older male patients with lymphomas may be at higher risk of osteopenia than older men in the general population.
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Eur Radiol. Mar 2007; 17(3): 743–761. Published online Sep 21, 2006
MR imaging of therapy-induced changes of bone marrow http://1.usa.gov/1iurdY2
 
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