Changes in Bone Mineral Density in Newly Diagnosed Testicular Cancer Patients After Anticancer Treatment

• Published in: The journal of clinical endocrinology and metabolism 2014-11, Vol.99 (11), p.4101-4108
• Main Authors: Willemse, P. M, Hamdy, N. A. T, de Kam, M. L, Burggraaf, J, Osanto, S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - pharmacology; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone Density - drug effects; Endocrinopathies; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Humans; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - drug effects; Male; Medical sciences; Middle Aged; Neoplasms, Germ Cell and Embryonal - drug therapy; Pelvic Bones - diagnostic imaging; Pelvic Bones - drug effects; Radiography; Testicular Neoplasms - drug therapy; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2014-1722

Context: Patients with germ cell tumors (GCTs) have an excellent prognosis but are at risk for silent fractures. Data on bone mineral density (BMD) after anticancer treatment are scarce. Objective: The objective of the study was BMD monitoring in GCT patients treated with or without chemotherapy. Design: We prospectively studied 63 newly diagnosed GCT patients with a median age of 33 years (range 16–70 y) within 3 months of unilateral orchidectomy. Twenty-seven patients (42.9%) had no metastases. Thirty-six patients (57.1%) with metastatic disease received combination chemotherapy. Setting: This study was conducted at the outpatient clinic of a single academic institution. Interventions: We performed dual-energy X-ray absorptiometry scans and collected blood samples on a yearly basis, before and up to 5 years after anticancer treatment. Main Outcome Measures: Changes in total hip and lumbar spine BMD, serum concentrations of gonadal hormones, and bone turnover markers were measured. Results: BMD remained normal in stage I patients. In patients with metastatic disease, a significant decrease in lumbar spine BMD (−1.52%; P = .004) and total hip BMD (−2.05%; P < .0001) was observed 1 year after chemotherapy and remained stable thereafter for up to 5 years. There was no significant relationship between the observed decrease in BMD and gonadal status, vitamin D status, or cumulative dose of cisplatin or (antiemetic) corticosteroids. Conclusions: Metastatic GCT survivors demonstrate significant bone loss within the first year after curative combination chemotherapy, with no recovery up to 5 years after anticancer treatment. Whether this bone loss is associated with increased fracture risk and whether this could be prevented by bone modifying treatment remains to be established.