Correspondence

Anabolic Therapies for Osteoporosis

N Engl J Med 2007; 357:2410-2411December 6, 2007

Article

To the Editor:

In their review of anabolic therapies for osteoporosis, Canalis et al. (Aug. 30 issue)1 mention contraindications to teriparatide use, including skeletal malignant conditions. We wish to add an additional caution concerning the use of this drug in patients with a history of cancer. Patients with non–small-cell lung cancer, breast cancer, and other cancers have been shown to have micrometastatic tumor cells in the bone marrow that are associated with poor outcomes.2,3 It is not known whether patients without evidence of disease for many years have “micrometastases” in the bone marrow as well. The high-bone-turnover state (sequential osteoblastic activity followed by osteoclastic activity) created by teriparatide might fuel occult micrometastases through liberation of bone-matrix–derived growth factor and cytokine release in the microenvironment. An additional concern regarding patients with hematologic cancers is the stimulatory effect of teriparatide on hematopoietic stem cells through osteoblastic cells situated within the bone marrow “niche.”4,5 In patients with severe osteoporosis and a history of cancer, the benefits of teriparatide in preventing fractures should be weighed against these theoretical risks.

Azeez Farooki, M.D.
Monica Fornier, M.D.
Monica Girotra, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10065

Dr. Farooki reports receiving speaking fees from Procter & Gamble and Novartis. No other potential conflict of interest relevant to this letter was reported.

5 References

1. 1

   Canalis E, Giustina A, Bilezikian JP. Mechanisms of anabolic therapies for osteoporosis. N Engl J Med 2007;357:905-916
   Full Text | Web of Science | Medline

2. 2

   Cote RJ, Beattie EJ, Chaiwun B, et al. Detection of occult bone marrow micrometastases in patients with operable lung carcinoma. Ann Surg 1995;222:415-425
   Web of Science | Medline

3. 3

   Braun S, Vogl FD, Naume B, et al. A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med 2005;353:793-802
   Full Text | Web of Science | Medline

4. 4

   Whitfield JF. Parathyroid hormone: a novel tool for treating bone marrow depletion in cancer patients caused by chemotherapeutic drugs and ionizing radiation. Cancer Lett 2006;244:8-15
   CrossRef | Web of Science | Medline

5. 5

   Scadden DT. The stem cell niche in health and leukemic disease. Best Pract Res Clin Haematol 2007;20:19-27
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   M GIROTRA. 2010. Treatment of Male Osteoporosis with Parathyroid Hormone. , 681-689.
   CrossRef