Bone Density May Decline After Chemotherapy

After chemotherapy, patients with testicular germ cell tumors may experience a decrease in bone mineral density.

After undergoing chemotherapy for germ cell tumors, patients with metastatic disease experienced significant decreases in bone mineral density, according to recently published data.

Testicular germ cell tumors are a common form of cancer in young men, but new treatments have improved the prognosis and cure rates.

“Long-term detrimental effects of cancer treatments on the skeleton may be associated with significant skeletal morbidity, so that it is of clinical relevance to evaluate the presence of these skeletal complications in [germ cell tumor] survivors to allow timely intervention to decrease or prevent associated increased fracture risk,” researchers wrote in the Journal of Clinical Endocrinology & Metabolism.

Sixty-three patients with newly diagnosed germ cell tumors (median age, 33 years) were assessed within 3 months of unilateral orchidectomy. Of these patients, 42.9% had no metastases, and the 57.1% with metastatic disease received combination chemotherapy.

Researchers evaluated changes in patients’ bone mineral density (BMD) using dual x-ray absorptiometry scans and blood samples collected on a yearly basis at baseline and up to 5 years after chemotherapy.

Results revealed significant declines in BMD at the lumbar spine (–1.52%; P=.004) and the total hip (–2.05%; P<.0001) 1 year after chemotherapy. BMD then remained stable for up to 5 years after treatment.

Gonadal status, vitamin D status or cumulative dose of cisplatin or antiemetic corticosteroids did not appear to affect BMD.

The researchers reported that BMD remained normal in patients with stage I disease.

Despite their findings, the researchers noted that further evaluation of this association between chemotherapy and bone loss in patients with germ cell tumors is required.

“Whether the modest, but persistent chemotherapy-induced changes in BMD may be associated with increased fracture risk and whether this potentially increased fracture risk may be decreased or prevented with the use of bone modifying treatment remains to be established,” they wrote.


  1. Willemse PM et al. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2014-1722.