Effect of Bisphosphonates on Bone Mineral Density and Fracture Prevention in Gastric Cancer Patients After Gastrectomy

Goal: To evaluate the effectiveness of bisphosphonates in preventing fractures in gastric cancer patients by increasing bone mineral density (BMD). Background: The effectiveness of bisphosphonates is questionable in gastric cancer patients who have undergone gastrectomy, although they display a high prevalence of osteoporosis. Study: Forty-seven gastric cancer patients with osteoporosis were retrospectively analyzed. All patients were supplemented with calcium and vitamin D. Twenty-four patients were treated with bisphosphonate (bisphosphonate group) and 23 patients were untreated (control group). Fractures, severe bone pain, and adverse effects of bisphosphonates were monitored. BMD of the lumbar spine and femoral neck were measured before and 1-year treatment with bisphosphonates by dual-energy X-ray absorptiometry. Results: During a 1-year follow-up, 7 of the 47 (15%) patients developed new fractures. The bisphosphonate-treated group had a significantly lower fracture rate than the control group (n = 1 vs. 6, P < 0.05). Lumbar spine BMD increased in both groups (0.047 +/- 0.03 vs. 0.021 +/- 0.03 g/cm(2), respectively), whereas femoral neck BMD increased only in the bisphosphonate group (0.032 +/- 0.03 vs. -0.004 +/- 0.02 g/cm(2), respectively). Furthermore, the bisphosphonate group showed greater increases in lumbar spine and femoral neck BMDs than the controls (P < 0.05). No difference was found between alendronate and risedronate in terms of BMD at follow-up. Conclusions: Therapy using bisphosphonates might be effective at increasing BMD and reducing fracture risk in gastric cancer patients after gastrectomy. Further well-designed randomized controlled trials are needed for confirmation.