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MASCC Bone Study Group


Chair:  Ourania Nicolatou-Galitis, DDS ( - Greece
Vice-Chair:  Winston Tan, MD ( - USA
Vice-Chair: Beatrice Edwards, MD ( - USA

Study Group Minutes
2016 Minutes alt - Annual Meeting - Adelaide, Australia


The mission of the MASCC Bone Study Group is to conduct research and develop guidelines for the prevention and treatment of skeletal complications in patients with cancer. Skeletal complications arise as a result of both the disease and the treatments for various cancers (e.g., aromatase inhibitors and androgen-deprivation therapy). The Bone Study Group is an interdisciplinary effort with the objective of raising awareness of the skeletal complications common in people with cancer. These complications can shorten survival and may have a significant impact on quality of life.


The objectives of this Study Group are to identify new targets for the prevention and treatment of bone metastases, to establish guidelines for the management of skeletal complications (such as osteonecrosis of the jaw), and the prevention of atypical fractures in patients treated with antiresorptive therapies. Further, the Study Group aims to improve patients’ knowledge of bone health. This Group focuses on improved standards of care with respect to early identification of bone metastases, risks for osteoporosis, and early intervention. The group also serves as a resource for multicenter clinical trials and translational studies. 

Guidelines Guidelines

  • Bone Health in Cancer Patients
    In September, 2014, The European Society for Medical Oncology (ESMO) published clinical practice guidelines for maintaining bone health in patients with cancer. The guidelines address both multidisciplinary treatments for reducing skeletal effects of metastatic disease and strategies for minimizing treatment-induced skeletal damage. The guidelines article was published in the Annals of Oncology by R. Coleman, J. J. Body, M. Aapro, P. Hadji, and J. Herrstedt on behalf of the ESMO Guidelines Working Group.

Past Workshops


Many recent publications of the Study Group members have focused on osteonecrosis of the jaw (ONJ) and its risk factors. Although dental extraction has long been considered as the main local risk factor for the development of ONJ, recent findings show that the process of necrosis starts before dental extraction. For example, Nicolatou-Galitis et al. (2015) have presented clinical and radiologic data showing periodontal tissue involvement prior to the appearance of ONJ and prior to dental extraction in patients treated with antiresprptives. The authors present a case series of 5 patients who presented with localized inflammatory periodontal tissue involvement and progressed to necrotic exposed bone, consistent with ONJ, before dental extractions were performed. Their findings suggest that pain, tooth mobility, purulence, periodontal ligament widening, and increased alveolar bone density in patients treated with antiresorptives or angiogenesis inhibitors may be signs of developing osteonecrosis and should alert the dental practitioner to the possibility of early ONJ.

The Study Group is currently working on two systematic reviews. One initiative, led by Ourania Nicolatou-Galitis, concerns ONJ in cancer patients receiving antiresorptives, angiogennesis inhibitors, targeted agents, or classical chemotherapy. The second is a survey, led by Beatrice Edwards, of research on vitamin D and its association with cancer outcomes. The publications listed below represent Study Group projects as well as other publications by Study Group members.

Nicolatou-Galitis O, Galiti D, Moschogianni M, Sachanas S, Edwards BJ, Migliorati CA, Pangalis G. Osteonecrosis of the jaw in a patient with acute myeloid leukemia, who received azacitidine. J Cancer Metasta Treat 2016;2:220-3. 

Edwards BJ, Gradishar WJ, Smith ME, Pacheco JA, Holbrook J, McKoy JM, Nardone B, Tica S, Godinez-Puig V, Rademaker AW, Helenowski IB, Bunta AD, Stern PH, Rosen ST, West DP, Guise TA. Elevated incidence of fractures in women with invasive breast cancer.  Osteoporos Int. 2016 Feb;27(2):499-507.

Edwards BJ, Sun M, West DP, Guindani M, Lin YH, Lu H, Hu M, Barcenas C, Bird J, Feng C, Saraykar S, Tripathy D, Hortobagyi GN, Gagel R, Murphy WA Jr. Incidence of atypical femur fractures in cancer patients: The MD Anderson Cancer Center experience.  J Bone Miner Res. 2016 Feb 19. [Epub ahead of print]. 

Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R Jr, Pignolo RJ, Sellmeyer DE. Managing osteoporosis in patients on long-term biphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016 Jan;31(1):16-35. Review. 

Edwards BJ, Saraykar S, Sun M,  Murphy WA Jr., Lin P, Gagel R, Resection of granulomatous tissue resolves silicone induced hypercalcemia, Bone Reports (2016).

Edwards BJ. Anticancer effects of vitamin D. American Journal of Hematology/Oncology, 2015 (11): 26-36.

Tan WW, Harris JE, Shepard RC, Stopeck AT, Swart R, Downey L, et al. Bone health and breast cancer:  Management overview of bone health in breast cancer. Medscape. May, 2016.

The authors review adjuvant biophosphonate therapy in primary and metastatic breast cancer to improve bone density and decrease bone metastasis. They consider adverse effects of treatment and the use of denosumab for women with breast cancer and evidence of bone metastases. 

Migliorati CA. Osteonecrosis of the jaw. The ASCO Post 2015, 6(15).

Nicolatou-Galitis O, Razis E, Galiti D, Galitis E, Labropoulos S, Tsimpidakis A, Sgouros J, Karampeazis A, Migliorati C. Periodontal disease preceding osteonecrosis of the jaw (ONJ) in cancer patients receiving antiresorptives alone or combined with targeted therapies: Report of 5 Cases and Literature Review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Dec;120(6):699-706. 

Wagner-Johnston ND, Sloan JA, Liu H, Kearns AE, Hines SL, Puttabasavaiah S, Dakhil SR, Lafky JM, Perez EA, Loprinzi CL. 5-year follow-up of a randomized controlled trial of immediate versus delayed zoledronic acid for the prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen: N03CC (Alliance) trial. Cancer. 2015 Aug 1;121(15):2537-43. 

Dueck AC, Singh J, Atherton P, Liu H, Novotny P, Hines S, Loprinzi CL, Perez EA, Tan A, Burger K, Zhao X, Diekmann B, Sloan JA; Alliance for Clinical Trials in Oncology. Endpoint comparison for bone mineral density measurements in North Central Cancer Treatment Group cancer clinical trials N02C1 and N03CC (Alliance). Osteoporos Int. 2015 Jul;26(7):1971-7.

Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J; ESMO Guidelines Working Group. Bone Health in Cancer Patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014 Sep;25 Suppl 3:iii124-37. Free Full Text

Vardas, E., Coward, T., Papadopoulou, E., Nicolatou-Galitis, O. Dental extractions as the major local risk factor of bisphosphonates related jaw osteonecrosis in cancer patients receiving intravenous bisphosphonates therapy. A systematic review. Mediterranean Oncol J MOJ. 2014;1:26–33.

Nicolatou-Galitis O, Koutsoukos KA, Galitis E, Bamias A, Dimopoulos MA. Stomatitis, gingivitis and periodontal abscess in a patient with metastatic renal cell carcinoma receiving temsirolimus and bevacizumab: A cumulative toxicity? Mediterranean Oncol J MOJ 2014;1:45-49.

Nicolatou-Galitis, O, Razis E., Galiti D, Vardas E, Tzerbos F, Labropoulos S. Osteonecrosis of the jaw in a patient with chronic myelogenous leukemia receiving imatinib - A case report with clinical implications. Forum of Clinical Oncology, December 2013.

Ripamonti C, Maniezzo M, Pessi MA, Cislaghi E, Mariani L, Stefania B. Efficacy and tolerability of medical ozone (O3) gas insufflations in patients with osteonecrosis of the jaw treated with bisphosphonates. Preliminary data. Medical ozone gas insufflation in treating ONJ lesions. J Bone Oncol. 2012;1: 81-87.

Nicolatou-Galitis O, Migkou M, Psyrri A, Bamias A, Pectasides D, Economopoulos T, Raber-Durlacher JE, Dimitriadis G, Dimopoulos MA. Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carcinoma receiving sunitinib: Report of 2 cases with clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:234-8. 

Nicolatou-Galitis O, Papadopoulou E, Sarri T, Boziari P, Karayanni A, Kyrtsonis MC, Repousis P, Barbounis V, Migliorati CA. Osteonecrosis of the jaw in oncology patients treated with bisphosphonates: prospective experience of a dental oncology center. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:195-202.  

Ripamonti C, Cislaghi E, Mariani L, Maniezzo M. Efficacy and safety of medical ozone (O3) delivered in oil suspension applications for the treatment of osteonecrosis of the jaw in patients with bone metastases treated with bisphopshonates: Preliminary results of a phase I-II study. Oral Oncol 2011;47:185-90. 


Papadopoulou E, Nicolatou-Galitis O, Vardas E, Repoussis P, Ardavanis A, Bafaloukos D, Sgouros J, Christodoulou C, Vaslamatzis M, Linardou H, Ntalakou E, Marioli N, Stefanou D, Syrigos K. Treatment and prevention of osteonecrosis of the jaw associated with medication: 2009-2014. MASCC/ISOO Annual Meeting on Supportive Care in Cancer. Copenhagen, Denmark, 25-27 June 2015.

Please contact the Study Group Chairs above with your questions.
MASCC Study Group Coordinator, Don Gubitosa