Bone and Musculoskeletal

Beatrice Edwards, MD
Winston Tan, MSHPeD, MD


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Mission and Goals

The mission of the MASCC Bone and Musculoskeletal 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 and Musculoskeletal 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. 


Past Workshops

E-learning Module on ONJ

An e-learning module on Osteonecrosis of the Jaw ONJ) has been produced by ecancer.ogr and is available for 1 CME credit. The module is designed to support the clinical practice of oncologists, dentists, and oral surgeons and focuses on management strategies for ONJ. Ourania Nicolatou-Galitis and Cesar Migliorati are among the ecancer ONJ faculty.

See also the editorial by Ourania Nicolatou-Galitis that appeared in ecancer medical science (ecancer 2018, 12:ed77), which introduces the module.

The definition, pathobiology, and risk factors for ONJ in cancer patients who receive BTAs are discussed in a recent ecancer module for Osteonecrosis of the Jaw ( The module covers ONJ prevention, early diagnosis, and management. It address the critical question of dental extraction during BTA therapy and the  importance ofcollaboration between dental and oncology professionals, as well as patients.

Research Highlights

Research Highlight: Natural History and Resolution of Medication-Related ONJ in Cancer Patients
MASCC members Mark Chambers, Ourania Nicolatou-Galitis, and Deborah Saunders were part of an international research team that conducted an observational case registry study to describe the rate and time course of osteonecrosis of the jaw (ONJ) associated with cancer chemotherapy. ONJ risk factors, treatment patterns, and antiresorptive agents were also tracked in this study, which will appear in Supportive Care in Cancer and is available online via Open Access (Schiødt M et al., 2017). The significance of this case registry report is that it documented the effect of specific therapies on ONJ in a substantial number of patients with advanced cancer. It also reports the effects of local oral and medication risk factors for ONJ, as well as treatment, management, and patient outcomes.

Bone Health in Elderly Cancer Patients: A SIOG Position Paper
MASCC members Matti Aapro, Jean-Jacques Body, and Annie Young are members of an International Society of Geriatric Oncology (SIOG) Task Force on bone protection in older patients with cancer. The work of the Task Force has led to a recent SIOG position paper: Bone Health in the Elderly Cancer Patient (Body JJ et al. Cancer Treat Rev, 2016 Dec;51:46-53; follow link for full text). The paper includes general recommendations for the use of bone-modifying agents, recommendations (with grades of evidence) for managing bone metastases in breast and prostate cancer, recommendations from the European Myeloma Network for the management of bone-related complications, and recommendations for nursing care as part of the multidisciplinary management of elderly patients with bone metastases. 

Osteonecrosis of the Jaw
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.

Other Research
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.

Recent Member Publications

Recent Study Group member publications related to skeletal complications in patients with cancer.


Last Updated on Saturday, June 19, 2021 07:12 AM