Drug Safety

, Volume 31, Issue 5, pp 359–371 | Cite as

Chemotherapy-Associated Osteonecrosis in Cancer Patients with Solid Tumours

A Systematic Review
  • Katharine Shim
  • Mary J. MacKenzie
  • Eric Winquist
Review Article


Non-traumatic osteonecrosis of bone is recognized as a potential complication in solid-tumour cancer patients receiving treatment with cytotoxic chemotherapy. This review summarizes recent reports of osteonecrosis associated with chemotherapy in cancer patients, and describes the possible underlying pathophysiology and options available for its diagnosis, prevention and treatment. Fifty-four reported cases of non-traumatic osteonecrosis in adult patients with solid tumours receiving chemotherapy were identified by searching for reports in the medical literature. Osteonecrosis was observed most commonly in men receiving chemotherapy for testicular cancer. Osteonecrosis was also seen in patients receiving chemotherapy for breast, ovarian, small-cell lung cancer and osteosarcoma. Most patients had received corticosteroids, had femoral head involvement and had delayed onset of osteonecrosis. It appears that patients at higher risk for osteonecrosis with chemotherapy are identifiable. As the long-term survival of patients with solid tumours receiving chemotherapy increases, the prevalence of treatment-related osteonecrosis may also increase. Patients should be informed that osteonecrosis is a potential complication of cancer treatment. Measures to reduce risk should be taken, and patients should be monitored for early symptoms. Routine screening for chemotherapy-associated osteonecrosis is not recommended; however, a high index of clinical suspicion in patients at risk may allow for early intervention and preservation of the joints.


Femoral Head Osteonecrosis Testicular Cancer Bone Marrow Oedema Severe Acute Respiratory Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to Jan Figurski for his assistance with their literature search.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Katharine Shim
    • 1
  • Mary J. MacKenzie
    • 1
    • 2
  • Eric Winquist
    • 1
    • 2
  1. 1.Schulich School of Medicine and DentistryUniversity of Western OntarioLondonCanada
  2. 2.Division of Medical OncologyUniversity of Western OntarioLondonCanada

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