Radiation-Induced Bone Alterations in Cancer Therapy

Radiotherapy remains a cornerstone of modern oncology, yet its collateral impact on skeletal integrity is increasingly recognised as a source of long-term morbidity. Ionising radiation disrupts the balance of bone remodelling by stimulating osteoclast-mediated resorption and impairing osteoblast-driven formation. This imbalance leads to deterioration of trabecular architecture, cortical thinning and increased marrow adiposity, with resultant osteopenia, pathological insufficiency fractures and delayed fracture healing. In paediatric and growing bones, radiation interferes with endochondral ossification and chondrocyte proliferation, potentially causing growth disturbances. Underlying mechanisms include DNA damage in bone cells, altered cytokine and Wnt/β-catenin signalling, changes in local vascularity and matrix composition. Advances in dose modulation, particle therapy and image-guided techniques aim to reduce skeletal exposure, while emerging pharmacological and dietary interventions seek to protect bone without compromising tumour control. A comprehensive understanding of these processes is essential to develop targeted countermeasures, optimise treatment planning and preserve long-term musculoskeletal health in cancer survivors worldwide.

Research from Nature Portfolio

Dietary intervention with dried plum has been shown to prevent cancellous bone loss induced by ionising radiation in animal models. Supplementation reduced expression of resorption-related genes, mitigated oxidative damage in the marrow microenvironment and preserved trabecular bone volume and strength following photon or heavy-ion exposure. This work highlights the potential of specific nutrient-based strategies to protect skeletal tissues during radiotherapy without diminishing antitumour efficacy.

Radiation-Induced Bone Alterations in Cancer Therapy publication trend

The graph below shows the total number of articles in radiation-induced bone alterations in cancer therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Osteoclast: A specialised multinucleated cell responsible for bone resorption during remodelling.

Osteoblast: A bone-forming cell that synthesises and mineralises the organic matrix.

Endochondral ossification: The process by which bone tissue is formed from a cartilage template, critical for longitudinal growth.

Trabecular architecture: The three-dimensional lattice of spongy bone that provides strength and flexibility.

Ionising radiation: High-energy particles or photons that remove electrons from atoms, causing direct and indirect DNA damage in tissues.

References

1. A novel multifunctional radioprotective strategy using P7C3 as a countermeasure against ionizing radiation-induced bone loss. Bone Research (2023).
2. Proton and Carbon Ion Irradiation Changes the Process of Endochondral Ossification in an Ex Vivo Femur Organotypic Culture Model. Cells (2023).
3. Therapeutic Irradiation: Consequences for Bone and Bone Marrow Adipose Tissue. Frontiers in Endocrinology (2019).
4. PTH1–34 Blocks Radiation-induced Osteoblast Apoptosis by Enhancing DNA Repair through Canonical Wnt Pathway*. Journal of Biological Chemistry (2014).
5. The Influence of Radiation on Bone and Bone Cells—Differential Effects on Osteoclasts and Osteoblasts. International Journal of Molecular Sciences (2020).
6. Dried plum diet protects from bone loss caused by ionizing radiation. Scientific Reports (2016).
7. Altered Composition of Bone as Triggered by Irradiation Facilitates the Rapid Erosion of the Matrix by Both Cellular and Physicochemical Processes. PLOS ONE (2013).