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Cancer, bone health and osteoporosis

Osteoporosis is a condition that causes your bones to weaken and become very fragile. The bones become less dense and are more likely to fracture – sometimes from a minor fall or bumping into furniture. There are two types of osteoporosis:

Annette Schork, RN, BSN, OCN, CBCN, is one of four oncology registered nurses at the Cancer AnswerLine™

Annette Schork, RN, BSN, OCN, CBCN, is one of four oncology registered nurses at the Cancer AnswerLine™

  • Primary osteoporosis is the result of a normal physiologic process—usually aging and/or menopause.
  • Secondary osteoporosis is due to bone loss from a medical condition or a treatment side effect.

Who is at risk for osteoporosis?

Talk with your doctor about your risk of osteoporosis. You may be at higher risk depending on your family history, diet and whether you have ever smoked. Older women (over 65) and older men (over 70) are generally at higher risk. White people also seem to have an increased risk.

Risk factors for secondary osteoporosis can be related to the type of cancer you had, your treatment, or the way your body responded to treatment. Specifically, risks may exist for survivors of certain types of cancers and treatments that could spread to the bone such as:

  • Breast cancer
  • Prostate cancer
  • Multiple myeloma (cancer that occurs in the antibody-producing white blood cells)
  • Other solid tumor types such as lung, testicular, ovarian and endometrial (uterine wall) cancers

Treatment for some cancers, such as breast or prostate cancer, can include blocking or eliminating certain hormones in your body. Blocking sex hormones (testosterone or estrogen) helps to slow the growth of cancer cells. However, the sex hormones also help protect the bones. If your body is deprived of these hormones, osteoporosis can develop. This does not mean that you should not receive this type of treatment, because it may be the most effective way to treat your type of cancer.

According to Dr. Catherine Van Poznak, a University of Michigan Comprehensive Cancer Center oncologist who specializes in breast cancer’s relationship to bone, “People with breast or prostate cancer who undergo treatments that block specific hormones may be at higher risk of thinning bones. Also, certain chemotherapy drugs used to treat these or other cancers may induce ovarian failure in younger women, causing bones to thin as a result of early menopause and estrogen deprivation. In addition, steroids may also accelerate bone loss in both men and women.”

Osteoporosis is treatable, but not curable. This means that once you know you have this condition, you should work with your health care team to develop ways to slow down any bone loss.

Symptoms of osteoporosis may include:

  • Weight loss
  • Stooped posture
  • Curving of the upper back (Dowager’s hump)
  • Bone tenderness
  • Loss of one or two inches in height
  • Bone break or fracture

An individual can have osteoporosis and not experience any symptoms. If you think you are at risk for osteoporosis, a bone mineral density screening (sometimes referred to as a DEXA scan) may be right for you. If it’s lower than normal or declines while you’re in treatment, there are medications called bisphosphonates you can take to strengthen your bones. Some examples of medications used to treat osteoporosis are Fosamax, Actonel, Boniva, and Reclast.

There are also lifestyle changes you can make to keep your bones as strong as they can be:

  • Consider a vitamin D supplement. Vitamin D also plays a vital role in bone health and is often not as readily available in an average diet, unless you drink fortified milk or orange juice. Most people need between 400 IU and 800 IU per day.
  • Add weight-bearing exercise to your routine. Gravity helps encourage bones to become denser at areas that support weight, so make sure you incorporate weight-bearing exercise into your workouts. Walking is an excellent option, particularly when carrying hand weights.
  • Avoid tobacco and alcohol. Tobacco use and excessive alcohol consumption have both been associated with bone loss.
  • Get your daily dose of calcium. Recommendations vary based on age, but most people need between 1000 mg and 1200 mg per day of calcium. Ideally, calcium is consumed as part of a well-balanced diet that includes dairy products rich in calcium. However, many people benefit from the use of supplements. Calcium is best absorbed in portions of 400 mg to 600 mg at a time, so plan to take it in divided doses throughout the day.

Have you experienced osteoporosis as a result of cancer or cancer treatment?  What have you done to strengthen your bones?  Feel free to leave a comment.

Additional Resources:

National Institutes of Health:  What Breast Cancer Survivors Need to Know About Osteoporosis

U-M Bone Deep:  Bone Health Resources

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