Bone Health


Osteoporosis is a disease that causes bones to thin and weaken. It can cause bones to easily break. A risk factor is anything that increases your chances for a disease. Risk factors for osteoporosis include being female, family history, advanced age, low body weight, sedentary lifestyle choices, and low calcium and vitamin D levels. More than 10 million Americans have osteoporosis and as many as 40 million more have low bone mass and are at high risk of developing the disease.

"When most people think of bones, they do not think of them as living and growing organisms; however, this is exactly what they are. Bones are made up of active cells that are constantly replaced and growing," says Andrew Bunta, MD, vice chairman of the department of orthopaedic surgery Northwestern Memorial Hospital and at Northwestern University Feinberg School of Medicine in Chicago.

He says a healthy lifestyle that includes regular exercise and a healthy diet is a key to promoting bone health. Consuming a proper amount of calcium and vitamin D is among the best ways to prevent osteoporosis. Calcium, a mineral that is stored primarily in the bones and teeth, aids the growth of blood vessels and muscles. "Our bodies continually remove and replace calcium as we grow, and vitamin D aids in its absorption and incorporation into our bones so it is important to get enough of both," adds Bunta.

How Cancer is a Factor

People undergoing cancer treatment are more at risk for osteoporosis. “Treatments including radiation, chemotherapy, and medications may pose a bone health risk,” says Richard Theriault, DO, MBA, professor, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston. "Radiation may have direct toxic effects on bone but remains a mainstay of treatment for bone metastases and local therapy post primary breast surgery. Radiation techniques have been designed to minimize risks to bone health," he says.

Chemotherapy, says Dr. Theriault, has a major effect on bone health by shutting down the ovaries and causing early menopause in premenopausal women. "This results in a hypoestrogen state with negative impact on bone density." Further, Dr. Theriault explains that some medications, such as steroids, used to prevent nausea and vomiting may also have a negative impact on bone health. "In postmenopausal women, aromatase inhibitor agents used for adjuvant therapy to reduce the risks of cancer recurrence result in profound hypoestrogen states and thereby increase risks of osteopenia/osteoporosis and fractures," Dr. Theriault says.

Risk by Gender

Kenneth W. Lyles, MD, professor of medicine and medical director of Medicine Site-Based Research at Duke University Medical Center in Durham, North Carolina, says there are two large groups that are at risk for osteoporosis: women with breast cancer and men with prostate cancer.

With regard to women battling breast cancer, studies have shown that chemotherapy, radiation therapy, and some other medications increase the risk for osteoporosis. Dr. Lyles says that talking with your doctors is needed before treatment begins. Your doctor will assess your risk for osteoporosis based on lifestyle factors, family history, and other health conditions, including rheumatoid arthritis. "Accelerated bone loss is a real issue in cancer care," he says. "With frailty increasing and from other illnesses, the risk of falling increases and therefore patients are at risk for falls and fractures."

Osteoporosis can also cause depression, says Dr. Lyles. Not directly but indirectly by its symptoms, depression can be triggered. Back pain, losing height, becoming stooped, a protruding stomach, and trouble performing daily tasks can take a toll on mental health.

Men being treated for prostate cancer can also be affected by androgen depletion therapy. This treatment makes men more likely to have bone loss. "For men, if they suffer a hip or spine fracture, it can be a big setback; it can send them on a path toward more health problems," he says. Dr. Lyles says that 15 to 25 out of 100 patients who experience a hip fracture have a higher risk of death.

Healthy lifestyle choices, including regular exercise, not smoking, taking vitamin D and calcium, and maintaining a healthy body weight, may offset the risk, says Dr. Lyles.

Managing Side Effects

Both cancer and cancer therapy can have a negative impact on quality of life, says Catherine Van Poznak, MD, Assistant Professor, University of Michigan Comprehensive Cancer Center, Ann Arbor. "It is important to have an open discussion with one’s health care provider to address symptoms and toxicities so that steps can be taken to mitigate those toxicities," she says. "The goals of care can vary by the tumor condition and by the individual’s preferences. A patient may open a dialog with their provider by addressing what is important to them, and determine whether therapy side effects are interfering with their other priorities."

Posted in: In Treatment, Survivorship