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Bone health is critical for overall health and wellness but especially important for breast cancer patients and survivors. In a Breast Cancer Research study, breast cancer survivors had a 68 per cent higher risk of osteoporosis and osteopenia than cancer-free women.
Hormonal therapy for breast cancer can increase the risk of bone fractures, which is another reason why bone health is so important. As breast cancer survival rates rise and survivors live longer, good bone health is becoming increasingly important in preserving the quality of life.
The more you understand your risk of osteoporosis, the better you will be able to protect your bones before, during, and after treatment. In this guide, we’ll go over the basics of osteoporosis, the connection between breast cancer treatment and osteoporosis, and how to properly care for your bone health to reduce your risk of developing osteoporosis.
What exactly is osteoporosis?
Osteoporosis is that condition in which bones lose strength and density due to hormonal changes, changes in bone quality, and vitamin D or calcium deficiency, increasing the risk of fractures. While osteoporosis cannot be reversed, bone density can be improved and fractures avoided.
Osteoporosis is a silent disease with few symptoms; you might not realize you have it until you fall and break a bone. One in every three women and five men over 50 will suffer an osteoporotic fracture. According to the National Institutes of Health, more than 53 million people in the United States have osteoporosis or are at high risk due to low bone mass.
The risk of breaking a bone in those with osteoporosis is determined by family history, medical conditions, and medications, among other factors. The Fracture Risk Calculator from American Bone Health can assist you in determining your 10-year fracture risk.
What is the cause of osteoporosis?
The risk of osteoporosis increases with age and is related to your family’s medical history, as with many other conditions. Lower oestrogen levels are another important factor which can be affected by breast cancer treatment. Because oestrogen protects against bone loss, women who have experienced menopause, had their ovaries removed, or undergone various breast cancer treatments are at a higher risk of osteoporosis. This topic will be covered in greater depth later in this guide.
Previous fractures not caused by injury, smaller size/body weight, certain medications, and medical conditions such as diabetes, Crohn’s disease, celiac disease, and hyperthyroidism are all risk factors for osteoporosis.
The Breast Cancer and Osteoporosis Connection
Osteoporosis and breast cancer are inextricably linked. Breast cancer can weaken bones by causing inflammation, which promotes the bone breakdown and slows new bone growth.
Thanks to breast cancer awareness efforts and breast cancer early detection programs, the number of women who died from breast cancer dropped by 40 per cent from 1998 to 2017, saving more than 322,000 lives, according to the American Cancer Society. New studies shared by Future Medicine, the Mayo Clinic, and Breast Cancer Research, among others, have shown a clear link between breast cancer treatment and osteoporosis.
Is there a link between breast cancer and osteoporosis?
Treatment for breast cancer can lower bone density and increase the risk of osteoporosis and fractures.
Breast Cancer Treatments that Have an Effect on Bone Health
Several common breast cancer treatments can impact bone health and strength in premenopausal and menopausal women.
Chemotherapy
Some chemotherapy treatments reduce oestrogen levels, which can result in early menopause. Shutting down the ovaries can help prevent breast cancer from recurring in women who have not yet reached menopause; however, this can result in bone loss and an increased risk of bone fractures.
Suppression of Ovarian Function
Ovarian suppression treatments prevent the ovaries from producing oestrogen, decreasing bone strength. When the medications are stopped, oestrogen production resumes.
Breast cancer treatment may also include surgical ovarian removal, a permanent form of ovarian suppression that can increase the risk of osteoporosis.
Radiation Treatment
Radiation therapy kills cancer cells that may remain in the breast following surgery. Still, it can also increase the risk of bone loss and fractures, including an increased risk of rib fractures due to radiation exposure in that area.
Tamoxifen
Tamoxifen is a drug that prevents oestrogen from promoting cancer growth. It slightly increases the risk of osteoporosis in women who have not reached menopause but reduces the risk in postmenopausal women.
Aromatase Blockers
Aromatase inhibitors are estrogen-blocking hormone therapies sometimes used to treat oestrogen receptor-positive breast cancer in postmenopausal women. These scientifically proven treatments prevent cancer cells from receiving the hormones they require to grow. Muscle and joint pain, menopausal symptoms, and bone density loss, which increases the risk of fractures, are possible side effects.
Breast Cancer Treatment-Related Bone Loss
Interestingly, most people don’t realize they have bone loss until they have a fracture, which is why screening is so important.
While the general age for osteoporosis screening is 65 for women and 70 for men, anyone who has had treatments known to affect bone loss or density or who has experienced fractures that were not caused by an injury should be checked sooner.
A bone density scan can aid in tracking the progression of potential bone loss during breast cancer treatment. If you are unsure, consult your doctor to see if you should be screened for osteoporosis.
Measuring Bone Health
Assessing Bone Health
Before, during, and after breast cancer treatment, a variety of tools can assess bone health and provide baseline information.
Physical Examination
A physical exam focused on bone health may include a spine exam and measurement to determine if you have lost height since your last assessment and your medical history.
Blood and urine tests
Blood and urine tests can assist in identifying potential causes of bone loss. They can examine blood calcium levels, thyroid function, vitamin D levels, a 24-hour urine calcium measurement, and various biomarker tests in greater detail. These tests can also assist your doctor in determining whether another medical condition contributes to bone loss.
Scans for Bone Density
Bone-density scans use X-rays to assess bone strength, predict fracture risk, and diagnose osteoporosis. A DEXA scan, or dual-energy X-ray absorptiometry, is the gold standard and most commonly used test because it is quick, safe, and painless. A low-level X-ray scanner passes over the body to measure bone mineral density, especially in the spine and hip.
The amount of radiation absorbed by the bone is used to calculate bone density; an osteoporosis diagnosis indicates that bone density is below the expected range (or a T-score of less than -2.5).
If you have been diagnosed with breast cancer, your doctor will most likely recommend a baseline DEXA scan before starting treatment and regular scans as you receive treatment. This information will determine whether medication, lifestyle changes, or other protective measures are necessary to prevent further bone loss. If you haven’t had a bone-density scan and are recovering from breast cancer or have received treatment for breast cancer, consult your doctor to see if you qualify.
Bone Fracture Risk Evaluation
Your doctor can help you determine your risk of future fractures. Furthermore, the American Bone Health Fracture Risk Calculator can help you determine your risk factors.
Talking to Your Doctor About Your Bone Health
Your doctor can answer your questions about bone health and density and discuss potential lifestyle changes, treatments, and options.
As a breast cancer survivor, you may want to ask your doctor the following questions in addition to any others you may have:
- How can I lower my chances of fracture?
- What dietary or exercise changes can I make to protect my bones better?
- Is there anything else I should do?
- How might my current treatments be affecting my bone health?
- What will be the next step?
Taking Care of Your Bones After Breast Cancer Treatment
If your bone mineral density decreases during breast cancer treatment, you can make lifestyle changes or speak with your doctor about medications to keep your bones as strong as possible.
Changes in Lifestyle for Strong and Healthy Bones
Fortunately, your lifestyle choices can have a long-term positive impact on your bone health. Consider the following recommendations to keep your bones healthy and strong during and after breast cancer treatment.
Food and Nutrition
A well-balanced diet of whole foods promotes bone health. You should get most of your essential nutrients from your diet rather than supplements and eat various whole colourful foods. Good nutrition will keep your bones strong and help you maintain your weight, which is important for avoiding fractures.
The three nutrients listed below are especially important for bone health and should be included in your daily diet:
- Calcium: Dairy products have the most amount of calcium content per serving size. Dark-green leafy vegetables, fish with bones, dried beans and peas, and calcium-fortified juice and cereal are all good sources of calcium. Consume one calcium-rich food per meal and think about taking a calcium supplement. The amount of calcium you require changes with age, so ensure you get enough for your current needs.
- Although vitamin D can be produced when your skin is exposed to sunlight, it is not a reliable source of vitamin D for most people. People need anywhere from 15 to 50 mcg (600 to 2,000 international units) of vitamin D daily to stay healthy. The National Academy of Medicine recommends 15-20 mcg for healthy adults (600–800 IU). If you have osteoporosis, the Endocrine Society recommends a higher dose of up to 50 mcg (2,000 IU) daily. Fatty fish, vitamin D-fortified foods, beef liver, egg yolks, and vitamin D supplements are the best whole-food sources.
- Magnesium: This mineral, found in green vegetables, nuts and seeds, legumes, whole grains, and avocados, helps your body regulate calcium and vitamin D. Adult women should consume 320 mg of calcium per day.
Protein is also an important building block for bone health, as it helps build and repair muscles and is recommended to be consumed with every meal. Keeping your muscles strong as you age will help support your bones and prevent falls and injuries. The amount of protein you require is determined by your age and weight. The USDA suggests.36 grammes of protein per pound of body weight. A 150-pound person, for example, requires approximately 54 grammes of protein per day. People who are more physically active require more protein.
Protein-rich foods include lean meats, dairy products, lentils, nuts, and seeds. You may need to combine foods to get all your amino acids from a plant-based diet to get complete proteins. Black beans, for example, can be served with brown rice or whole-grain bread.
Exercise
Weight-bearing exercise promotes bone health. Walking, dancing, stair climbing, gardening, and strength training are common examples. Weight-bearing exercise stresses the bones, which causes the cells to produce more bone, resulting in increased bone strength. Thirty minutes of weight-bearing daily exercise can significantly improve your bone strength and health.
While biking and swimming are excellent cardiovascular exercises, they do not place weight on the bones and do not improve bone strength. If you enjoy these activities, there is no need to stop doing them; incorporate more weight-bearing movements into your routine.
Avoiding activities that increase your risk of falling, such as rollerblading, is also critical. Many exercises, including tai chi and yoga, can help you improve your balance. There are even group fitness classes for bone health, breast cancer patients, chair work, and more.
Vitamins and supplements
In addition to a multivitamin, daily calcium and vitamin D supplementation resulted in significant hip and other fractures in studies—vitamin D helps the body absorb calcium, making a great pair. Magnesium, vitamin K, and zinc are also important for bone health. Consult your doctor to determine the best vitamins and supplements for you.
Tobacco and Alcohol
Both alcohol and smoking have a detrimental effect on bone density.
According to the American Academy of Orthopaedic Surgeons, smoking reduces blood supply to the bones, slows bone-forming cell production, impairs calcium absorption, and reduces estrogen’s protective effect. Furthermore, consuming more than 3 ounces of alcohol daily hastens bone loss. If you smoke or drink alcohol, you should include these factors in your fracture prevention plan and seek medical attention if necessary.
It is never too late to consult your doctor about bone density or strength, especially if you have breast cancer. Strong bones can help you avoid injuries and fractures and improve your overall health and wellness.
