Breast Cancer & Your Bones
- Certain breast cancer treatments can weaken bones and increase fracture risk.
- Breast cancer can spread to bones where it can cause damage and pain.
- There are treatments to strengthen bones and prevent fractures.
- There are many treatment options to improve pain if the cancer has spread to your bones.
Here's what you should know about your bone health and breast cancer.
Read MoreHow Breast Cancer Treatment Affects Bone Health
Your ovaries naturally produce the hormone estrogen, which protects your bones among its other jobs. It keeps them strong and resistant to breaks. As you get older, your estrogen levels drop. Breast cancer treatment can speed up that process. In women who have hormone-receptor positive breast cancer (ER/PR+), estrogen can fuel the growth of cancer cells. If you have this type of cancer, you may take aromatase inhibitors, such as Arimidex and Aromasin. These medications prevent an enzyme in fat tissue, called aromatase, from naturally turning other hormones in your body into estrogen. By taking these medications you reduce the amount of estrogen in the body which in turn can slow cancer growth in women with hormone receptor positive breast cancers.But, as Virginia Kaklamani, M.D., explains, "Estrogen deprivation, which is how aromatase inhibitors work, causes osteoporosis." Dr. Kaklamani leads the Breast Cancer Program at UT Health San Antonio MD Anderson Cancer Center.
Other treatments can have a negative impact on your bones, too. Some chemotherapy drugs can damage your ovaries. Other breast cancer treatments might involve removal of your ovaries or stopping the ovaries from producing estrogen. All of these add up to lower estrogen levels and higher risk for osteoporosis.
Dr. Elizabeth Comen answers the question ‘Will I look older after breast cancer treatment?’
Keeping Your Bones Strong & Healthy
Breast cancer treatment alone won't cause osteoporosis. Bone loss doesn't have a single cause. It's the result of a combination of factors. You can't control all of them, but some of them you can.
Risk factors for osteoporosis that you can't control include:
- Older age
- Being a woman
- Being white or Asian
- Having a first-degree relative with the condition
- Having a smaller frame
But, there are other things you can control that have a big impact on bone health.
"Breast cancer survivors need weight bearing exercise and vitamin D supplements to help preserve their bone health," Dr. Kaklamani says.
Dr. Sairah Ahmed explains the importance of diet and exercise when you have cancer.
Weight bearing exercise simply means physical activity that requires you to support your own body weight, such as brisk walking, running, and dancing. That helps your bones hold on to the strength they need to support you as you age. If you quit making this demand of your bones, they can become weak, brittle and prone to breaks. Exercise that challenges your balance is a good idea, too. This helps you stay steady and keep from falling as you age, which helps keep your bones intact. Swimming and biking are good for your heart, but they don't help your bones.
Vitamin D helps your body absorb calcium. Your bones need calcium to stay strong. You can get vitamin D from the sun, from foods to which manufacturers add vitamin D, and from supplements. Adults from ages 51 to 70 should get 600 IUs a day from food or supplements. (The sun isn't a great source of vitamin D if you wear sunscreen to avoid skin cancer or don't get outdoors much.) After age 70, you need 800 IUs of vitamin D a day.
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Women over 50 need at least 1,200 mg and no more than 2,000 mg of calcium every day. If you don't get enough from dairy, dark leafy greens, soy products, and foods fortified with calcium, get the rest from a supplement.
Here are other things you can do to keep your bones healthy and strong:
- Maintain a healthy weight; people who are underweight have greater risk of bone breaks.
- Limit drinking to no more than two drinks a day.
- Quit smoking; smokers have a higher risk of osteoporosis.
When Breast Cancer Spreads to Bones
Sometimes breast cancer can spread to the bones where it can cause local damage and pain. When this happens the cancer is called metastatic breast cancer and is considered stage IV. Most patients with stage IV disease will have treatment with a drug that travels and kills cells everywhere in their body such as chemotherapy, immunotherapy, hormonal therapy, or other targeted therapies. When cancer spreads to your bones and causes pain, there are also several other treatments your doctor may use to alleviate your pain. These treatments may be local treatments or might be other drugs that your doctor may prescribe that make it harder for cancer to spread to your bones. Some of these medications can also strengthen your bones. Common treatments your doctor may use include:
- Radiation Therapy
- Surgery
- Targeted therapy such as Denosumab
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