No Bones About It: Tips for Monitoring and Promoting Bone Health After Cancer

Bone health is a common concern for the general population as they age. Bone strength or “density” decreases naturally with age due to a slowing of the body’s production of cells that help rebuild bone. A person’s general health, including nutrition status, muscle strength, and activity level can play a role in bone health.

Osteoporosis is a disease that causes your bones to be weak and sometimes break easily. Major fractures, such as a hip fracture, increase the risk of infection, blood clots, and heart disease. It is one of the leading causes of morbidity and mortality in the elderly.  

Osteoporosis is less common in men than women. Women who have gone through menopause are at the highest risk for osteoporosis, making up over 80% of cases. Estrogen assists in the process of bone production in women. When women become menopausal, they produce less estrogen and bone production decreases.

Certain types of cancer and cancer treatments can lead to bone loss or decreased bone density. 

Risk Factors 

  • Hormone or “endocrine” therapies: These treatments are often used in breast, prostate, and other cancers. Medications called aromatase inhibitors, leuprolide, or other cancer treatments can impact bone density. Androgen deprivation therapy (ADT), or orchiectomy (removal of testicles) can decrease hormone levels in men. This decrease in hormone levels can result in decreased bone density over time.  

  • Radiation therapy administered to weight bearing bones or brain

  • Some chemotherapy drugs can decrease calcium levels throughout the body. 

  • Prolonged steroid use (two months or more) 

  • Cancer spreading to the bones: Cancers that most commonly spread to the bone include breast, prostate, lung, and multiple myeloma. 

  • Survivors of childhood cancers 

  • A history of gastrectomy (surgical removal of the stomach) 

  • History of allogeneic stem cell or bone marrow transplant 

  • Early menopause 

  • Being underweight 

  • Reduced physical activity 

Your provider will help you weigh the benefits and risks of your cancer treatments. In most cases, the benefits of treating your cancer will outweigh the risk of decreased bone density. However, there are ways that you can play an active role in improving your bone health during and after cancer treatment.  

How to Protect Bone Health

  • Stay strong. Performing weight bearing exercises and resistance training puts stress on the bones which triggers them to form more bone. Strength training can lead to stronger bones and muscles. Strong muscles can also improve balance which decreases your risk for a fall. 

  • Soak up some Vitamin D. Get 800-1000IU (international units) of Vitamin D3 daily. This can be done through 10-15 minutes of sun exposure (to hands, arms, and face) or through your diet. A few foods contain natural vitamin D, including some fish (salmon, tuna, mackerel), liver oil, and egg yolk. Milk (but not milk products such as cheese or ice cream) often has Vitamin D added and can be a reliable source of Vitamin D and calcium together. For more information on Vitamin D recommendations, click here

  • Get 1000-1200 mg of calcium daily. Aim for four to eight servings of calcium-rich foods daily through your diet. Calcium rich foods include dairy (milk, yogurt, and cheese), canned fish, dark green vegetables (broccoli, kale, and collard greens), almonds, sunflower seeds, apricots, and figs. 

  • Supplement if needed. If getting the recommended calcium and Vitamin D naturally is difficult to manage, talk to your provider about adding a Vitamin D and calcium supplement. While calcium supplements are available, it is best absorbed in your diet.  

  • Limit alcohol and tobacco consumption. Alcohol should be used in moderation and in general, the least amount consumed, the better. Cigarette smoking is associated with a reduced bone density and an increased risk of fractures. 

  • Prevent falls. Remove obstacles and clutter from your living space. Keep areas well lit. Utilize assistive devices for walking if needed, especially in the middle of the night or at times when you may be more disoriented or confused.  

  • Maintain a healthy weight. Eating a healthy diet is good for your bones. Being underweight has been shown to cause bone loss and increased risk of fractures.  

  • Limit caffeine intake. Large quantities of caffeine have been linked to increased risk of bone fracture (breaks in the bone).  

Medications to Improve Bone Health

  • Bisphosphonates: There are several medications in this class that help decrease bone loss by blocking cells that destroy bone. Depending on the medication, it is given orally or through an IV. 

  • RANK ligand inhibitors-Denosumab (Prolia, Xgeva): This medication is usually given every six months as a subcutaneous injection (using a small needle, the medication is injected just underneath the skin, typically in the abdomen). This treatment promotes the release of bone-derived growth factors and increases calcium levels.  

Good to Know

Medications may not be recommended for every patient. All medications have some risk of side effects. Speak with your provider about what options you have for improving your bone health.  

Questions to Ask Your Provider 

  • What are my personal risk factors for osteoporosis? 

  • Should I have a bone density scan? 

  • Would you suggest that I take any medications or supplements for bone health?