Breast Cancer

Bone Health

Bone health is important for all women, and especially for women treated for breast and gynecologic cancers. Maintaining healthy bones is necessary to prevent and manage osteoporosis, a condition in which bone mass and density decrease. This causes bones to become thin and weak and increases their risk for fracture.

Because the loss of estrogen after menopause can decrease bone density, treatments that decrease estrogen levels (such as hormone therapy, some chemotherapy drugs and the surgical removal of the ovaries) increase the risk of osteoporosis. Radiation therapy to the pelvis can also weaken the bones in the area. The spine, wrists and hips are the most susceptible to fracture as a result of osteoporosis. Be sure to talk to your doctor about your vitamin D and calcium levels and if he or she recommends a supplement.

Warning signs of bone loss include:

  • joint and back pain
  • arthritis-like symptoms
  • slouched posture
  • shorter stature
  • broken/fractured bones

Preventing and managing osteoporosis

If you are at risk for osteoporosis or will be receiving treatment that increases your risk, your doctor may request bone mineral density testing before treatment begins to obtain a baseline value for later comparison. The test most often used is a low-dose X-ray technique known as dual-energy X-ray absorptiometry, commonly called densitometry or a DEXA scan. This test calculates bone density according to how much radiation the bone absorbs.

Osteoporosis is indicated by a bone density lower than the range expected in premenopausal women or other women similar to you in age and ethnicity. Testing is noninvasive, painless and takes about 20 to 30 minutes to complete. If you are at high risk for osteoporosis, your doctor may prescribe a medication approved for the prevention and/or treatment of osteoporosis (Table 1). In addition, changes in lifestyle habits can help keep your bones strong (Table 2).

Some complementary and herbal supplements are marketed as agents to help prevent and/or treat osteoporosis, but none has been found to be effective in clinical trials in humans. Be sure to talk to your doctor before taking any supplements.

Table 1. Medications to prevent/treat osteoporosis

Drug Indication How given
alendronate sodium (Fosamax) Prevention/treatment Oral
calcitonin (Miacalcin, Fortical) Treatment
Nasal spray
Injection
denosumab (Prolia) Treatment
Injection
estrogen therapy Prevention/treatment
Oral
Skin patch
ibandronate (Boniva) Prevention/treatment Oral
Injection
raloxifene (Evista) Prevention/treatment
Oral
risedronate (Actonel, Atelvia) Prevention/treatment
Oral
teriparatide (Forteo) Treatment Injection
zoledronic acid (Reclast) Prevention/treatment
Injection

Managing metastatic bone disease

Bone is the most common site for breast cancer to metastasize (spread). It can be painful and can also weaken bones, causing them to break easily. Metastasis to the bone most often affects the spine, ribs, pelvis, skull and the long bones of the arms and legs.

Three drugs have been approved for women with metastatic breast cancer and evidence of bone destruction (Table 3). This treatment helps prevent bone fractures and can reduce the need for surgery or radiation therapy to alleviate bone pain.

Radiation therapy can also help prevent or treat fractures, especially in weight-bearing bones. Radiation beams target the area of the metastasis, and relief is usually immediate and complete.

Talk to your doctor about which of these treatments may be best for you. Women with metastatic bone disease should also take calcium and vitamin D supplements and adopt other lifestyle habits to prevent osteoporosis (Table 2).

Table 2. Lifestyle habits to decrease risk of osteoporosis

Possible resulting side effects
Activity Specific examples
Include enough calcium and vitamin D in your diet
(The American Society of Clinical Oncology recommends 1,200 mg of calcium and 400-800 U of vitamin D each day for women.)
Calcium:
▪  Dairy products (low-fat milk, yogurt and
   cheese)
▪  Calcium-fortified orange juice
▪  Dark green leafy vegetables (broccoli,
   spinach, collard greens, bok choy)
▪  Tofu
▪  Almonds
▪  Vitamin-fortified cereal
▪  Calcium supplement
Vitamin D:
▪  Vitamin D-fortified milk
▪  Herring, salmon, tuna
▪  Vitamin-fortified cereal
▪  Exposure to sunlight
▪  Multivitamin
Engage in weight-bearing exercise and/or strength training (three to four times per week for maximum benefit)
Walking
Jogging
Tennis (or other racket sports)
Dancing
Lifting weights
Yoga
Minimize the risk of falls
Use hand rails on stairs and in bathroom
Ensure sufficient lighting around the house
Secure or remove throw rugs
Use a cane or walker if necessary
Don’t be afraid to ask for help walking
Wear shoes that fit properly, have a rubber sole and a low heel
Control what you intake
Drink little or no alcohol
Avoid smoking

Table 3. Medications to manage metastatic bone disease 

Drug How given
denosumab (Xgeva) Injection
pamidronate disodium (Aredia) Injection
zoledronic acid (Zometa) Injection

Additional Resources

 

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