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Breast cancer treatment affects bone mass, but you can protect your bone health


Ruban Dhaliwal, MD, discusses estrogen and bone loss. (PHOTO BY SUSAN KAHN)

Ruban Dhaliwal, MD, discusses estrogen and bone loss. (PHOTO BY SUSAN KAHN)


No matter whether her breast cancer is treated with surgery, radiation or medications, a woman‘s resulting loss of estrogen translates into bone loss – and an increased risk for fracture.

Advances in cancer treatment have significantly improved survival rates, but “cancer therapies are related to bone loss,” says Ruban Dhaliwal, MD, an expert in bone and mineral disorders. Dhaliwal is an assistant professor who sees patients at Upstate‘s Joslin Diabetes Center and also conducts clinical research. Reduced bone mass leads to osteoporosis, in which bones become brittle and may break easily.

The risk of a spinal fracture is five times higher for breast cancer patients than for the general population, Dhaliwal explained in a presentation to staff at Upstate University Hospital this spring. She also told how the loss of bone mass that occurs with cancer treatment is substantially higher than the loss that occurs with normal aging.

Osteoporosis is prevalent among women, and fractures related to osteoporosis are more common among them than heart attacks, strokes and breast cancer diagnoses combined. Dhaliwal says the best protection is to build and maintain healthy bones, and screen for osteoporosis.

A bone density test similar to an X-ray can reveal bone loss. In some patients, doctors may monitor the continual process in which new bone tissue is formed as old bone tissue is reabsorbed, a process known as bone remodeling.

Bone mass forms from birth through adolescence. Bone mass generally remains stable for most women from the second decade of life until menopause, when it declines along with the reduced production of estrogen.

If a woman faces breast cancer, “no matter which chemotherapy we use, the time of menopause is pushed forward five to 10 years,” Dhaliwal says. Chemotherapy-induced menopause results in rapid bone loss. A woman‘s individual risk of bone loss is related to the type of medication she takes, for how long and in what dose.

Hormonal therapy also induces bone loss in pre-menopausal women. Aromatase inhibitors, a type of hormonal therapy, cause an increase in bone turnover, bone loss and fractures -- although evidence shows they do a good job preventing the return of breast cancers.

Bone loss is a concern for patients with other types of cancer, too. Men with prostate cancer see a decline in testosterone, and patients with thyroid cancer may need to keep their levels of thyroid stimulating hormone below normal, which leads to bone loss.

How to protect your bones

Bone mass is affected by genetics, nutrition, physical activity, underlying hormonal diseases, lifestyle and overall health. How best to maximize your bone mass?

  • Getting adequate calcium, from diet and/or supplements – a total of 1,000 to 1,200 milligrams a day.

  • Help your body absorb calcium by taking 600 to 800 international units of vitamin D daily.

  • Maintain a healthy weight.

  • Participate in weight-bearing exercises, such as walking.

  • Take measures to prevent falls in your home.

  • Limit excessive alcohol and caffeine intake.

  • Avoid tobacco.

  • Seek bone mineral density screening and discuss pharmacological treatment for bone loss, if necessary, with your health care provider.

Source: Endocrinologist Ruban Dhaliwal, MD

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.