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  Strong Bones for Life during and After Cancer Treatment

How does cancer increase the risk for bone loss?

Men and women with certain types of cancer are at a greater risk for developing bone loss. Various cancer treatments can increase the risk of osteoporosis for both men and women. Furthermore, women who develop breast cancer in their premenopausal years are often thrust into an early menopause by treatment and may suffer rapid bone loss as a result.

Are there certain types of cancer more associated with osteoporosis?

It appears that individuals with breast cancer, ovarian cancer, prostate cancer, testicular cancer, multiple myeloma (a bone marrow cancer), and various metastatic cancers that have spread throughout the body are at risk for osteoporosis.

How do the hormonal changes affect bone loss in men and women?

Bone loss in men generally begins later and advances more slowly than it does in women. Men tend to have larger and stronger bones than women and don’t experience the abrupt hormonal changes that occur with menopause. But as they age, men do lose bone density, in part because of a natural decrease in testosterone and estrogen, which may be important for bone health in men also. By age 65 – 70, men and women lose bone mass at similar rates. This may be related to declining physical activity, use of medication, decreased vitamin D levels, and impaired calcium absorption, all of which are more common in older adults and may be related to bone loss.

What influence does estrogen have on a woman’s risk of osteoporosis?

Estrogen levels in women may influence a woman’s risk of osteoporosis. The evidence suggests that the greater a woman’s estrogen exposure, the lower the risk of osteoporosis.

How do hormonal therapies that are used for cancer treatment affect the bones?

Tamoxifen has been shown to decrease bone mineral density in premenopausal women (women who have not gone through menopause). However, in postmenopausal women tamoxifen seems to increase bone mineral density. Aromatase inhibitors (such as Arimidex, Femara, and Aromasin) can cause bone loss and increase the risk of osteoporosis in postmenopausal women.

Prostate cancer is a common type of cancer in men. Androgen deprivation therapy (ADT), blocks the production of testosterone, and is commonly used to treat men with prostate cancer. In some studies, bone mineral density measurements were substantially lower in men with prostate cancer treated with ADT than in men not receiving therapy.

Since osteoporosis is a silent disease, an individual undergoing hormone therapy for the treatment of cancer should request a full osteoporosis evaluation from their healthcare provider before starting hormone therapy. The evaluation should include a bone mineral density (BMD) test. If necessary, there are many medications available to slow bone loss and help prevent broken bones.

Does treatment for cancer increase the risk for bone loss and/or osteoporosis?

People diagnosed with breast cancer are at a greater risk of osteoporosis because many of the treatments aimed at fighting tumors reduce the amount of estrogen in the body. Women undergoing treatment for breast cancer may experience premature menopause, increasing their risk for bone loss which may lead to osteoporosis. Some hormone medications used to destroy tumors, such as aromatase inhibitors, also interfere with the body’s estrogen production or estrogen action.

Does radiation treatment increase the risk for bone loss?

There is no convincing evidence that radiation treatment increases the risk of bone loss. It may, however, increase the risk of fracture in the bone underlying the radiated area.

When I am being treated for cancer, how can I protect my bones?

There are some very simple steps to take to help protect your bones:

Eat a variety of healthy (nutrient-rich) foods. Make half your plate vegetables and fruit, add lean protein, include whole grains, select heart-healthy fats, and remember to include a calcium-rich food or drink at each meal. For more information about healthy food choices, go to

Reach and maintain a healthy weight. Eat the amount of calories and protein you need. The amount that you need will depend on your height, weight, age, physical activity, and medical condition.

Get the calcium you need. It is recommended that adults consume 1000 to 1200 milligrams (mg) of calcium each day. It is best to get calcium from the foods you eat. It is important to only eat the calcium rich foods you tolerate and/or those that are permitted according to your healthcare provider, if you are on a special diet. Foods rich in calcium such as low fat dairy foods (milk, yogurt, cheese), dark green leafy vegetables (bok choy, broccoli, collard greens, kale, mustard greens, and turnip greens), canned fish (sardines, salmon) eaten with bones, or calcium-fortified (with calcium added) foods. The body uses calcium best when it is spaced through the day. Try to eat a calcium rich food at each meal or snack. If you think that you are not getting the recommended amount of calcium in the foods you eat, it is important to consult with your healthcare provider to find out if a calcium supplement is right for you. Calcium supplements should not be taken without the advice of your healthcare provider. Too much calcium taken on a routine basis, particularly from supplements, may be harmful.

Get the recommended amount of vitamin D. It is important to only eat the vitamin D rich foods you tolerate and/or those that are permitted according to your healthcare provider, if you are on a special diet. There are only a few good natural sources of vitamin D including fatty fish such as catfish, eel, mackerel, salmon, sardines, tuna and shiitake mushrooms. Small amounts of vitamin D are added to all cow’s milk, some types of beverages (almond, coconut, rice, or soy beverages and orange juice), yogurt, cheese, and nutrition bars. Adults 50 years of age and above should consume 800-1000 IU or 20-25mcg daily. Your healthcare provider may recommend more vitamin D than above stated amounts based on your individual needs.

Be physically active. Your bones get stronger and denser when you make them work. Walking, climbing stairs, and dancing are impact (or weight-bearing) exercises that strengthen your bones by moving your body against gravity when you are standing. Resistance exercises such as lifting weights or using exercise bands strengthens your bones and your muscles too! Tai Chi is an example of physical activity that improves posture and balance to help decrease the risk for falls and fractures. Exercise can be easy; try 10 minutes at a time, adding the minutes up to reach your goal.

Don’t smoke. If you do, STOP. Call 1-800-NYQUITS for information about how to quit.

Limit alcohol. Before drinking alcohol, it is important to speak to your healthcare provider about possible interactions with your medication or your medical condition. Too much alcohol can be harmful for your bones and your overall health.

Take action to prevent falls. Most broken bones occur as a result of a fall that can be prevented. Some actions to prevent falls at home include using nightlights, removing or securing scatter rugs, and getting rid of clutter.

For more information about staying strong during and after cancer treatment, visit the New York State Cancer Services webpage