Bone health

Estrogen is a hormone produced by the ovaries that plays an important role in protecting bones. Hormone-sensitive breast cancer is treated using medications and/or interventions that can lower the body’s estrogen levels, such as hormone therapies and surgery to remove the ovaries. Chemotherapy can also prevent the ovaries from functioning correctly.

This sudden drop in estrogen levels can cause menopausal symptoms or even early menopause and can have an impact on the bone health of people with breast cancer. Women treated for breast cancer are at greater risk for bone breakdown and osteoporosis than women who enter menopause naturally. Osteoporosis results in lower bone density and causes bones to become fragile and more vulnerable to fracture.

Adapted nutrition and some healthy lifestyle habits can help to prevent and limit bone breakdown. The Breast and Bone Health Program website funded by the Quebec Breast Cancer Foundation has more information on bone health after a breast cancer diagnosis.

Nutrition plays an important role in the bone health of people with breast cancer. Certain nutrients are particularly important for maintaining bone mineralization:

Calcium is an essential mineral for bone health. To ensure a sufficient daily intake, make sure you have a good source of calcium at each meal:

• Dairy products (such as milk, yogurt, cheese) are the best sources of highly absorbable calcium. For a calcium-rich diet, you can add cheese to dishes, replace cream by yogurt or evaporated milk (twice as concentrated in proteins and calcium as regular milk), or add skim milk powder to recipes.
• Calcium-rich mineral water (250–300 mg of calcium per litre) is also an attractive and easily absorbed source of calcium, making it a great way to boost calcium intake.
• Canned salmon and sardines are good sources of calcium, but only if the bones are eaten.
• Plant-based beverages (such as soy, almond, rice) as well as orange juice are generally calcium enriched.
• Other fruits and vegetables are natural sources of calcium and can serve to supplement calcium intake. These include oranges, dried figs, legumes (such as chickpeas, snow peas, edamame, beans), tofu, nuts and seeds (such as almonds, hazelnuts, sesame seeds) and leafy vegetables (such as kale, broccoli, spinach, bok choy). Incorporate these foods into your meals and snacks to supplement your calcium intake.

Vitamin D is also crucial for bone health because it helps the body properly absorb calcium. Although our bodies produce vitamin D when exposed to the sun, it is also important to obtain this vitamin through our food. Here are some dietary sources of vitamin D:

• Fatty fish such as salmon, swordfish, snapper, mackerel, herring and sardines, trout
  • Cod liver
  • Egg yolks
  • Dairy products (often enriched with vitamin D)
  • Some vitamin D-enriched plant-based beverages

Protein is also essential to bone formation and repair. It is therefore important to ensure sufficient protein intake to promote bone density. Watch the My Active Health Nutrition video (in French only) titled Chaque bouchée compte to learn more about protein intake.

The nutrition guide entitled Get Started With Bone Healthy Nutrition! providesmore information on using nutrition to promote bone health after a breast cancer diagnosis.

You may wish to see a nutritionist to assess your nutritional intake and get personalized advice based on your needs. When it is difficult to ensure sufficient intake through diet, your medical team can recommend nutritional supplements. Calcium may interfere with some medications. Talk to your care team or local pharmacist before taking any supplement.

In addition to adapted nutrition, other healthy lifestyle habits can help to prevent bone demineralization and strengthen bones:

• Regular physical activity is essential for maintaining bone density. The physical activity component of the Quebec Breast Cancer Foundation’s My Active Health Program helps you get moving safely every day. Learn about free adapted yoga courses online or in studios near you.
• Smoking can accelerate bone breakdown and hinder bone reconstruction. The I Quit Now site and helpline can help you cut your tobacco use.
• Alcohol consumption can limit calcium absorption and hinder bone reconstruction. Following alcohol consumption recommendations is not always easy. Ask your doctor to recommend resources if you need help.
• It is crucial to follow the recommendations of health professionals with regard to osteoporosis prevention, screening and treatment. As needed, your doctor can prescribe calcium and vitamin D supplements, which may or may not be combined with other drug therapies to prevent or slow bone loss.

Breast and Bone Health Program, funded by the Quebec Breast Cancer Foundation

Osteoporosis Canada – Nutrition  

Shi Y, Zhan Y, Chen Y, Jiang Y. Effects of dairy products on bone mineral density in healthy postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos. 2020 Mar 18;15(1):48. doi: 10.1007/s11657-020-0694-y. PMID: 32185512.

Iuliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L, Van Loan M, Zadeh AG, Nguyen T, Seeman E. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ. 2021 Oct 20;375:n2364. doi: 10.1136/bmj.n2364. PMID: 34670754; PMCID: PMC8527562.

Kędzia G, Woźniak M, Samborski W, Grygiel-Górniak B. Impact of Dietary Protein on Osteoporosis Development. Nutrients. 2023 Oct 28;15(21):4581. doi: 10.3390/nu15214581. PMID: 37960234; PMCID: PMC10649897.

Jackson MK, Bilek LD, Waltman NL, Ma J, Hébert JR, Price S, Graeff-Armas L, Poole JA, Mack LR, Hans D, Lyden ER, Hanson C. Dietary Inflammatory Potential and Bone Outcomes in Midwestern Post-Menopausal Women. Nutrients. 2023 Oct 7;15(19):4277. doi: 10.3390/nu15194277. PMID: 37836561; PMCID: PMC10574295.