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What should you know about bone health and breast cancer?

– Julie Lapointe, post-doctoral candidate in the Department of Oncology at McGill University’s Faculty of Medicine, who is also a member of the research team for the Hope & Cope program, demystifies the question.

While the breast cancer survival rate is increasing steadily, in recent years researchers and clinicians have taken an interest in the bone health of women who survived the disease. What should we know about this subject?

What Is Osteoporosis?

Osteoporosis Canada defines osteoporosis as “ … a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fractures (broken bones), particularly of the hip, spine and wrist.” Osteoporosis is often considered a silent villain: bone loss has no symptoms until a fracture happens, causing pain and complications.

Some of the risk factors shared by all women are: age (increased risk over 65), a family history of osteoporosis, low body weight, absence of menstruation for several months at some point in the past (except for during pregnancy and/or menopause), use of certain medications that cause osteoporosis as a side effect, low calcium intake, lack of physical activity, tobacco use, excessive alcohol consumption (more than three drinks a day) and/or being postmenopausal or having experienced early menopause (before age 45).

What Is the Link Between Breast Cancer and Bone Health?

The main connection between breast cancer and bone health is the treatments given to women affected by breast cancer, especially some chemotherapy and hormonotherapy treatments. During their first year of beast cancer treatment, women lose, on the average, 2% to 4% of the calcium in their bones. Those who have undergone both chemotherapy and hormonotherapy may lose even more bone substance.

Why? On the one hand, these treatments impact the bones directly by destabilizing bone marrow, making the bones more brittle and thus more susceptible to fractures. On the other hand, breast cancer treatments impair ovarian function which leads to reduced estrogen levels. In this case, estrogen, that protects bones, can no longer contribute to maintaining strong bones.

Studies show that women, who are not yet menopausal when cancer treatment begins, lose more bone substance than those who have begun menopause. The treatments also accelerate bone degradation in women already affected by osteoporosis.

According to Julie Lapointe, all women being treated for breast cancer need to pay special attention to bone health. She recommends that women being treated discuss the matter with their medical team. The doctor, pivot nurse, pharmacist, nutritionist, physiotherapist and kinesiologist are all professionals who can provide advice on bone health.

How Do I Know if I Have Osteoporosis and What Treatments Are Available?

Osteoporosis develops gradually and without symptoms until the bones are so brittle that they end up breaking. There are two types of fractures linked to osteoporosis: fragility fractures and vertebral compression fractures. Fragility fractures are caused by a minor impact that would normally not cause such a fracture, for example falling to the ground and breaking a hip. Vertebral compression fractures are associated with a loss of height of 2 cm or more.

In the past, osteoporosis treatments were administered only following a firm diagnosis of osteoporosis (often when a bone fractured for no apparent reason). Today, there are tests that measure bone density and predict future risks of osteoporosis and associated fractures. If required, certain medications are available that can help prevent osteoporosis, prevent further loss of bone density, or help solidify the bones if they are already brittle, namely by reactivating calcium formation. One thing is certain: the more brittle the bones have become, the more difficult it is to treat the condition. Prevention is therefore crucial when it comes to osteoporosis. To learn more about existing treatments, talk to your medical team.

How Do I Prevent Bone Deterioration?

Some useful strategies are available to women treated for breast cancer who want to reduce their risk of osteoporosis or who want to improve their bone health. Here are a few—and remember, it’s never too late to take better care of your bones.

Eat a Balanced Diet

A balanced diet, rich in calcium and vitamin D, can help prevent bone deterioration.

First, bones need calcium to stay strong. The recommended daily intake of calcium is 1,000 mg for women under 50 years of age, and 1,200 mg for those over 50. Dairy products (such as milk, cheese and yogurt) and vegetables and lentils are good sources of calcium. Calcium supplements are an option for those who are not getting sufficient amounts from their diet. It is a good idea to monitor the consumption of foods that may cause a loss of calcium, such as too much caffeine (more than two to three cups of coffee a day) or even salt.

As well, vitamin D plays an important role in the bones’ ability to absorb calcium and in overall bone health. There is naturally occurring vitamin D in foods such as egg yolks, fish and liver. The recommended intake is 800 to 2,000 international units (IU) per day for adults over 50 years of age. Most people reach this level by taking a vitamin D supplement.

Physical Activity

It is recommended that women being treated for cancer remain active by doing non-impact activities such as walking or climbing stairs. Staying active during treatment, while taking into account one’s overall state of health, helps the bones remain healthy and improves muscle strength, posture, balance and coordination.

In most hospitals, a physiotherapist or kinesiologist can help set up an exercise program appropriate for each woman’s situation. At the end of treatment, a more intense bone strengthening exercise program may be followed, under the supervision of a professional trained to work with breast cancer patients. Generally speaking, impact exercises, both aerobic and resistance training, may be recommended to do two to three times a week. However, it’s best to consult your doctor before starting an exercise program for osteoporosis.

Tobacco and Alcohol

Besides being harmful to your heart and lungs smoking is also bad for the bones. Women who smoke tend to go into menopause earlier than those who do not. Smoking also causes a decrease in the production of estrogen that contributes to bone fragility. Smokers are also prone to absorb less calcium from the foods they eat. As for alcohol, studies suggest that a high daily consumption (more than three drinks) could have a negative impact on bone health. In fact, consumption of alcohol is associated with a less nutritious diet and a higher risk of falling.

Recommendations for women affected by breast cancer with bone metastasis should be personalized and determined by several risk factors including the location of the metastasis, the severity of the lesions and the effect of these lesions on everyday activities. To obtain more specific recommendations, it’s best to consult your medical team.

Since 2014, the Quebec Breast Cancer Foundation funds the Breast & Bone Health Program developed by the Segal Cancer Centre in collaboration with the Hope & Cope Wellness Centre. Through this program, women affected by breast cancer can receive advice from a nurse and a physiotherapist to protect, improve and promote bone health in an oncology care setting. Visit the program website.

To learn more, visit osteoporosis.ca.