Bone Loss or Osteoporosis

Many side effects of treatment can induce bone loss (osteoporosis), thinning of the bones (osteopenia) and increase the risk of fractures. There is also a connection between cancer-related bone disease and death. Osteoporosis comes from the Greek language and means “porous bones”. Once bones become porous they lose their strength and can easily fracture or break. This can then lead to disability and decreased mobility which in turn results in further bone loss.

Keeping your bones strong and healthy is more than just a good idea. It can also be a lifesaver.

• Primary osteoporosis is the result of a normal physiologic process -- usually aging and/or menopause.
• Secondary osteoporosis is due to bone loss from a medical condition or as a result of medical treatment, including some cancer treatments.

Who is at risk for osteoporosis?

Talk with your doctor about your risk of osteoporosis. You may be at higher risk depending on your family history, diet and whether you have ever smoked. Older women (over 65) and older men (over 70) are generally at higher risk. White people also seem to have an increased risk.

Risk factors for secondary osteoporosis can be related to the type of cancer you had, your treatment, or the way your body responded to treatment. Specifically, risks may exist for survivors of certain types of cancers and treatments that could spread to the bone such as:

• Breast cancer
• Prostate cancer
• Multiple myeloma (cancer that occurs in the antibody-producing white blood cells)
• Other solid tumor types such as lung, testicular, ovarian and endometrial (uterine wall) cancers

What cancer treatments affect bone health?

• Hormone therapy, such as aromatase inhibitors for breast cancer or androgen deprivation therapy for prostate cancer
• Steroids, such as prednisone
• Blood thinners
• Radiation therapy, especially to the pelvis

Treatment for some cancers, such as breast or prostate cancer, can include blocking or eliminating certain hormones in your body. Blocking sex hormones (testosterone or estrogen) helps to slow the growth of cancer cells. However, the sex hormones also help protect the bones. If your body is deprived of these hormones, osteoporosis can develop. This does not mean that you should not receive this type of treatment, because it may be the most effective way to treat your type of cancer.

Symptoms of osteoporosis may include:

• Weight loss
• Stooped posture
• Curving of the upper back (Dowager’s hump)
• Bone tenderness
• Loss of one or two inches in height
• Bone break or fracture

An individual can have osteoporosis and not experience any symptoms. If you think you are at risk for osteoporosis, a bone mineral density screening (sometimes referred to as a DEXA scan) may be right for you. If it’s lower than normal or declines while you’re in treatment, there are medications called bisphosphonates you can take to strengthen your bones. Some examples of medications used to treat osteoporosis are Fosamax, Actonel, Boniva, and Reclast.

What can you do to keep your bones strong?

Bone loss is treatable, but not curable. This means that once you know you have this condition, you should work with your health care team to develop ways to slow down any bone loss.

Diet

Eat a nutritious diet – eating a good balance of whole grains, fruits, vegetables and lean proteins will both help you maintain a healthy weight and ensure that you get the nutrients your body needs, including vitamins A, C,K, phosphorus and more. In addition, eat calcium-rich foods and get enough vitamin D to help the body absorb calcium.

Ask your health care provider if you would benefit from supplements or increasing your oral intake of calcium and Vitamin D -- both of which are needed for strong healthy bones. By age 65 or 70 men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes, says the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Exercise

Weight-bearing exercise, such as weight training, walking, hiking, jogging and climbing stairs, helps strengthen bones. Please be sure to check with your healthcare provider before beginning any exercise program

Quit Smoking

If you don't smoke, don't start.

Limit Alcohol

Stick to no more than one drink for women, two drinks for men each day. One drink is defined as 12 oz. beer, 1.5 oz. of spirits or a 5 oz. glass of wine.

Medication

Bisphosphonates: these prescription-only drugs work to build up and strengthen the bone, reducing the risk of fractures. Zometa and Xgeva are commonly used in cancers that spread to the bone.

Some specifics about bone loss in men with cancer

If you were to compare a 70 year old female and a 57 year old male, who would you guess to be more likely to die from a bone fracture? Surprisingly it is the man. The International Osteoporosis Foundation notes “Although fragility fractures are less common in men, when they occur, these fractures can be associated with higher rates of disability and death than in women. Overall, 1 in 5 men over the age of 50 will have an osteoporosis related fracture. This is greater than the likelihood of developing prostate cancer.” Unfortunately osteoporosis or bone loss in men with cancer puts them at even greater risk for fractures.

Some of the causes of bone loss in men with cancer can include:

• The long term use of steroids: This is especially common in the treatment and management of prostate cancer, leukemia, lymphoma, and multiple myeloma
• Decreases in the levels of testosterone which can be caused by hormone deprivation therapy for prostate cancer and male breast cancer. Also as a man ages, his testosterone levels decrease, helping to explain why the risk of bone loss increases with age
• Deceased mobility which can be caused by the tumor pressing on nerves or other organs, making movement painful

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