Healthy bones are essential to our overall well-being. Bones are not just hard structures that make up the skeleton network but living tissue that requires the same attention that we would give to organs such as the heart and lungs. Bones enable us to stand upright and move about, protect vital organs from injury, and store minerals essential to life. Strong, healthy bones allow us to participate in activities of daily living without pain and loss of function and promoting bone health is important at any stage of life. People with cancer need to pay special attention to bone health since cancer itself and the treatments given for cancer can place you at an increased risk for bone complications.

Information about promoting bone health during cancer

CancerCare, a nonprofit organization that provides professional support services to anyone affected by cancer, offers an online resource providing cancer patients and their families with useful information about maintaining good bone health. Patient information booklets about bone health for people with prostate cancer, lung cancer, and multiple myeloma, can be downloaded from their website at CancerCare Connect® Booklets:

• Better Bone Health for Men Living With Prostate Cancer addresses the special needs of men living with prostate cancer. Since men can live long healthy lives with prostate cancer it is important to develop strategies to improve and maintain quality of life.
  
  
• Bone Health For People Living With Multiple Myeloma provides patients and their families with information about dealing with bone complications and bone pain, which is the most common problem related to multiple myeloma.
  
  
• Caring For Your Bones When You Have Lung Cancer provides patients who have lung cancer with tips on how to maintain strong healthy bones.

Below are important issues regarding bone health, especially during cancer treatment.

Osteoporosis

As we age our body loses the ability to replace the vital cells necessary to repair and rebuild bone mass and bones become thin and more porous. This condition is called osteoporosis and is the most common kind of bone disease. When bones become weak and fragile they are more likely to fracture (break) and cause pain and disability that can interfere with quality of life. Other factors besides age can play a role in loss of bone mass:

• Cancer can spread to the bone itself (metastasis) and can cause bones to weaken in certain places. This may place you at an increased risk for fracture and pain.
  
  
• Certain chemotherapy drugs can stimulate bone loss, increasing your risk for osteoporosis.
  
  
• Radiation therapy to the pelvis may increase the risk of pelvic and hip fractures in women 65 and older. This risk may be greater for women who have osteoporosis prior to treatment.
  
  
• Women have a greater risk than men of osteoporosis especially after menopause when there is loss of the hormone estrogen. More than 80% of people diagnosed with osteoporosis are women. Estrogen is an essential hormone that helps maintain bone density; estrogen levels drop off significantly after menopause.
  
  
• Hormone therapy that suppresses the male hormone testosterone given to men with prostate cancer can contribute to the rate at which bone mass and density is lost.
  
  
• Long term use of nicotine and alcohol also increases the risk of osteoporosis. If you smoke, quit now and limit your intake of alcohol to reduce your risk of osteoporosis.
  
  
• If you have a family history of osteoporosis, your risk is greater.
  
  
• Certain medications such as steroid therapy that is often given in cancer treatment, and medications such as thyroid hormone given to people with thyroid disease, can also increase the rate of bone loss.
  
  
• Prolonged bed rest and inactivity can increase the rate of bone loss.
  
  
• Inadequate calcium, vitamin D, and nutrition result in weakened bones.

Promoting bone health

There are steps that can help reduce your risk of bone loss and promote strong, healthy bones during cancer treatment.

Early detection and prevention. Loss of bone mass doesn't happen overnight and generally goes unnoticed until a person experiences pain, loss of function or develops a fracture. The most common test to measure bone mass is called a DEXA scan or bone density scan, and it may be done before, during, and after cancer treatment.

Get your daily requirement of calcium and vitamin D. Calcium is an important mineral stored by your bones and keeps bones strong and healthy. It is important to replace calcium your body loses especially as you get older. Certain drugs used to treat cancer can deplete calcium. Foods high in calcium include green, leafy vegetables such as broccoli, cheese, yogurt, and calcium-fortified foods such as orange juice, pasta, and milk. It is equally important to make sure you get enough vitamin D in your diet since vitamin D helps your body absorb and retain calcium. Vitamin D is manufactured in the skin using energy from sunlight and can also be found in vitamin D fortified food, such as milk. Before you take any vitamin or mineral supplement, talk with your doctor about your individual needs.

Exercise. Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) places stress on your bones, thus stimulating the production of cells that cause bone formation. Regular weight-bearing exercise also promotes strong muscles, which give you more stability when walking. Talk with your doctor about an exercise program tailored to your needs to help promote bone health.

Maintain a healthy weight. Eating a well balanced diet is important to good bone health. Being underweight can contribute to bone loss and fractures.

Prevent falls. The primary risk factor for fractures in people who have osteoporosis is falling. Poor vision, ill-fitting shoes, a cluttered living environment, mental impairment, sedation related to pain management therapy and poor concentration can increase your risk for falling. Exercises, such as Tai Chi, that improve balance will lessen the chances of falling.

Bisphosphonates. Treatment with bisphosphonates, medications that slow the rate of bone thinning, may reduce new bone damage and promote bone healing. They are also given to patients who experience bone pain related to metastatic (spread) disease. For more information, read Cancer.Net's Patient Guides on Bisphosphonates for Breast Cancer and Bisphosphonates for Multiple Myeloma.

Don't ignore symptoms. If you are experiencing painful joints, back pain, or stiffness report these symptoms to your doctor as soon as possible. Warning signs of more severe bone complications are often mistaken for arthritis-like symptoms.

Additional Resources

breastcancer.org: Overview of Bone Health

Lance Armstrong Foundation: Osteoporosis

National Cancer Institute

National Osteoporosis Network

The Prostate Net

Multiple Myeloma Research Foundation

Lung Cancer Alliance

More Information

Exercise and Cancer

Last Updated: January 29, 2008