If you are battling breast cancer, we know how challenging the journey can be. With the advancement of modern medicine, there are now very effective treatments for breast cancer. That is why the number of women who are recovering from cancer is also increasing. But during this battle, you may be at risk of another health problem that you may not be aware of. That is, bones become weak, thin, and easily broken. We call this in medicine 'Osteoporosis'. Because it often comes without any symptoms, some people also call it the "silent disease". Therefore, it is very important to educate yourself about this.
What is the connection between breast cancer and bone thinning?
Simply put, there is a strong link between breast cancer and osteoporosis. This is due to several factors.
Consider this: Breast cancer is most common in women over the age of 60. The risk of bone loss also increases at this age. Especially after menopause, when the body's estrogen levels drop. Estrogen is a hormone that helps keep our bones strong. So when this hormone decreases, the strength of our bones also gradually begins to decrease.
In addition, cancer itself causes inflammation in the body. This increases the rate at which old bone cells break down and slows down the rate at which new bone cells are formed. This is another reason why bones become weak.
Studies have shown that about 80% of postmenopausal breast cancer survivors are at risk of bone mass loss.
How do cancer treatments weaken bones?
Bone loss is not only caused by cancer. Some treatments for cancer can also directly affect this. In particular, hormone therapy and chemotherapy can cause bone density to decrease. Osteopenia can occur first, which can then progress to osteoporosis.
Most importantly, bone loss caused by cancer treatment can occur about seven times faster than what occurs naturally with aging.
About two-thirds of breast cancers are hormone receptor-positive. This means that the cancer cells are stimulated to grow by hormones like estrogen. So treatments for this condition work by reducing the levels of estrogen in the body, or by blocking the hormone. While this is essential to controlling the cancer, unfortunately it also robs our bones of the estrogen they need.
Let's look at the table below to see what are the main cancer treatments that can affect the bones.
| Type of treatment | How it affects bones |
|---|---|
| Tamoxifen | This drug blocks the action of the hormone estrogen on cancer cells. Although it slightly increases the risk of bone thinning in women before menopause, it reduces the risk in women after menopause. |
| Aromatase Inhibitors (AIs) | These drugs (e.g. Anastrozole, Letrozole) reduce the body's production of estrogen, which significantly increases the risk of bone thinning. |
| Ovarian Suppression | The ovaries stop producing estrogen. This can be done temporarily with drugs such as Goserelin (Zoladex) or permanently by surgically removing the ovaries. This increases the risk of bone loss. |
| Chemotherapy | While these powerful drugs kill cancer cells, they can also damage the ovaries and cause menopause at an early age, increasing the risk of bone thinning. |
Other factors that increase the risk
While you are undergoing breast cancer treatment, your risk of bone thinning may be even higher if the following factors also apply to you:
- Being over 65 years of age.
- Smoking.
- Excessive daily drinking.
- Having had previous fractures.
- Long-term use of steroid drugs.
- Body weight less than 57 kilograms (125 pounds).
If one or more of these apply to you, please be sure to talk to your doctor about your personal risk. There is no need to panic, but it is important to be informed in advance.
How to check bone health?
Your doctor can monitor your bone health before, during, and after cancer treatment. The main test used for this is a DEXA scan .
This is a painless, very simple test. It's like a special X-ray. It measures the bone mineral density of your spine and hip. It's a good idea to have this scan done before starting treatment and keep it as a baseline measurement. Then you can compare it later to see if your bone density has decreased.
The result of this test is given as a T-score. If this value is -2.5 or lower, it is considered osteoporosis and treatment may be required.
What treatments are given to strengthen bones?
If you have low bone density or are at risk for fractures, your doctor may prescribe bone-strengthening medications. They use a tool like the FRAX tool to calculate your risk.
| Drug type | Functionality and examples |
|---|---|
| Bisphosphonates | These prevent bone loss and reduce the risk of fractures. They are given as pills or intravenous injections. Examples: Alendronate, Ibandronate, Zoledronic acid. |
| Denosumab (Denosumab - Prolia) | This is an alternative for those who cannot use bisphosphonates. It is given as an injection every 6 months. This also reduces the breakdown of bone tissue. |
| Raloxifene (Raloxifene - Evista) | It acts like the hormone estrogen on the bones, strengthening them. It is used to prevent and treat osteoporosis. |
Things you can do yourself to protect your bones
In addition to medications, changing your lifestyle can also help keep your bones strong.
- Eat foods rich in calcium and vitamin D. These two nutrients are essential for bones. You need about 1000-1200 milligrams of calcium and 800-1000 international units (IU) of vitamin D per day. These are abundant in milk and dairy products, yogurt, cheese, dark green vegetables (spinach, kale), and small fish (such as sardines). If you don't get enough from your diet, consider taking a supplement under medical advice .
- Do weight-bearing exercises. Things like walking, climbing stairs, and playing tennis put pressure on your bones and strengthen them. Lifting weights and using resistance bands are also great.
- Quit smoking and alcohol completely. Both of these weaken bones. Smoking, in particular, reduces the body's ability to absorb calcium from food.
During and after your cancer treatment, always discuss your bone health with your doctor. Don't be afraid to ask about any concerns or questions you may have.
Take-Home Message
- Breast cancer and some of its treatments (especially hormone therapy) can weaken your bones and increase your risk of osteoporosis.
- Because this is a "silent disease," it is very important to be aware of this early, rather than waiting for symptoms to appear.
- Talk to your doctor and consider getting a DEXA scan if necessary.
- You can protect your bones by eating a diet rich in calcium and vitamin D, doing weight-bearing exercise, and avoiding smoking/alcohol.
- Talk openly with your doctor about anything related to your health, especially any concerns related to bone health.
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