5 questions about bone health and cancer

Losing bone density is common as you age, when cells that help rebuild bones aren’t replaced as quickly. Because of this, your bones may become thin and full of tiny holes, making fractures more common. While bone loss is a part of aging for many people, certain types of cancer and cancer treatments may lead to bone loss – no matter your age.

To better understand bone loss in cancer patients and options for keeping bones healthy, we spoke with Sonali Thosani, M.D. Here’s what she had to say.

Are certain cancer patients more likely to have bone health issues?

In general, women are at the highest risk, regardless of whether they’ve had cancer. That’s because bone loss usually happens after menopause.

Patients with breast or prostate cancer also are at risk for bone loss because they’re often treated with drugs that affect hormones.

Survivors of childhood cancers may have the highest risk for bone health issues, Thosani says. “Children treated for cancer often have limited physical activity, and they’re exposed to certain types of chemotherapy and radiation therapy that interfere with bone development,” she adds.

Which types of cancer treatment may increase the risk of bone health issues?

Chemotherapy drugs like doxorubicin and cisplatin can reduce calcium levels in your body, which can lead to bone loss.

Aromatase inhibitors, which are commonly used to treat breast cancer, can also cause bone loss. “For example, in postmenopausal women, tamoxifen treatment preserves bone marrow density. But when it’s used in premenopausal woman, it may actually increase the risk of bone loss,” says Thosani.

If you’ve had radiation, you may be more likely to develop bone loss, especially near the site of radiation. “Bone loss from radiation treatments is often delayed for several years,” says Thosani. That’s why screening and follow-up care are important for maintaining healthy bones. Radiation can also cause growth-hormone deficiency and delayed bone growth. This can increase the risk of fractures later in life, especially for younger patients.

If you’ve had a hematopoietic stem cell transplant, you may also be at higher risk of bone loss. “We don’t know if the transplant itself causes bone loss, but we know the treatments patients receive during transplant increase the risk of bone loss,” Thosani says.

Patients who take steroids to treat nausea may also be more likely to have bone loss since these medications interfere with your body’s ability to absorb calcium.

Lack of physical activity may lead to bone loss, too. So, if you’ve had limb surgery or been in bed for long periods of time during or after treatment, talk to your doctor.  

What are the signs of bone loss?

“Unfortunately, most patients don’t realize they have bone loss until they break a bone,” says Thosani.

That’s why she says screening is so important – even if you don’t meet the typical age for bone health screenings.

“The general recommendation for osteoporosis screening is age 65 in women and age 70 in men,” says Thosani. But if you’ve had any treatments known to cause bone loss or a spine, wrist or hip fracture that wasn’t caused by a traumatic incident, you should be checked out for bone loss.

Bone density scans are a good way to determine if you’re experiencing bone loss before, during or after cancer treatment. Talk to your doctor about whether this screening is right for you.

How can patients protect their bones?

Eating calcium-rich foods like cheese, yogurt and broccoli can help you maintain bone health and strength. Foods rich in vitamin D -- like orange juice, milk and pasta -- can help your body absorb calcium.  

MD Anderson patients can request a referral from their care team to see one of clinical dietitians for nutrition counseling.

If you’re underweight, you’re more likely to experience bone loss. A dietitian can make recommendations to help you gain weight and maintain a healthy weight. Moderate exercise may also stimulate cells that help grow bones and build muscle, which can help prevent falls.

Falls are often the cause of osteoporosis-related bone fractures. To prevent falls, make sure the floor around you is clear of rugs, magazines, papers or other things that could trip you up.

Anything else you want cancer patients to know about bone health?

“If you have concerns about your bone health, talk to your doctor to discuss treatment options,” says Thosani.

If you’re an MD Anderson patient, ask your care team for a referral to our Bone Health Clinic, which provides treatment for cancer patients with bone disorders or bone loss caused by cancer treatments. Our team of experts can evaluate you and treat conditions like osteoporosis, low bone mass, fractures, height loss and vitamin D deficiency. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.