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How Cancer Affects Your Bones

… and What You Can Do about It

by Huifang Lu, MD, PhD, and Xerxes Pundole, MD, MPH

Knowledge image

Milk and other calcium-rich foods can help keep your bones strong.

Healthy bones are important throughout your life. Bones aid movement, support the body, protect organs, produce red and white blood cells, and store minerals. Bone is a dynamic tissue that is constantly reabsorbing bone material and using it to regenerate itself. When bone mass is lost faster than it can be re­placed, bones become thin and porous, and osteoporosis (a condition that makes bones more likely to crumble) can develop.

What causes bone disease?
The bone mass in your body peaks in your mid-20s and then decreases slowly over the course of your lifetime. Poor nutrition, inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and cancer treatment can all contribute to bone loss. For women, menopause can accelerate bone loss. Some types of chemotherapy and radia­tion therapy can affect the bone, directly or indirectly, by inducing early meno­pause in women and low testosterone levels in men. The use of steroids can also increase your risk of bone damage, as can the spread of the original tumor to the bone. Cancer-related bone disease can result in significant pain and disability.

How is bone disease detected?
Bone loss doesn’t happen overnight. It often goes unnoticed until a frac­ture occurs and you experience pain. A bone mineral density test can detect the amount of minerals present in cer­tain bones and predict your risk of fracture. Bone mineral density is as­sessed using a DEXA scan, which is a non-invasive, painless procedure that uses minimal radiation. A DEXA scan can be performed before, during, or after treatment for cancer.

Weight-bearing physical activity, such as walking, dancing, and stair climbing, stimulates the production of bone-forming cells, ultimately creat­ing stronger bones.

Author of Article photo

Dr. Huifang Lu

If you’re experiencing back or joint pain, you should tell your doctor early on, as more severe signs of bone problems can be misdiagnosed. Early detection can guide the prevention or treatment of bone loss and can prevent fractures from occurring.

How can you prevent or treat bone disease?
Calcium is stored in bones and makes them sturdy. This mineral depletes with age and with the use of certain medications. Green, leafy vegetables, cheese, yogurt, calcium-fortified juices and milk, and other calcium-rich foods can replenish the losses, helping your bones to maintain adequate calcium levels.

Getting sufficient vitamin D, which helps absorb and store calcium, is also necessary. Your body makes vitamin D by using energy from sunlight. Certain foods also contain vitamin D. However, most people do not get enough calcium or vitamin D from their typical diets, so you should talk to your doctor about over-the-counter bone-strengthening supplements.

Author of Article photo

Dr. Xerxes Pundole

Weight-bearing physical activity, such as walking, dancing, and stair climbing, stimulates the production of bone-forming cells, ultimately creat­ing stronger bones. You should work with your doctor to formulate an exer­cise plan based on your needs, abilities, and fitness level. Maintaining a healthy weight is also important for good bone health, as being undernourished or underweight can contribute to bone loss and fractures.

Smoking cigarettes and chewing tobacco are habits that can lead to poor bone health. If you use tobacco products, you should consider quitting. Your doctor can help you develop a cessation plan. Daily consumption of three or more alcoholic drinks can contribute to bone loss as well.

Falls are the leading cause of frac­tures in people who have osteoporosis. To help prevent falls, wear shoes that fit well, and remove clutter from your living area to avoid tripping and injuring yourself. Daily muscle-strengthening exercises can help improve your balance during walking and other activities, thereby decreasing your risk of falls caused by poor balance. Keep in mind that poor vision and drowsiness can increase your chances of falling.

Can medications help?
Medications used to slow the rate of bone resorption, such as bisphosphonates or denosumab, may help reduce bone damage. These medications also help with cancer-related bone pain. Your doctor can determine whether such medications are right for you.

Dealing with cancer-related bone problems in addition to cancer treatment and cancer itself can be difficult. How­ever, by working with your doctor and applying the strategies mentioned here, you can stay on top of your bone health.

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Dr. Huifang Lu is an associate professor of Rheumatology and Clinical Immunology and the director of the multidisciplinary Bone Health Clinic at The University of Texas MD Anderson Cancer Center in Houston, TX. Dr. Xerxes Pundole is a graduate research assistant at MD Anderson and is currently studying osteoporosis in people with cancer.

This article was published in Coping® with Cancer magazine, September/October 2013.