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What Breast Cancer Survivors Need to Know about Osteoporosis & Vitamin D Deficiency

by Nancy Waltman, PhD, APRN-NP

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Milk and other dairy products are great sources of calcium, which is essential for strong bones.

Osteoporosis is a major health concern for postmenopausal women, and breast cancer survivors are at even greater risk for developing the condition. Here’s why: Breast cancer treatment can involve blocking the body’s production of estrogen. This is necessary because estrogen can drive cancer cell growth. However, estrogen also promotes bone health, so a drop in estrogen levels increases a woman’s risk for developing osteoporosis. The following are steps you can take to reduce that risk.

Ask your doctor about bone mineral density (BMD) testing.
All premenopausal women with cancer treatment-induced menopause, postmenopausal women receiving estrogen-blocking drugs (such as aromatase inhibitors), and all women over 65 should undergo BMD testing. BMD test results diagnose both early bone loss and osteoporosis, allowing you to address the issue before it becomes more serious.

Make sure you’re getting enough calcium and vitamin D.
Calcium and vitamin D are essential for strong bones. Calcium is the “building block” of bone, and vitamin D helps to absorb the cal­cium you ingest so it can be used by the bone.

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Dr. Nancy Waltman

Women should be getting 1200 mg of calcium daily, either through their diet or with the help of a supplement. Milk and dairy products are good sources of calcium, but you may need to take a calcium supplement, depend­ing on how much calcium you’re getting from your diet. For reference, an eight-ounce glass of milk contains 300 mg of calcium.

Many breast cancer survivors have vitamin D deficiencies, which increases their risk for bone loss. To find out whether you have a vitamin D deficiency, your doctor can perform a test to deter­mine the amount of vitamin D in your blood. The best sources of vitamin D are fish (such as salmon), vitamin D-fortified milk, and sunlight, but most breast cancer survivors should be taking vitamin D supplements daily. Talk with your doctor to determine your appro­priate daily dosages of both calcium and vitamin D supplements.

Make positive lifestyle changes.
Excessive use of alcohol, tobacco, and caffeine; chronic stress; an unhealthy diet; and systemic inflammation can increase your risk of osteoporosis. Mak­ing some simple lifestyle changes to decrease these risk factors can help lessen your chance of bone loss.

Engage in regular weight-bearing and resistance exercises.
All adults should do 150 minutes of weight-bearing exercises (such as walking or jogging) per week and resistance exercises (such as lifting weights) twice weekly. Weight-bearing and resistance exercises can reduce your risk of osteoporosis be­cause increased muscle strength puts greater demands on bones, resulting in stronger bones and reduced bone loss. Exercise also improves balance, thereby reducing your risk of falling, which can result in fractures.

Take bisphosphonate medications as prescribed.
Bisphosphonates, such as alendronate, risedronate, and ibandro­nate, are relatively safe and are effective in both maintaining and building bone mineral density. Ask your doctor if you should be taking bisphosphonates.

As a breast cancer survivor, you are a member of a very special sisterhood of women who are tough, resilient, and able to take on any challenge that comes their way. One ongoing challenge for you will be to maintain the health of your bones, but it’s certainly a doable one.

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Dr. Nancy Waltman is a professor at the University of Nebraska College of Nursing in Omaha, NE. She has conducted research on vitamin D and exercise to promote bone health in breast cancer survivors for more than 15 years.

This article was published in Coping® with Cancer magazine, March/April 2014.

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