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What Does Breast Cancer Have to Do with My Bones?

by Ana Maria Lopez, MD, MPH, FACP

Breast Cancer image

As women are surviving and living longer after breast cancer, medical professionals are identifying new health issues that are particular to you, the breast cancer survivor. One of these areas of concern is bone health.

Bone health is a matter of importance to all women. Our mother?s generation took it for granted that with age would come fragile bones. Now, we know that the risk of developing fragile bones, or osteoporosis, is a result of a woman?s unique blend of family history, ethnicity, nutritional status (specifically calcium intake as a young person), body mass index (BMI), and physical activity. We also know that bone density can be measured and that, with treatment, less dense bones can improve.

What does this mean for the breast cancer survivor?
Breast cancer can take its toll on the bones, even if it doesn?t involve the bones. After a breast cancer diagnosis, a person may become less active. This change in activity may result in BMI changes that promote bone loss. For a woman undergoing chemotherapy, her bones will experience direct toxicity from the treatment. If the woman is premenopausal, chemotherapy can induce premature menopause through its toxic effects on the ovaries. The consequent hormone deficiency will contribute to bone loss.

Breast cancer can take its toll on the bones, even if it doesn’t involve the bones.

Author of Article photo

Dr. Ana Maria Lopez

In addition, aromatase inhibitors (therapies for hormonally sensitive breast cancer, which block estrogen production at the source, the adrenal gland) place the postmenopausal woman at risk for bone loss. Accompanied by the normal weight gain associated with breast cancer chemotherapy and the decrease in physical activity, the woman with breast cancer is at prime risk for bone loss earlier and faster than is the woman without breast cancer.

Why does bone health matter?
Our bones, along with our muscles, hold us together and allow us to move. If our musculoskeletal system is not strong, then we are prone to falls. If a person with osteoporosis falls, there is a greater likelihood of fracture, which is a major healthcare concern. Women who experience a hip fracture have an increased risk of death.

What can you do to promote bone health?
Since breast health is at least partly dependent on peak bone mass, young girls and women should maintain adequate calcium intake and be physically active. These two factors should be part of general health maintenance across the lifespan, even during the cancer journey. Breast cancer survivors are generally encouraged to take 1200 mg calcium with 400-800 IU of Vitamin D and to engage in regular weight bearing exercise such as walking.

Following through with these recommendations after a breast cancer diagnosis may not be easy. When thinking about calcium intake, remember that a wide variety of foods are sources for calcium. There is no need to limit your options to dairy. Although supplements are always an option, they may cause constipation. To prevent constipation, start slowly with one 500-600 mg tablet daily. Take it with food, consciously increase your fiber intake, and stay hydrated. When you are comfortable that your bowel regimen is normal for you, consider increasing to two tablets daily. Add the other tablet at a different time; do not take both tablets together.

Regarding physical activity, be gentle with yourself during treatment. Think positively. Identify what you can do. Taking a couple of short walks daily is better than none at all. Remember not to get discouraged. Take into account all the activity you do: taking your child to the park, standing to cook, walking the dog, etc. Physical activity will also help to keep your heart healthy and will release endorphins, your body?s own “feel good” medicine. And remember that the more that you maintain your bone and muscle mass, the easier the transition will be after your treatment is over.

After your treatment is completed, rejoice at your accomplishment and your new lease on life. Although you may have become debilitated after therapy, your risk for fracture may lessen as your balance improves from gaining strength from increased muscle mass. This is an opportunity for you to re-shape your life and strengthen your core. Explore activities that you may not have done before. You are a survivor. Use your survivor?s courage to hike, to complete a marathon, to dance. It is good for your bones. It is good for your heart. It is good for YOU!

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Dr. Ana Maria Lopez is associate professor of Clinical Medicine and Pathology and medical director of the Arizona Telemedicine Program at the Arizona Cancer Center in Tucson, AZ.

This article was published in Coping® with Cancer magazine, July/August 2008.