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Building Strong Bones

by Margaret Rosenzweig, PhD, FNP-BC, AOCNP, and Adam Brufsky, MD, PhD

Maintaining bone health is a vital component of wellness. A “thinning” of the bones, known as osteopenia or osteoporosis (bone marrow density that is lower than normal), occurs naturally with age. There are additional factors that can place you at risk for osteoporosis. Some risk factors, such as smoking, a diet lacking in Vitamin D and calcium, lack of weight bearing exercise, and chronic persistent stress, can be controlled, thereby decreasing your risk of osteoporosis. Other risk factors are non-modifiable. These include age, race, gender, small body frame, and family history.

The skeleton is often at risk during and after cancer treatment. This is particularly true in women with a history of breast cancer who are receiving the class of drugs known as aromatase inhibitors or in women with menopause induced by chemotherapy. The other category of individuals at risk for osteopenia or osteoporosis is men with a history of prostate cancer who are receiving therapy.

Calcium is necessary to keep bones strong and healthy.
Some drugs used to treat cancer may deplete
the calcium in your body.

It is important to be mindful of bone health throughout cancer treatment and beyond. There are many things you can do to maintain your bone health, including meeting your daily requirement of calcium and vitamin D intake, doing weight bearing exercise, maintaining a healthy weight, getting appropriate screening to assess bone mass, and if necessary, taking prescriptions to build bone density.

Calcium and Vitamin D
Calcium is an important mineral stored by your bones and is necessary to keep bones strong and healthy. Some drugs used to treat cancer may deplete the calcium in your body. As a result, you should be mindful of your diet and try to include foods high in calcium (green, leafy vegetables; cheese; yogurt; orange juice; pasta; milk). Additionally, it is important to include enough vitamin D in your diet because vitamin D is essential in helping the body absorb and retain calcium. Vitamin D is manufactured in the skin, using energy from sunlight, but it is also found in vitamin D fortified food. Calcium and vitamin D supplements may be beneficial for osteoporosis prevention, but be sure to talk to your healthcare provider before beginning a supplement regimen.

Exercise
Exercise, combined with a balanced diet, is important to bone health. Physical activity (walking, dancing, stair climbing, jumping rope) places stress on your bones and stimulates the production of cells that cause bone formation. Regular weight-bearing exercise also promotes strong muscles, which improves stability when standing or walking and may reduce incidence of falls and osteoporotic fractures. Be sure to talk to your doctor about developing an exercise program that is appropriate for you.

Screening
Cancer and cancer therapy can change bone metabolism. Individuals with a history of cancer are more at risk for osteoporosis and should receive a routine and regular assessment of bone health. While a physical examination can suggest osteoporosis, screening primarily consists of measuring bone mineral density. The Dual Energy X-ray Absorptiometry (DEXA) scan is considered the gold standard for measuring bone density, but it is not performed more than once a year. Routine cancer imaging studies such as radiographs, MRI, CT, and PET-CT may also suggest osteoporosis. Your healthcare team will help you determine your risk and the frequency of scans.

Prescriptions
Your doctor can track your bone mass and bone loss on your bone density scans. If you have been taking supplements and your bone density scans still show significant osteoporosis, your doctor may recommend bisphosphonates. Bisphosphonate treatment is used to slow the rate of bone thinning. It also may reduce new bone damage and may promote bone healing. Bisphosphonate therapy is associated with reduction in the number of hip and vertebral fractures in women with breast cancer and has been shown to prevent bone loss in men with prostate cancer.

Self Care
When bones become weak and fragile, they are more likely to break and cause pain and disability. However, there are many things you can do, or may already be doing, that can improve your bone health. Exercise and nutrition are essential to preserving bone health. Making simple lifestyle changes will help you build strong bones – during and after cancer treatment.

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