The Link Between Breast Cancer and Bone Health

The Link Between Breast Cancer and Bone Health

As if a diagnosis of breast cancer isn’t bad enough, the dreaded disease as well as its treatments can trigger other health problems, including a deleterious link to bone health, specifically an increased risk for osteoporosis. Yup. Cancer never seems to let us forget.

Because I am in a bony state of mind, please allow me to give you a few ABC’s of Bone Health and why it matters.

Let me begin with terminology. The medical term bone density (BMD) refers to the amount of mineral matter in bones. It is important to pay attention to this because in clinical medicine, poor bone density can indirectly indicate the presence of osteoporosis and a higher risk for fractures. Sorry to be the bearer of bad news. At my last bone density scan, my results showed the beginnings of osteoporosis, likely resulting from – so I was told – “all of the chemo.”

Why, you wonder?  Well because chemotherapy can (and did in my case) cause a loss of ovarian function, which in turn creates lower estrogen levels. Now this was the goal for me. Because my cancer was estrogen positive (meaning that my cancer needed estrogen to grow), we wanted to eliminate the estrogen flowing through my body.

But the pickle is that estrogen contributes to bone strength and helps protect bones and keep them healthy. So, with an intentionally depleted amount of estrogen in my system (to prevent the cancer from growing and proliferating), my bone health suffered.

Get it?

So, how to measure? The  Dual-energy X-ray absorptiometry (DEXA) is the most common test for measuring bone density (and the one that I had). Low-energy X-rays scan the bones to measure their density, and a computer calculates the results.

Understanding the Test Results

• Bone density tests provide T-scores and Z-scores that compare one’s bone health with that of other people.
  • A Z-score uses averages for others of the same gender and age for comparison, and a score below minus two suggests a bone mass lower than that of others in the same age group.
  • The T-score relies on averages for healthy, young adults of the same gender for comparison, with a score of minus one, zero or any positive number indicating a healthy, normal bone density. A T-score between minus one and minus two-and-one-half is lower than average and indicates a risk for osteoporosis, while a score lower than two-and-one-half reveals the likelihood of osteoporosis and weak, brittle bones.

Ok, so most of you know me by now and know that I always have to find a Silver Lining and, ideally, proffer some suggestions to help counteract the nonsense that I described above. So these are the suggestions for helping with fragile bone health:

• Calcium-fortified Foods. Calcium-fortified foods must have an added 10 percent or more of the FDA daily recommendation for calcium.  In addition to orange juice, other foods that are fortified with calcium include dark leafy green veggies (e.g., watercress & broccoli), salmon, tofu, and almonds.
• Vitamin D and Calcium Supplements: Here’s the thing: calcium makes bones stronger, and Vitamin D helps bodies absorb calcium. So, they go hand-in-hand. An added Silver Lining is that Vitamin D also helps decrease the risk of breast cancer as well as other cancers. What doctors can’t quite agree on is the amount of vitamin D we actually need. The traditional recommendation is 200 to 600 international units (I.U.) every day (e.g., multivitamins typically contain 400 IU’s). However, new research suggests that that amount is not enough. Experts now suggest taking a 1,000-IU supplement on top of a multivitamin. This is what I’m taking.
• Exercise and Bone Health Bone and muscle are living tissues and both become stronger in response to exercise. Working against gravity with weight-bearing exercise is the best way to promote bone health. I’ve recently started lifting weights. Oh dear heavens am I ever sore, however, the Silver Lining is that I everyday, I feel like I am getting stronger. Climbing stairs, walking, and dancing (!!) are other good examples of exercise that is helpful for increasing bone strength. An added Silver Lining is that exercise decreases the risk of breast cancer recurrence.
• Drugs 
  • Denosumab (Xgeva/Prolia) is a monoclonal antibody that can be effective in reducing bone complications from breast cancer. In terms of side effects, Denosumab is relatively new, and long-term results are unknown at this time.
  • Zoledronic acid (Zometa) is a bisphosphonate that may help delay bone pain, spinal cord compression, fractures and other bone complications. In addition, the drug may provide an anti-tumor effect. Here’s the issue with Zoledronic acid: it can lead to kidney toxicity and may require monitoring of kidney function with adjustments before each dose.
  • My bone density test results were on the verge of requiring drugs; however, knowing how badly that I react to any and all drugs, my doctor “prescribed” weight bearing exercise and a focused increase in calcium foods and supplements.
• Avoid alcohol and smoking (DUH).Heavy alcohol use and smoking also contribute to osteoporosis (among a whole host of unsavory side effects!), so puhhhhhlease abstain from both habits to not only help protect your bone health, but your overall health as well!

Hope that this info helps you. It is certainly helping me as I try to prevent any more loss of my bone density.  What has helped you?  I’d love to hear!