Evidence Update: Osteoporosis and Breast Cancer

Osteoporosis, or porous bone, is a condition characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures. According to the Journal of Bone and Mineral Research, the number of adults 50 years and older with osteoporosis or low bone mass will increase by 17.2 million (32%) from 2010 to 2030. Women comprise 80% of Americans diagnosed with osteoporosis. Women have a much higher risk of developing osteoporosis as they typically have smaller, thinner bones than men and lose bone density faster due to the changes with menopause. Breast cancer treatments, medications, and surgery have a considerable impact on bone health, and patients may experience a loss of ovarian function, or may go through menopause earlier. Fortunately, there are ways to combat breast cancer related bone loss. A recent study published by the Osteoporosis International Journal, assessed the effects of resistance training on improving bone health and body composition in prematurely menopausal breast cancer survivors. The results revealed that impact and resistance training effectively combat bone loss and worsening body composition in premature menopause in breast cancer survivors.  In addition to exercise, pharmacologic intervention (prescription medicines) can be used as a means to effectively manage osteoporosis and osteopenia (weak bones) in breast cancer survivors.

Winters-Stone, K.M., Dobek, J., Nail, M., Bennett, J.A., Leo, M. C., Torgrimson-Ojerio, B., Luoh, S.W., Schwartz, A. (2013). Impact and resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial. Osteoporosis International; Vol 24.

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Osteoporosis

Osteoporosis, or “porous bone”, is a disease characterized by low bone mass and structural deterioration (weakening) of bone tissue. Osteoporosis can lead to broken bones. Osteoporosis is called a “silent disease” because many people do not realize that they have osteoporosis until they suffer a fracture. According to the National Osteoporosis Foundation, osteoporosis is a health threat for an estimated 44 million Americans or 55 percent of the people 50 years of age and older. Eighty percent of the people affected by osteoporosis are women.

You may be at risk for osteoporosis if:

calcium-pillsChemotherapy may cause early menopause. The resulting loss of estrogen can lead to bone loss. The CMF (cyclophosphamide, methotrexate and fluorouracil) combination of chemotherapy drugs has been shown to trigger menopause more frequently than regimens containing Adriamycin.

If you take steroids to deal with side effects of chemotherapy, these medications may promote bone loss. Studies have shown that taking glucocorticoid steroids (like Prednisone and Dexamethasone) for more than 3 months is a major risk factor for osteoporosis.

If you are postmenopausal and have hormone receptor positive breast cancer, you may be taking an aromatase inhibitor (AI) such as Arimidex, Femara or Aromasin. These hormonal therapies may also cause bone loss.

Some hormonal treatments actually protect bones. Selective estrogen receptor modulators (SERMs) like Tamoxifen and Evista (raloxifene) are good examples. Evista is used to treat osteoporosis. Tamoxifen has been shown to protect the bones of postmenopausal women; however, it has been shown to increase bone loss in pre-menopausal women.

Lifestyle approaches for preventing bone loss in women:

  1. Exercise – Strengthening exercises and weight-bearing exercise are important for preventing bone loss. These exercises build the muscles around the joints and stimulate bones to become stronger. You may need to consult a physical therapist to prescribe the most appropriate exercise routine for you and your individual situation.
  2. Calcium and Vitamin D – Eating a well-balanced diet with emphasis on calcium is essential for bone health. Dairy products are the most calcium-rich foods available. Other dietary sources include salmon, tofu, cooked broccoli, kale, spinach, brussel sprouts and rutabagas. Calcium supplements are also available. Vitamin D comes from your diet and from the sun. It is necessary for your body to utilize calcium.
  3. Stop smoking.
  4. Limit alcohol, caffeine and salt intake.

Medical approaches for preventing and treating bone loss in women:

  1. Bisphosphonates. Bisphosphonates are drugs that prevent bone loss by acting on bone cells called osteoclasts. milkOsteoclasts remove old bone from the skeleton and pave the way for other bone cells, osteoblasts, to lay down new bone. By stopping osteoclasts from removing bone, while still allowing osteoblasts to make new bone, bisphosphonates help to increase bone mass. Common examples of bisphosphonates are Fosamax, Actonel and Boniva.
  2. >Calcitonin. Calcitonin is a naturally occurring hormone that is important for calcium regulation and bone metabolism. It prevents bone loss in much the same way as bisphosphonates.
  3. Selective estrogen receptor modulators (SERMs). As described above, Evista is actually prescribed to prevent bone loss. Tamoxifen has been shown to prevent bone loss in post-menopausal women.
  4. Forteo. Forteo was approved by the FDA in 2002. It is a form of human parathyroid hormone. It works to prevent bone loss by actually stimulating the osteoblast bone cells to make more new bone. The long-term clinical outcomes of the drug are still under investigation, and it is typically used only for patients who have already suffered fractures.

If you feel you may be at risk for osteoporosis, you can have your doctor perform a bone mineral density screening to evaluate your bone health. For more information, visit the National Osteoporosis Foundation at www.nof.org or speak to your physician.

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