Bone Health

Breast cancer treatment can affect the health of your bones. Hormonal changes and menopause put some women at increased risk for losing bone tissue because of decreased estrogen levels.

Bone Loss from Breast Cancer Treatment

You should be aware of two bone loss conditions:

• Osteopenia means you have less bone density or bone mass than normal.
• This can lead to osteoporosis, where the decrease in bone mass and density makes bones fragile and easier to break.

Talk to your doctor about taking a bone-density test (often called a DEXA scan). This test should be done at baseline before treatment and monitored annually, with the frequency potentially increased to every 6-12 months depending on your individual situation. You can find out your risk for bone conditions and take action to stay healthy.

Doctors may use a class of drugs called bisphosphonates or denosumab to treat osteoporosis. These drugs can also help with bone issues related to cancer. They can:

• Treat hypocalcemia (abnormally low calcium levels) and other, related cancer symptoms.
• Reduce metastasis to the bones.
• When cancer has spread to the bones: prevent fractures, improve healing and reduce pain.

Note: Bisphosphonates and denosumab have different properties and side effects. Bisphosphonates accumulate in bone tissue, while denosumab does not — stopping denosumab can cause a rapid rebound in bone loss. Talk with your healthcare team and ask questions to decide what's best for you and your bones.

Taking Care of Your Bones

To support your bone health:

• Get adequate calcium — typically 1,000-1,200 milligrams a day for most adults — through diet and supplements if needed. Good sources include low-fat dairy products, leafy green vegetables (like broccoli, kale, and bok choy), canned fish with soft edible bones (such as sardines), almonds, tofu set with calcium, and calcium-fortified cereal and juice.
• Get adequate vitamin D. Adults under 70 generally need 600 IU daily, while those over 70 need 800 IU daily. Some people with breast cancer treatment-related bone loss may need higher doses. Consult your oncology team to determine if Vitamin D supplements are needed and at what dosage.
• Eat a balanced diet.
• Stay active, especially through weight bearing and strengthening exercises.
• Quit smoking, or don’t start.
• Limit alcohol intake.