Bone health

Keeping your bones healthy and strong requires more attention as you age. After you turn 30, the processes that build and strengthen your bones naturally slow and your bones begin to weaken. Because these processes are controlled by our hormones, treatments for breast cancer that target hormones or affect the organs that produce them can have long-term effects on the health of your bones, putting you at a greater risk for fractures and breaks. Fortunately, there are ways to help keep your bones healthy during breast cancer treatment and into old age through good habits in life and, if needed, with medicines.

About your bones

Though they may seem solid and unchangeable, your bones are living tissue and they are constantly being broken down and rebuilt through your entire life. The strength and compactness of your bones, called bone mineral density, is controlled in your body by three types of cells:

• Osteoclasts, which break bones down
• Osteoblasts, which rebuild and repair bones
• Osteocytes, which are mature osteoblast cells at rest

Your bones are constantly being broken down by osteoclasts and reformed by osteoblasts. When you are young, the osteoblasts are able to work faster at rebuilding so your bones become strong and dense, but as you age they work more slowly and your bones may start become less dense, a process called thinning or bone loss.

Bone loss

As a child and then a young adult, your body was able to build bone faster than it was broken down, allowing your bone to grow denser and stronger. This means your bones were less likely to break or fracture. But after age 30 the cells that rebuild bones cannot keep up with the ones that break them down. This lowers your bone density and the bones themselves become weaker, a process called bone loss.

If a bone mineral density scan shows that you have a lower bone density, your doctor may say you have osteopenia. Your bones are not as likely to fracture at this stage, but you should consider taking action to improve your bone health before they get weaker.

When a person has very low bone density causing their bones to be brittle and more likely to break it is called osteoporosis. Some factors can affect your risk for osteoporosis. Women, for example, are at a higher risk than men. When a woman goes through menopause her body will make much less estrogen, a hormone that helps regulate the rebuilding of bones. This sudden change may cause rapid bone loss in the first years of menopause. The risk is higher if you went through menopause early or your ovaries stopped working for a time, both of which are side effects of some breast cancer treatments.

While coping with breast cancer, your bone health may seem like just another item to add to a long list of worries, but there are ways to protect your bones during treatment by making healthy life choices and, if necessary, by taking bone-protecting medicines. Ask your healthcare providers what they recommend for you and read about improving your bone health.

Risk factors

Though everyone experiences some bone loss as they age, there are certain factors that may make you more likely to develop osteoporosis. You have a higher risk for bone problems if you:

• Are female
• Are thin or have a small frame
• Have osteoporosis in your family history
• Do not exercise regularly
• Had your periods interrupted by treatments or started menopause early
• Do not get enough calcium in your diet
• Drink too much alcohol or smoke
• Have or had an eating disorder, problems with your metabolism or any condition that affects the way your body absorbs vitamins
• Have used steroids, certain breast cancer treatments or other medicines over a long period of time. Ask your doctors if any of your medicines have bone loss as a side effect.

Some factors — including your build and past treatment — cannot be changed, but these do not mean you will definitely get osteoporosis. By addressing the factors you can, like exercise and diet, you can improve bone health and lower your risk.

Diagnosing osteoporosis

Osteoporosis has no symptoms. Most people are diagnosed only after they have suffered a fracture or a break of the bone and their doctor orders a DEXA scan, a test that measures bone mineral density. Speak to your doctor about how breast cancer treatment may affect your risk for developing osteoporosis and whether you should have a bone mineral density scan.

Bone and joint pain are common side effects in people being treated for breast cancer, but they are not always caused by bone loss. Some medicines like aromatase inhibitors, a type of hormonal therapy given to women who have been through menopause, may contribute to bone loss. But they also may cause joint pain as a side effect even if your bones are healthy. Describe your pain to your health care provider, being as specific as you can, and make sure you get a thorough exam. See our page on bone pain to learn more.

Effects of osteoporosis

Having osteoporosis means your bones are not as strong as they once were and may fracture more easily as the result of a fall, because you have bumped into something or because you tried to carry more weight than your bones could handle. Fractures are often the way people discover they have osteoporosis. A common break as a result of bone loss is when a vertebra, one of the bones in your spine, collapses. This can cause back pain, a “stoop” or hunched posture, or a loss in height. The most common fractures for people with osteoporosis happen in the wrist, spine and hip.

Avoiding falls

The results from a DEXA scan will provide the diagnosis of osteoporosis as well as other information that your doctor can use to speak about your risk of getting a fracture. If you have osteoporosis or low bone density, you should take care to avoid falls, collisions and other physical impacts that could result in a fracture while you take steps to make your bones stronger.

Some suggestions, like doing weight-bearing exercises, both keep your bones strong and help you avoid falls by developing stronger muscles and better balance. You should take steps to avoid slippery surfaces and tripping hazards and to make sure you can see where you are walking. Steps you can take at home or in your daily life to avoid falls are:

• Wear supportive shoes with rubber soles for better traction
• Keep rooms free of clutter
• Make sure all rooms have easily accessible light switches and that stairways are well-lit
• Walk on the grass when sidewalks are slippery

Falls can also be the result of another disease or condition. Speak with your doctor if something affects your balance or how you walk. Be aware of any problems you have with vision too, since good eyesight will help you avoid hazards.