Bone health

Maintaining healthy bones throughout your life is vital and if you are a woman diagnosed with breast cancer, bone health is even more important for you. Research demonstrates that some breast cancer treatments have been shown to speed up bone loss or cause an increase in loss of bone density. Women are also twice as likely as men to develop osteoporosis (a disease that means your bones are weak and more likely to break) after age 50.


Some chemotherapy medicines can have a direct effect on your bone health. Women who are pre or peri-menopausal (and receive chemotherapy, may have significant bone loss due to early menopause forced by the chemotherapy

Aromatase inhibitors (hormonal therapy):

  • Arimidex (chemical name: anastrozole)
  • Aromasin (chemical name: exemestane)
  • Femara (chemical name: letrozole)

Aromatase inhibitors prevent the formation of estrogen. This loss of estrogen can in turn lead to bone loss during hormone therapy treatment. Aromatase inhibitors are typically used in postmenopausal women diagnosed with hormone-receptor-positive early breast cancer.

Ovarian removal causes irreversible menopause. This sudden early menopause may cause loss of bone density. Ovarian shutdown through the use of medication temporarily prevents your ovaries from producing estrogen.

Hormone therapy medicines known as SERMs (selective estrogen receptor modulators) can actually help protect your bones by slowing bone loss. SERMs are:

  • tamoxifen
  • Evista (chemical name: raloxifene)
  • Fareston (chemical name: toremifene)

If an aromatase inhibitor or chemotherapy are included in your treatment plan, talk to your Surgeon, GP or breast care nurse about ways to protect your bones during and after treatment.

Some other risk factors for bone loss include:

  • age
  • postmenopausal status
  • small and thin body frame
  • family history of osteoporosis
  • low bone mass (osteopenia)
  • smoking
  • low levels of calcium or vitamin D
  • not exercising
  • drinking two alcoholic drinks or more several times a week

The following medical conditions are also risk factors for bone loss:

  • hyperthyroidism or hyperparathyroidism
  • chronic lung disease
  • inflammatory bowel disease
  • Cushing’s disease
  • multiple sclerosis
  • arthritis

Different hormonal therapy and chemotherapy medicines can be used in your treatment plan. If you’re worried about the effects of treatment on your bones, talk with Dr Gault about your concerns. During follow-up visits during treatment, ask Dr Gault about your bone health and whether protective measures are right for you.

If you’re at high risk for osteoporosis and your bone mineral density declines during breast cancer treatment, there are three types of medicine you can take to reduce the risk of or treat osteoporosis: bisphosphonates, Zometa (chemical name: Zoldronic Acid), Evista (chemical name: raloxifene), or the targeted therapies Prolia (chemical name: denosumab) or Xgeva (chemical name: denosumab. In addition to these medications, healthy lifestyle changes can be made to aid in keeping your bones as healthy and strong as they can be.

Lifestyle changes you can make to keep your bones as strong as they can be include:

Getting enough calcium.

Include foods that are high in calcium in your diet:

  • dairy products such as low-fat milk, yogurt, and cheese
  • calcium-fortified orange juice
  • dark green leafy vegetables: broccoli, spinach, collard greens, and bok choy
  • tofu
  • almonds
  • vitamin-fortified cereal
  • calcium supplements

Getting enough vitamin D.

Vitamin D helps your body to absorb calcium, to improve your levels you could take a vitamin D3 supplement. Vitamin D rich foods include:

  • vitamin D-fortified milk
  • herring, salmon, and tuna
  • vitamin-fortified cereal

Do weight-bearing exercise.

Exercise makes your bones and muscles stronger and helps slow bone loss. 30 minutes of weight-bearing exercise 3-4 times a week, is required for maximum bone health benefits. Your 30 minutes of exercise can be done in 10-minute blocks.

Examples of weight bearing exercise include:

  • walking
  • jogging
  • stair climbing
  • playing tennis, racquetball, or squash
  • dancing
  • lifting weights

Limit or avoid alcohol and quit smoking.