Breast Cancer and Osteoporosis

A reply by Dr. R. Bravo Prats

Q: My wife is a recent breast cancer survivor. She’s had bone density tests every four months during this past year and they were all fine. But I am concerned, because now she’s one inch shorter than she was at her last doctor visit four months ago. Is this a reason for concern?

Congratulations on your wife being a survivor, may she continue to do well. A 1” loss in just four months would be unusual, my initial impression is that it’s a mistake and she should get her height checked again a few times, on bare feet and at the same time of day each time. All the same, you are right to be concerned about your wife’s height loss because there is a link between breast cancer and osteoporosis. This is the reason your wife’s doctor routinely checks her bone density and measures her height.

Osteoporosis is a disease that results from a decreasing bone mass, which leads to thinning, porous and weak bones. As the bones lose strength, they also lose bone density, which may lead to a loss in height and a higher risk of bone fractures. Unfortunately, the leading to osteoporosis is often silent and without symptoms. It is important to screen for this disease in high-risk individuals by conducting bone density studies (or DEXA scans).

Fortunately, most women with breast cancer will live long after their treatment ends. But the cancer as well as some of the treatments used may increase the risk
for osteoporosis. This may be higher if the person had low bone mass (osteopenia) to start with. Here are some reasons for the link between breast cancer and
osteoporosis:

• Breast cancer itself. This disease can increase the bone dissolving process of cells known as osteoclasts.
• Early menopause. Some types of menopause may stop the ovaries from producing estrogens. Lack of bone protective estrogens may cause bone loss.
• Steroids, often given to help cope with the side effects of chemotherapy can affect bone loss with continuous use.
• Menopause surgically induced or radiationinducedto slow breast cancer growth can also lead to a sudden lowering of estrogen levels, as well as a rapid loss of bone mass.
• Early research suggests that newer types of hormonal therapies used for postmenopausal women with breast cancer have the potential to lead to a loss of bone density, but further study is ongoing. Even though bone cannot be totally replaced once it has been lost, there are measures available to prevent osteoporosis and to treat the condition after onset.

Our first approach is through lifestyle adjustments. These can be very beneficial and include:

• Adequate daily calcium in the diet as well as a daily dose of vitamin D.
• Regular weight bearing exercises such as dancing,climbing stairs, walking, as well as strength exercises for the arms and upper body.
• Stop smoking as it weakens the bones and decrease your alcohol intake
• Maintain good posture. Yoga, Pilates and tai-chi may help with health and flexibility.
• Of course there are also medications available to prevent and treat osteoporosis. These are helpful especially for a patient with breast cancer.

Your wife’s bone density studies have been normal, we know her bone health is OK; however she will still need to be monitored, most likely on a yearly basis
rather than every four months. I suggest you your wife to have a meeting with her health-care team to discuss the best ways to staying cancer free, while at
the same time keeping her bones healthy and strong.

Best of health to the both of you!

If you are concerned or have questions with regards to your health by all means write in to editor@webexpressguide.com in confidence and Dr Prats will reply to you direct.