Dr. Andrea Singer discusses osteoporosis, how it relates to cancer survivors, and how you can prevent it.
Andrea J. Singer, MD, FACP, CCD,
Chief Medical Officer, National Osteoporosis Foundation
What is osteoporosis?
For more than 35 years, the National Osteoporosis Foundation (NOF) has been educating Americans about the importance of bone health and how to help prevent osteoporosis. Osteoporosis is a serious bone disease that occurs when the body loses too much bone, makes too little bone, or both. The result is that bones become weak and may break; this can occur from a fall or, in serious cases, even from something as small as sneezing.
Osteoporosis literally means “porous bone.” Under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break. If an individual is age 50 or older and has broken a bone, ask a doctor or healthcare provider about a bone density test.
Who is most affected by osteoporosis?
Osteoporosis affects men and women of all races. White and Asian women — especially older women who are past menopause — are at the highest risk.
Here are some facts from www.nof.org:
- Of the estimated 10 million Americans with osteoporosis, 80 percent are women.
- Approximately 1 in 2 women and up to 1 in 4 men over age 50 will break a bone because of osteoporosis.
- A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine, and ovarian cancer.
- Women tend to have smaller, thinner bones than men, which makes them more likely to get osteoporosis.
- Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause.
- Family history also plays a role. Having a parent with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
Do chemotherapy and radiation lead to bone loss and increase the risk of osteoporosis?
Cancer patients face an increased risk for bone loss, osteoporosis, and fractures, and bone disease causes high rates of morbidity and mortality in cancer patients. This can be caused both by the cancer itself and by the effects that come with many cancer-specific therapies. Cancer surgery and treatments can affect the entire body, not just the area of the cancer. Hormonal therapy, chemotherapy, and radiation may cause bone loss. While radiation-induced bone loss is primarily caused by direct damage to bone, chemotherapy-induced bone loss may be the result of both direct effects on bone remodeling and indirect systemic effects, the most studied and well known of which is the loss of ovarian function, which can lead to early menopause in premenopausal women.
As mentioned above, radiation primarily causes direct damage to bone tissue. In children and adolescents, most damage from radiation occurs to the growth plate, causing growth disturbances, while in adults, bone loss and incomplete healing of bone damage results in skeletal-related events such as insufficiency fractures.
What can people do to limit bone loss during chemotherapy or radiation?
Bone loss is a common finding in patients with cancer, and these patients need to be made aware of their increased risk for osteoporosis and given advice on what they can do to strengthen their bones and lower their risk of fracture. Diet, exercise, and lifestyle changes are keys to preventing osteoporosis and need to be emphasized to cancer patients who face a higher risk for osteoporosis after treatment.
If you’re underweight or have significant weight loss, you may be more likely to experience bone loss. A dietician or nutritionist can make recommendations to help you gain or maintain a healthy weight. Moderate exercise may also help stimulate the cells that help bones remodel and build muscle, which can help prevent falls.
Balance issues are also common among cancer survivors. The risk of falls and fall-related injuries increase among those with balance issues and low bone density. Balance and strength exercises can help prevent falls by improving the ability to control and maintain body position whether in motion or when stationary. Furthermore, stability and balance exercises can help patients regain function and mobility to resume their normal activities, and they’re a key component for recovery after cancer treatments.
Multiple agents, such as bisphosphonates and denosumab, have become available to reduce bone damage during and after cancer treatment. Further research is needed to decrease the disease burden from therapy-induced bone loss in cancer patients.
What should people know to protect themselves from osteoporosis? Where should people go for information or checkups?
Osteoporosis and broken bones are not a normal part of aging. There are so many things that you can do daily to help protect your bones during your lifetime. You are never too old to get started! Good bone health begins in childhood and young adult years, but it should not stop there. No matter what your age is today, there are lots of healthy habits that you can do now to affect your bone health for the rest of your life. Click here to learn user-friendly tips to help prevent osteoporosis.
Here are some daily to dos:
- Get enough calcium and vitamin D and eat a well-balanced diet.
- Engage in regular exercise.
- Eat foods that are good for bone health, such as fruits and vegetables.
- Avoid smoking and limit alcohol consumption.
NOF’s website is packed with excellent information about diet, exercise, fall prevention, medications and adherence, talking to your doctor, patient support, and much more. Visit www.nof.org to read user-friendly information shared in an engaging and memorable way. NOF also has a robust online support community where patients and caregivers share experiences.
NOF has a resource entitled Find a Professional with a list of partner professionals. If there is not a contact in your area, remember that many doctors continue to host telemedicine appointments. In addition, you may consider doing your own research and search for internists, gynecologists, primary care physicians, endocrinologists, rheumatologists, orthopedists, and geriatricians who also specialize in osteoporosis.