Breast Cancer and Osteoporosis: Beware the Connection

PJ Hamel Health Guide
  • When you’re diagnosed with breast cancer, it becomes the Big Gorilla in the corner, healthwise. The sore throat, head cold, or heartburn that used to worry you now pale in significance next to this new (and life-threatening) disease..

    So it’s little wonder that the vast majority of us, especially those of us younger than age 60 at diagnosis, don’t give a second thought to bone health.

    I’m not talking about avoiding a cancer metastasis to the bones; I’m sure we all think of that. No, I’m referring to regular, “normal person” bone health – the lack of which can lead to a disease no one even starts to think of till after age 60: osteoporosis.

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    Sadly, this inadvertent head-in-the-sand approach to osteoporosis can help grease the skids to this treacherous disease. There’s a direct link between breast cancer and osteoporosis – and if you don’t work to break that link, you could very well be heading towards an old age fraught with fragile bones and crippling fractures.

    So, what IS that link?

    Estrogen. Specifically the lack of it, in many women being treated for breast cancer.

    Estrogen helps keep our bones strong. In fact, it’s the prime hormone our bodies use to keep the constant bone remodeling process – where certain cells break down old bone, and others build new bone – in balance.

    And what’s the long-term treatment goal, for women with estrogen-responsive (ER/PR+) breast cancer? Stamp out estrogen! Via drugs that lower estrogen levels (or prevent it from working); or a hysterectomy or oophorectomy to remove our ovaries, we work to disable this valuable hormone.

    The natural way our bodies lower estrogen levels is via menopause. And what do many women with breast cancer go through as a result of chemotherapy? Menopause.

    And there goes the estrogen.

    Estrogen plays a vital part in our health for most of our lives; its loss is devastating. Remember hormone replacement therapy (HRT)? Thirty years ago, it was the Fountain of Youth for middle-aged women, who popped Prempro along with their daily multivitamin.


    Maintaining estrogen/progesterone levels beyond menopause was said to reduce a woman’s risk of heart attacks; keep skin and hair young and vibrant; allay the hot flashes and mood swings brought on by “the change,” AND prevent bone loss: osteoporosis.


    And HRT did work. In fact, it worked very well. But within the past decade, studies have shown that not only did HRT make us feel better; it gave some of us breast cancer, others cardiovascular problems. It was no longer a win/win; it was a win/BIG potential loss.


    End of HRT. Enter our recognition of the evil alliance between breast cancer and osteoporosis.


    Women with hormone-dependent breast cancer often undergo years of post-treatment estrogen suppression, via hormone therapy drugs like tamoxifen and the family of aromatase inhibitors: Aromasin, Femara, and Arimidex. Women on these drugs experience abnormally low levels of circulating estrogen: good for cancer prevention, bad for bones (at least in the case of AIs; tamoxifen actually increases bone strength).


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    In addition, some chemotherapy drugs promote loss of bone density. And research indicates that breast cancer itself can increase a woman’s level of osteoclasts, the cells that break down bone.

    Finally, long-term eating issues due to treatment can bring calcium and vitamin D levels to dangerous lows. Since both are crucial to bone health, their absence is sorely felt.

    So, what’s a survivor to do?

    First, be aware of the issue: breast cancer can encourage bone loss. Unless you’re a survivor who hasn’t gone into menopause, and isn’t taking an AI, and didn’t undergo chemo, you may be at risk.

    Second, if you haven’t had a DEXA scan (a test to measure bone density), ask your oncologist if you need one. When given at the beginning of treatment, and every 2 or 3 years thereafter, it allows you and your doctor to track how your bones are responding to your body’s lack of estrogen.


    Third, take dietary steps to prevent bone loss. Make sure you’re getting enough calcium and vitamin D. While opinions vary on just how much “enough” actually is, my doctor recommends a daily dose of 1000IU of vitamin D3, and 1500mg of calcium, through a combination of diet and supplements.


    Fourth, exercise. Yeah, yeah, heard that before, right? But not all exercise is created equal, as far as osteoporosis prevention is concerned. Walking isn’t the best way to protect your bones; you need to stress them a bit with something a little more vigorous, like weight-lifting, or sports where you jump around a bit. Weight-bearing exercises will definitely make a difference.


    Fifth, take drugs – if it comes to that. Drugs that help prevent bone loss – Fosamax, Boniva, et. al. – often aren’t the easiest medications to take. Unfortunately, they can come with their own challenging side effects. But if you’re experiencing significant bone loss, you may need to step up and take your medicine.


    I know the last thing you need on your mind is one more health issue to deal with. And you may very well avoid this particular one.

    But knowledge is power; and now that you understand the link between cancer and osteoporosis, you have the power to do something about bone loss.

    Are you dealing with osteopenia or osteoporosis? Check out HealthCentral’s osteoporosis site.

Published On: May 22, 2010