Cancer and Osteoporosis: An Unhappy Alliance

PJ Hamel Health Guide
  • You’re feeling fit, healthy, enjoying life. Sure, you’re not 20 years old anymore; maybe you can’t pedal uphill as fast, run as far, or dance all night. But for your age, you’re doing just fine.

    Scenario A: As part of your regular physical, the doctor suggests a DEXA scan . “Just precautionary,” he says. “Just a baseline. Everyone gets one at your age.”

    But then the results come back, and your doctor calls to tell you the bad news: you have osteoporosis. And your life changes forever.

    Scenario B: As part of your regular physical your doctor schedules a mammogram (or a PSA test). “You’re over 50; you should have one every year,” she says. “Just precautionary.”

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    But then the results come back, and your doctor calls to tell you the bad news: you have cancer. And your life changes forever.

    Which of these two kick-in-the-gut phone calls have you received?

    You have osteoporosis? You have cancer?

    How about both?

    Osteoporosis and cancer often go hand in hand – for both women AND men. Treatment for both breast cancer and prostate cancer often involves shutting off the essential sex hormones: estrogen for women, testosterone for men. These hormones can feed cancer; to help prevent recurrence,  hormone production is shut down, either via surgery, or drugs.

    But estrogen and testosterone play a vital part in our lives; their 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 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.

    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.

    In recent years, men with prostate cancer have increasingly been treated with anti-testosterone medications, such as Lupron and Zoladex. These medications do exactly what women’s hormone therapy drugs do: they suppress a man’s chief sex hormone, testosterone. Again, good for cancer prevention, terrible for bones. 

  • Thus, women with breast cancer and men with prostate cancer face an increased risk of osteoporosis. While there’s also some preliminary (though controversial) evidence that treatment for thyroid cancer may increase osteoporosis risk, as well, breast and prostate cancer are currently the two single proven cancer links to osteoporosis.

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    So if you’re receiving hormone therapy for breast or prostate cancer, which risk takes precedence?

    For all except those with very early, very minor cancers, I’m betting we choose to lower our cancer risk, and accept our increased risk of osteoporosis. After all, there are drugs we can take, lifestyle changes we can make, to help stop osteoporosis.

    But for those of us taking hormone therapy drugs for cancer, they’re the only proven weapon we currently have in our anti-cancer arsenal. We HAVE to stay on the drugs, bone loss be damned.

    And, bone loss doesn’t automatically mean osteoporosis. If bone loss is stopped in time – at the osteopenia level – your risk of a debilitating spinal or hip fracture is greatly reduced.

    Osteoporosis drugs, mainly the bisphosphonate family – Boniva, Fosamax, Actonel, et. al. – are proven ways to slow or stop bone loss. In addition, the aforementioned lifestyle changes – less alcohol, more exercise, maintaining healthy levels of calcium and vitamin D via diet and supplements – are also proven bone-loss preventives.

    So while none of us wants to get not one, but two of those “I’m sorry to have to tell you this” phone calls – it’s not the end of the world.

    We can fight cancer, AND keep our bones healthy: through cancer-fighting drugs, osteoporosis prevention drugs, and healthy living.

    Sure, you’d rather be drug-free. You’d also like to be 25 years old and healthy again. But just because you’ve been dealt a poor hand of cards, don’t think you have to cash in your chips. You’re still in the game, and that’s what counts.

Published On: March 06, 2010