Taking care of your bones

Patient Expert

Healthy bones can be the key to good health and happiness. Consider what you couldn't do without strong, healthy bones. No running, walking, jumping, bending, gardening, dancing, or holding a baby. So it's important to take good care of your bones, especially when you're being treated for cancer. Cancer medications, particularly steroid agents, can weaken your bones, especially in the first six to twelve months of treatment. In fact, up to 25% of people on long-term steroid treatment will sustain a fracture related to weakened bones, and these fractures can significantly impact health by causing pain, interfering with mobility, and increasing the risk of infection. Fortunately, steroid-induced osteoporosis is preventable and treatable, particularly when the correct preventative measures are taken at the beginning of steroid treatment.

Normal bones are constantly going through a process of breakdown and build-up, known as remodeling, which is the key to maintaining strength and mobility. When bones go through too much breakdown, or not enough build-up, they become porous and weak, a condition called osteoporosis. There are a number of risk factors for osteoporosis, including age over 50 years, female gender, menopause, smoking, obesity, and inactivity, and certain medications can contribute to bone breakdown, further increasing the risk of a fracture. Corticosteroids tend to induce bone loss in certain areas of your skeleton that are rich in trabecular bone, which is made of delicate bony sheets that form a sponge-like network. These weakened bones, particularly the wrist, hip, and spine, are prone to fracture from even minimal physical stress like walking.

Preventing and treating osteoporosis includes ensuring sufficient intake of calcium and Vitamin D in the diet. Calcium, the major mineral component of bone, is crucial to maintaining bone density. Vitamin D increases the intestinal absorption of calcium, and also prevents calcium loss in the kidneys. A daily intake of 1500 mg calcium and 400-800 IU of vitamin D is recommended to maintain normal bone mineral density. Calcium-rich foods include milk, yogurt, cheese, tofu, sardines, salmon, turnips, and green leafy vegetables, including as spinach, broccoli and kale. Vitamin D is found in fortified milk and butter, liver, cod liver oil, egg yolks, and cold saltwater fish (e.g., salmon, halibut, herring, tuna).

While food is the preferred source of calcium and vitamin D, supplements can be used if you're having difficulty getting an adequate amount in your diet. But you can take too much vitamin D and calcium, so be sure to stay under the tolerable upper intake levels-which is 2500mg/day for calcium and 2,000 IU/day for vitamin D.

The following list provided by the National Institutes of Health includes tips for meeting calcium requirements through a healthy diet:

  • Use fat free milk instead of water in recipes such as pancakes, mashed potatoes, pudding and instant, hot breakfast cereals.
  • Blend a fruit smoothie made with low fat or fat free yogurt.
  • Sprinkle grated cheese on your salad, soup, or pasta.
  • Choose low fat or fat free milk instead of carbonated beverages.
  • Serve raw fruits and vegetables with a low fat or fat free yogurt based dip.
  • Toss diced calcium-set tofu into your vegetable-based stir-fry.

Choose calcium-fortified foods such as certain cereals, orange juice and soy beverages.

Another consideration is that some foods can interfere with the absorption of calcium and vitamin D. Excessive protein, sodium, and caffeine can increase loss of calcium by the kidneys, while excessive fiber can block calcium absorption. Oxalic acid (oxylates), a compound found in spinach, rhubarb, beet greens, chard, and almonds, and phytates, found in legumes such as pinto beans, navy beans, and peas both interfere with calcium absorption. Try to eat these foods one hour before or two hours after eating calcium-rich foods. Also, soaking foods high in phytates or oxylates, then rinsing and cooking them in fresh water can reduce their calcium-blocking effects.

In addition to diet, lifestyle modifications can help prevent bone loss. Increasing physical activity and exercise, and limiting alcohol intake and smoking can reduce your risk of a fracture. In some cases, your doctor may recommend medication to prevent bone-breakdown.

The bottom line is that osteoporosis prevention measures should begin as soon as possible, ideally at the beginning of steroid therapy. If you are taking corticosteroids, or will begin taking them soon, you should talk to your doctor or care team about how to best protect your bones.