Survivorship

Bone Health

Frequently Asked Questions

by Sue Ott, MD, Associate Professor, Division of Metabolism, University of Washington School of Medicine

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. People who have had cancer treatment may be at increased risk for osteoporosis and bone fracture for several reasons. Many of these reasons are unavoidable - for example, the medications used to treat the cancer and any loss of estrogen or testosterone can harm bones but are necessary to fight the cancer. Your doctor can monitor your bones if you are on these treatments, and sometimes other medicines to protect the skeleton can be provided. 

Other risk factors for osteoporosis and bone fracture include inactivity, poor nutrition and unhealthy habits (smoking cigarettes or drinking more than 2 alcoholic beverages a day). The most important step a cancer survivor can take to improve the skeleton is to literally take steps! Whether by walking, dancing, or climbing stairs, these steps send messages to the bone cells to improve strength. We call these activities "weight-bearing," but this does not mean you have to go to a gym and lift weights. Instead, try to spend more time walking instead of driving, standing instead of sitting, climbing stairs instead of taking elevators. 

Appropriate nutrition is another strategy that can reduce one's risk for osteoporosis or lessen the effects of the disease. The most important aspect of nutrition for healthy bones is the total number of calories consumed. Weight loss causes bone loss, even in overweight people. Of course, we do not advise everybody to aim for obesity (although that would help the bones) but many men and women are actually underweight, and it would be healthy to gain weight by eating more calories. 

Calcium and vitamin D are other important considerations for healthy bones. Calcium is a mineral found in many foods and used by the body to help strengthen bones and teeth. The recommended total daily amount of calcium is 1200 mg, which can include calcium from foods as well as supplements. Vitamin D is a fat-soluble vitamin that is important because it helps maintain blood levels of calcium and is necessary for bone and tooth structure. Most cancer survivors in Seattle should be taking 800 to 1000 units of vitamin D per day. Also, it is important to note that this vitamin is formed in the skin on exposure to sunlight, so unless you are on vacation to a sunny place you will want to pay attention to how much vitamin D you are getting through your diet.  Excess calcium and vitamin D should be avoided; getting too much does not help and might cause side effects like kidney stones or calcium deposits.

We encourage all cancer survivors to take these steps for a healthy skeleton.

Frequently Asked Questions  

Q. What is osteoporosis?

Osteoporosis is a condition that causes weakening of bone and increased likelihood of sustaining a fracture. Osteoporosis can affect any bone in the body. The diagnosis of osteoporosis is made by measuring bone density. This is often done with a DEXA scan. For a DEXA scan you lie on a soft table and a machine moves over you without touching you. Pills and liquids are not necessary, there is no noise, it is painless and it takes a few minutes. People who are diagnosed with osteoporosis will be treated to modify their condition in an effort to prevent fractures.

Osteoporosis is common as we age. About one-third of women over the age of 65 have the diagnosis of osteoporosis. The diagnosis of osteoporosis means that your bone density is at least 2.5 standard deviations below the ideal peak bone mass found in young adults. Osteoporosis is considered severe if you have also sustained a fracture as a result of weak bone.

The two most common reasons people tend to get osteoporosis are low peak bone mass at the time of skeletal maturity or accelerated bone loss at the time of menopause. An individual reaches her highest bone mass at the time of skeletal maturity and loses bone steadily thereafter. Therefore, it is of utmost importance that young people take steps to ensure they develop as much healthy bone as possible. Once bone loss begins, it is also important to ensure the rate of bone loss is slow. The amount of bone loss can accelerate at the time of menopause. Some people will benefit by taking medications to prevent this bone loss.

Quick Facts on Bone Health

  1. At some point in early adulthood people reach peak bone density. Throughout life, some bone cells are made as some are depleted.
  2. At the time of peak bone density more cells are being made than are depleted, but as people age, the balance shifts so that more bone cells are lost than replaced.
  3. If bone loss is severe enough it can lead to osteoporosis, or porous, easily broken bones.
  4. Bone density tests are painless and use small amounts of radiation to give a measurement of the amount of minerals in the bones. These tests show how much bone has been lost and give doctors an idea of how likely a patient is to develop osteoporosis.