The treatment of certain cancers such as prostate cancer or breast cancer may require the use of treatments that can affect hormone levels in men and women respectively. These cancer treatments may lead to bone loss. Bone loss is typically associated with the use of anti testosterone therapy in men with prostate cancer, such as leuprolide, or goserelin, as well as anti estrogen therapy such as letrozole, and astrozole, or exemestane in women with breast cancer.
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People on these medications may experience ongoing bone loss, and some individuals are at risk for more rapid bone loss than others. Risk factors associated with bone loss include being over 65 years of age, history of fractures occurring with minimal trauma such as a fall from standing height, previous history of use of steroid medication such as prednisone, having a parent who had a hip fracture, being a smoker, consuming three or more units of alcohol every day, low body weight or having medical conditions such as overactive thyroid or parathyroid gland activity, rheumatoid arthritis or malabsorption.
Cancer treatment induced bone loss and fractures can be minimized by supplementing diet with vitamin D and calcium, combining this with weight bearing exercises which may strengthen your bones. Some of the common weight bearing exercises include brisk walking, low impact activities such as yoga or even fun activities such as dancing or sports like tennis. Apart from these measures, it is important that we avoid falls in individuals at risk for fractures. Hence, the use of canes or walkers is encouraged quitting smoking and limiting the amount of alcohol is extremely important in preventing further bone loss. Individuals at risk for cancer treatment induced bone loss may be required to undergo a bone density or DEXA scan. This scan is often helpful in estimating the amount of minerals in the bone and checks for bone loss conditions such as osteopenia or osteoporosis, as well as help estimate the risk of bone fractures. Your doctor may require you to get bone density at regular intervals, especially while on cancer treatments that can lead to excessive bone loss.
It is recommended that people identified as having high risk of fractures are also started on specific therapy for preventing further bone loss and potentially even improving bone mass. These medications can include oral pills that are typically taken once a week or a month, or skin injections that are administered once every six months. If the bone loss is especially high, the doctor may consider the use of other medications such as skin injections that are taken once a month or even daily.
In rare cases, the cancer may spread to the bone and put the person at a very high risk of developing compression of the bones. impingement of the nerves near the bones in the spine or spontaneous fractures in these very high risk situations. Your doctor may recommend the use of either radiation therapy to the bone surgery or specific medications given as skin injections every month or IV infusions every three months for an extended period of time. Your doctors may also utilize specific imaging techniques such as a nuclear bone scan, CT scan of the body, MRI or PET scans.
It is important to remember that bone loss is often a chronic condition as we grow older so are your bones and concomitantly the risk of fracture goes up even higher. Hence it is important that you do not discontinue these medications for protecting the bones without discussing with your doctor first. Remember to nurture your bones so that you bounce and not break after fall. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health. Presenter: Dr. Akshay Jain, Endocrinologist, Surrey, BC
Local Practitioners: Endocrinologist