Bone Density and Breast Cancer Treatments

How can you protect your bones during breast cancer treatment?

Recently I had a bone density test, a scan that I do approximately every 18 months. It has long been my favorite test as I don't have to undress much, no needles are involved and it is almost possible to take a short nap. Afterwards, thinking about bone loss and breast cancer treatments, it seemed a good idea to write a bit about this problem. We know that post-menopausal women are always at risk for bone loss, and we also know that treatment with any of the aromatase inhibitors (AIs) increases that risk.

Here is how it can happen: The AIs lower serum estrogen levels (the amount of the hormone found in a component of your blood). This may result in muscular skeletal effects and effects on bone metabolism. Lowering estrogen can result in osteopenia and osteoporosis and even lead to bone fractures.

Since aromatase inhibitors (anastrozole, letrozole, and exemestane) are routinely used in the treatment of estrogen-receptor-positive breast cancers in post-menopausal women, this is something that we must consider. As long as a woman continues to take one of the AIs, the bone loss may continue. When she stops this treatment, the effects may begin to reverse with some rebuilding of bone density. This is a side effect that can and should be monitored as long as a woman continues to take an AI.

What can we do to try to reduce the amount of bone density loss and lower our personal risks of osteopenia and osteoporosis? Here is the list:

• Periodic monitoring with bone density exams
• Calcium and Vitamin D supplements as recommended by your doctor
• Regular weight-bearing exercise. It is important to add some weights/lifting to your aerobic routine.
• Sunlight (this is for the needed Vitamin D which enables your body to absorb Calcium)
• Healthy diet
• Referral to a bone specialist when appropriate. There are several medications that can be helpful, and, if relevant, they should be discussed with an expert.

As always, the best advice is to begin by talking with your doctor about your personal situation and risks.