The most direct and efficient way to prevent osteoporosis is supplementation with adequate amounts of calcium, vitamin D, and weight-bearing exercise of appropriate intensity. High levels of calcium intake can reduce the risk of osteoporosis by 20%, and calcium combined with vitamin D can reduce the risk of hip fracture by 18% in postmenopausal women.
Risk assessment
Patients with breast cancer are commonly assessed for osteoporosis risk by measuring bone mineral density:
- Low risk when the T-value of bone mineral density >1;
- Moderate risk when -2.5 ≤ T-value ≤ -1;
- High risk when T value <-2.5 or fracture risk assessment tool predicts 10-year risk of major fracture >20% (hip fracture >3%).
Patients with breast cancer treated with endocrine therapy should have a bone density test every 1-2 years to keep abreast of their bone quality.
Preventive measures
Postmenopausal breast cancer patients and premenopausal women treated with ovarian function suppression should be given vitamin D and calcium prophylaxis regardless of BMD values before starting endocrine therapy and at least 30 minutes of moderate-intensity exercise daily, such as walking and jogging, and need to stop smoking and drinking to prevent falls and body impacts.
- Adults should have a daily intake of at least 800 mg of elemental calcium and a recommended dose of 200 IU of vitamin D intake;
- Postmenopausal women and the elderly should have a calcium intake of not less than 1000 mg and a vitamin D intake of 400 to 800 IU;.
- For breast cancer patients whose bone mineral density is assessed to be at moderate to high risk, the target daily dose of calcium intake should be 1500 to 2000 mg and 400 to 800 IU of vitamin D.
Biphosphonate pharmacologic interventions are strongly recommended for high-risk patients, and for intermediate-risk patients can be considered in conjunction with their risk factors to receive bisphosphonate pharmacologic therapy when appropriate.