While the exact cause of breast cancer is unknown, the risk of developing it increases with age, and is particularly high for women over the age of 60.
The risk of osteoporosis is already higher in these women because of age, and given the increased incidence of breast cancer and improved long-term survival, bone health and fracture prevention become important health issues for breast cancer survivors.
Osteoporosis-related facts
Osteoporosis is a condition in which bone density is reduced and fractures are more likely, and fractures from osteoporosis can lead to severe pain and disability.
Risk factors for osteoporosis formation include:
- Being thin or having a small bone structure.
- A family history of the disease.
- For women, menopause, early menopause, or absence of menstrual periods (amenorrhea).
- Use of certain medications, such as glucocorticoids.
- Insufficient intake of calcium.
- Insufficient physical activity.
- Inadequate physical activity.
- Smoking.
- Drinking too much alcohol.
Osteoporosis is an asymptomatic disease that can usually be avoided; however, if undetected, the disease can progress for years and be asymptomatic until a fracture occurs.
The disease has been called a “pediatric disease with geriatric implications” because the development of healthy bones at a young age is essential to prevent osteoporosis and fractures in later life.
The relationship between breast cancer and osteoporosis
Women treated for breast cancer are at increased risk for osteoporosis and fractures because of the protective effect of estrogen on bone and the loss of bone mass due to lower hormone levels.
Many breast cancer patients experience loss of ovarian function due to chemotherapy or surgery, so this can lead to lower estrogen levels, and for women who are not menopausal before cancer treatment, menopause can occur earlier than in women without breast cancer.
Studies have also shown that chemotherapy may have a direct adverse effect on bone, in addition to the fact that breast cancer itself promotes the production of osteoclasts, cells that destroy bone.
Management strategies for osteoporosis
Several approaches can reduce the risk of osteoporosis or reduce the impact of osteoporosis on patients.
Nutrition
Some studies have found an association between diet and breast cancer, but what foods or supplements can reduce breast cancer risk? It’s not clear, but in terms of bone health, a balanced diet rich in calcium and vitamin D is important.
Good sources of calcium include low-fat dairy products, dark green leafy vegetables, and calcium-fortified foods and beverages, and supplements can help ensure that your daily calcium needs are met.
The Institute of Medicine recommends a daily calcium intake of 1000 mg for men and women aged 19-50 years, increasing to 1200 mg after age 50 or older.
Vitamin D
This plays an important role in calcium absorption and bone health, and vitamin D is synthesized in the skin in the presence of sunlight.
Some people may need to take vitamin D supplements to meet the recommended daily intake of 400-800 IU.
Exercise
Like muscles, bones are living tissue and can be made stronger through exercise. The best exercise for bones is weight bearing, forcing the body to fight gravity, such as walking, climbing stairs, lifting heavy objects, and dancing.
Everyday exercise such as walking can prevent bone loss and provide many other health benefits, and recent studies have shown that exercise can also reduce the risk of breast cancer in young women.
A healthy lifestyle
Smoking has adverse effects on bones, heart and lungs, plus smokers absorb less calcium from their diet.
Some studies have found that women who drink alcohol have a slightly higher risk of breast cancer, and there is also evidence that alcohol has adverse effects on bone health.
People who drink heavily are more likely to experience bone loss and fractures due to malnutrition and increased risk of falls.
Bone density test
Specialized tests called bone mineral density (BMD) tests measure bone density in various parts of the body, detect osteoporosis before a fracture occurs, and predict the chance of a future fracture.
Women who are recovering from breast cancer should consult their doctor about the need for a BMD test.
Medications
There is no cure for osteoporosis, but the disease can be prevented and treated with medications, and studies of a drug for osteoporosis, bisphosphonates, have confirmed that this drug can in some cases treat breast cancer that has metastasized to the bone.
The ability to reduce the risk of breast cancer is currently being evaluated with raloxifene, another osteoporosis treatment drug, which is a selective estrogen receptor modulator (SERM) that has been shown to reduce the risk of breast cancer in women with osteoporosis.
The National Institutes of Health is sponsoring the Tamoxifen and Raloxifene Study, abbreviated STAR, to effectively compare raloxifene with tamoxifen in preventing breast cancer in postmenopausal women at high risk for breast cancer.