Breast cancer and osteoporosis: the link between them
The Osteoporosis-Breast Cancer Link
Breast cancer treatment often comes with some difficult side effects, including one you may not be aware of: bone loss. Here are a few ways breast cancer patients can keep their bones strong.
By Diana Rodriguez
Medically Reviewed by Lindsey Marcellin, MD, MPH
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When a woman undergoes breast cancer treatment, she may be left vulnerable to other health problems — specifically osteoporosis, a disease that robs bones of their strength and density. Why? The link between breast cancer and osteoporosis risk is all about the hormone estrogen.
A woman’s risk of developing breast cancer increases with age. So does her risk of developing osteoporosis, especially after menopause. The reason: Women produce much less estrogen post-menopause, and this is the hormone that helps protect bone density.
The Effects of Breast Cancer Treatment on Estrogen
Breast cancer treatments such as chemotherapy can lower estrogen levels in several ways. The ovaries, which are the main producers of estrogen in the female body, are very sensitive to chemotherapy. After chemotherapy treatment, ovarian function may decrease or stop altogether due to damage from chemotherapy drugs, putting a woman into sudden, premature menopause. Even if premature menopause does not occur, women who have undergone chemotherapy for breast cancer are more likely to have an earlier menopause, probably due to ovarian damage.
If a woman with metastatic breast cancer (cancer that has spread to other parts of the body) has radiation to the pelvic area, or has her ovaries removed, she will probably experience premature ovarian failure, and her estrogen levels will go down.
As a result, her bones have fewer years of estrogen exposure to keep them strong. When bone density drops because of insufficient estrogen, the risk of osteoporosis increases, since bones keep losing mass and the possibility of fracture becomes more likely.
Aside from damaging the ovaries, chemotherapy also seems to have a direct effect on a woman’s bones, causing damage that decreases bone density. And the cancer itself, even without bone-damaging chemotherapy, may cause an increase in the number of osteoclasts, cells that break down bone.
Treating Osteoporosis After Breast Cancer
Tests that screen for bone mineral density can tell you and your doctor if you are losing bone mass and have osteoporosis. If you are diagnosed with osteoporosis, your doctor will determine how severe the bone loss is and how your treatment should be managed.
Osteoporosis prevention and treatment options for women who have breast cancer or who have had breast cancer in the past may be different than for those without it. Hormone replacement therapy with estrogen and progestin may be prescribed for post-menopausal women who are concerned about bone health, but for breast cancer survivors, this is not an option due to the increased risk of worsening the cancer or causing a recurrence.
Selective estrogen receptor modulators, or SERMs, like Evista (raloxifene) and Nolvadex (tamoxifen), are often prescribed for women with a type of breast cancer called hormone-receptor positive. These are the breasts cancers that may grow or recur if exposed to estrogen. SERMS have the ability to selectively bind to the estrogen receptors in breast tissue, blocking any natural body estrogens from getting to these receptors and encouraging cancerous growth. They are often prescribed for long periods after cancer treatments are completed, and women who take them are less likely to have a recurrence of their breast cancer.
SERMS have the opposite effect on bone cells, which also have estrogen receptors. Here, they also bind to estrogen receptors, but have the effect of stimulating those receptors, resulting in slowed bone loss.
Other osteoporosis treatment guidelines that may be safe for women with breast cancer or those who have had breast cancer include:
- Taking bisphosphonate medications such as Actonel (risendronate), Fosamax (alendronate), or others that strengthen bones
- Quitting smoking
- Limiting alcohol consumption
- Getting regular weight-bearing exercise, light weightlifting, or activities like stair climbing and walking
- Increasing calcium and vitamin D intake
These safe therapies help maintain bone density and slow bone loss, and they’re also lifestyle changes that have positive effects in all areas of health. Bisphosphonate medications can even improve bone density — not just slow bone loss. They do have side effects, however, particularly a risk of severe heartburn caused by irritation of the esophagus.
The link between osteoporosis and breast cancer treatment is clear, but women who have undergone treatment for breast cancer need to be aware of their osteoporosis risk and take measures to preserve their bone health.
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