Cancer patients face an increased risk for bone loss and fractures due to both the direct effects of cancer on the skeleton and to the side effects that come with many cancer specific therapies. Cancer surgery and treatments affect the entire body, not just the area of the cancer. Patients react differently to cancer treatment with some experiencing side effects right after treatment is finished and some not showing symptoms until years later.
Bone loss is a common finding in patients with breast and prostate cancer and these patients especially need to be made aware of their increased risk for osteoporosis and given advice on what they can do to strengthen their bones and lower their risk of fracture.
Although osteoporosis can cause a break in any bone, osteoporotic bone breaks are most likely to occur in the hip, spine or wrist. A broken hip or fractures of the spine usually require a hospital stay or surgery and can lead to permanent pain, disability, or death.
Diet, exercise and lifestyle changes are keys to preventing osteoporosis and need to be emphasized to cancer patients who face a higher risk for osteoporosis after treatment.
The most common breast cancer is estrogen based and these cancer treatments work by starving the cancer of estrogen. The high incidence of breast cancer combined with increased survival rates will increase the percentage of those who suffer from both breast cancer and osteoporosis.
Many cancer treatments can lead to a loss of bone density, including:
1. Aromatase Inhibitors: Aromatase inhibitors inhibit aromatase from turning androgen into estrogen in areas of the body other than the ovaries and are used in post-menopausal women diagnosed with hormone receptor positive cancer. In post-menopausal women, aromatase inhibitor agents to reduce the risks of cancer recurrence result in decreased estrogen and cause an increased risk of osteopenia/osteoporosis and fractures. The aromatase inhibitors are: anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).
2. Androgen Deprivation Therapy: Androgen Deprivation Therapy hormone therapy leads to many side effects, including loss of muscle, increase in fat mass, osteoporosis, diabetes and heart disease. Men with prostate cancer who receive androgen deprivation therapy are also at risk for bone density loss and fractures.
3. Chemotherapies: Chemotherapy has a major impact on bone health by shutting down the ovaries and causing early menopause in premenopausal women. The decreased estrogen state has a negative impact on bone density. Doxorubicin (Adriamycin), methotrexate (Trexall), cyclophosphamide (Cytoxan) and 5-fluorouracil can cause premature menopause.
4. Oophorectomy: This surgical removal of the ovaries will induce an early menopause.
5. Medically shutting down the ovaries decreases estrogen, in order to reduce cancer growth. Often used for hormone-receptor-positive breast cancer, this procedure leads to lower bone density, especially if the ovaries are shut down at an early age.
6. Use of corticosteroids: Some medications used to prevent nausea and vomiting may also have a negative impact on bone health.
Balance issues are also common among cancer survivors. The risk of falls and fall-related injuries increase among those with balance issues and low bone density. Balance and strength exercises can help prevent falls by improving the ability to control and maintain body position whether in motion or stationary.
The fear of falling and fracturing many cancer survivors face can cause withdrawal and a decreased quality of life. Stability and balance exercises can help patients regain function and mobility to resume their normal activities of daily living and are a key component for recovery after cancer treatments.
Cancer patients may also face issues with body posture and changes in muscle placement, making postural exercises an important component of recovery. Posture exercises can help patients with proper body alignment and can be performed a few times per day. The body needs to always be aligned properly, so there is less stress on the spine. This will help one to maintain good posture, which can help improve kyphosis. Keeping muscles strong and flexible will also help with spinal stability.
To regain function and protect bones as cancer patients recover, proper body mechanics should be used throughout the day and during exercise sessions that include strength training, and weight bearing, stress reduction, posture, and balance exercises.
To learn more about diet and exercise tips to help prevent osteoporosis, visit the prevention section of NOF’s website: https://www.nof.org/preventing-fractures/.
By: Carol Michaels, MBA, ACE, ACSM
Carol is an award-winning leader in the fitness industry and a health and wellness expert known for her unique, creative, and fun exercise programs. Carol’s mission is to help people get fit and learn how to live healthy lifestyles. She works to help cancer patients recover from surgery and treatment and founded Recovery Fitness®, an exercise program designed specifically to meet the needs of cancer patients.
Learn more about Carol at: www.CarolMichaelsFitness.com.