Changes to bone density
Cancer treatments can affect bones which are still growing. You may be given drugs to treat any bone thinning. Exercise and a balanced diet can also help.
Throughout our lives, our bones are constantly being broken down and replaced with new bone. This helps keep their strength and shape. As a person gets older, their bones become less dense (thinner and more fragile). This is part of the natural aging process. During childhood and young adulthood, bones are still developing and growing. So having cancer treatment at a young age can sometimes mean bones start to age before they normally would. This loss of bone strength can be because of a problem called osteoporosis.
Cancer treatments that can affect bone density
It’s important to remember that your cancer treatment has been carefully planned by your treatment team. The aim is to give you the best treatment for your situation with the fewest side effects possible. However, the following treatments can have an effect on your bones:
- Steroids, such as prednisone and dexamethasone.
Sometimes it’s not the cancer treatment itself that affects bone density. Some cancer treatments cause other conditions, and they affect bone density. These conditions include:
- hormone deficiencies, for example growth hormone deficiency or oestrogen deficiency
- chronic graft versus host disease that’s treated by a long course of steroids
- conditions or side effects that mean spending a long time in bed (or not being mobile)
- taking medicines called anticonvulsants, which are used to prevent seizures.
Remember to keep taking all the medicines you’re prescribed. Speak to your doctor if you’re concerned about any side effects you think you might have.
What is osteoporosis?
Osteoporosis happens when not enough bone is forming, or when there's too much bone loss happening. This makes bones weak. At first you might not have any symptoms, but over time you can be more at risk of breaking a bone. Osteoporosis can affect any bone, but the bones most often affected are the wrist, leg bones, spine and hips.
What can cause osteoporosis?
The following things might put you more at risk of developing osteoporosis:
- Having a family history of osteoporosis.
- Being underweight.
- Drinking too much alcohol regularly.
- Not doing much physical activity.
- Having an illness that reduces your bone health. These illnesses include rheumatoid arthritis, inflammatory bowel disease, coeliac disease, lung and liver disease, and eating disorders such as anorexia and bulimia.
- If you’re a woman who’s gone through the menopause.
Having tests for osteoporosis
If your doctor thinks you have osteoporosis or you’re at high risk of getting it, you may need a bone mineral density scan. A bone mineral density scan is also known as a DXA (dual energy x-ray absorptiometry) scan.
During the scan, you’ll be asked to lie on your back on a couch while a scanner moves above your body. Special detectors in the scanner measure how much radiation passes through the bones, usually in your spine and hips. This information is sent to a computer that records your bone density.
The scan only takes a few minutes and is completely painless. You may be asked to put on a gown for the scan. You’ll also need to make sure there are no metal fastenings, such as zips, in the area of your body being scanned.
Some people worry that the amount of radiation from a DXA scan may be harmful, but the amount used is very low.
The results of the DXA scan will show whether you’re at low, medium or high risk of developing a fracture.
Treatment for osteoporosis
If you have osteoporosis, you might be given drugs to help your bones. These drugs include bisphosphonates, and calcium with vitamin D supplements.
Bisphosphonates are a group of drugs that can be used for different things. Your doctor might give you bisphosphonates:
- if you’re at risk of having fractures because of osteoporosis
- to prevent bone loss caused by cancer treatment
- to prevent or treat secondary bone cancer.
To treat osteoporosis, bisphosphonates are usually given as tablets. They can also be given by an injection into a vein, or by an infusion.
There are a number of different bisphosphonates, including:
- alendronic acid (Fosamax ®)
- ibandronic acid (Bonviva ®, Bondronat ®)
- sodium clodronate (Bonefos ®, Loron 520 ®)
- risedronate sodium (Actonel ®)
- disodium pamidronate (Aredia ®)
- zoledronic acid (Zometa ®, Aclasta ®)
- disodium etidronate (Didronel ®).
Calcium and Vitamin D
If you’ve had cancer treatment that’s known to increase your chances of getting osteoporosis, your doctor might prescribe you calcium and vitamin D supplements. These can be prescribed by your GP.
Looking after your bones
There are things you can do to help improve the health of your bones.
Physical activity and diet are really important for keeping your bones healthy. It’s important to get advice from your healthcare team before you start exercising regularly. How much you do will depend on your cancer type, the type of treatment you’ve had, how fit you are and what you want to achieve.
There are lots of different ways to exercise. Choose something you enjoy so you’re more likely to carry on with it. The best exercises for your bones are weight-bearing exercises. These include walking, climbing stairs, dancing, hiking and gentle weightlifting. High-impact exercise, like running long distances, can damage bones. So it’s important to get your treatment team’s advice before doing this kind of exercise.
Eating a balanced diet and having enough calcium will help keep your bones healthy. Vitamin D helps your body absorb calcium, so it’s important to get enough of that too.
We have more info about bone health. This information is written for people of all ages, not just for young adults.