After the menopause, all women have an increased risk of bone thinning (osteoporosis). But after breast cancer, some women are at a greater risk. This is because breast cancer treatments can reduce the amount of oestrogen in the body and oestrogen helps to keep bones healthy and strong.
The following treatments for breast cancer can increase the risk of bone thinning:
- chemotherapy, if it brings on an early menopause
- stopping the ovaries from working by removing them or by giving radiotherapy, or using drugs called LHRH analogues, such as goserelin
- hormonal therapy with aromatase inhibitors (anastrozole, exemestane or letrozole).
Before treatment with an aromatase inhibitor, national guidelines recommend that women have their bone health (density) checked by a DEXA scan using a very low dose x-ray. DEXA is short for dual energy x-ray absorptiometry.
These scans only take about 15 minutes. You lie on a couch while the scan is done. There are no injections involved. You don’t have to undress, as long as there aren’t any metal fastenings, such as zips, in the area to be scanned.
Your bone density can be monitored during and after treatment. Depending on the results, you may be prescribed calcium and vitamin D supplements and/or bone strengthening drugs (bisphosphonates). These help to minimise the risk of problems.
If you have a history of osteoporosis in your family, ask your cancer specialist about using bisphosphonates to help prevent osteoporosis.
There is some research evidence that bisphosphonates may help to prevent the risk of the cancer coming back in the bones (secondary bone cancer). Your doctor or specialist nurse can give you more information and may ask you to take part in a research trial.