Cancer and bone health

This information is about bone health. It explains:

  • what bone health is
  • how cancer treatments and other factors can affect your bones
  • treatments to protect your bones
  • tests you may have to check your bone health.

The information is not about bone cancer. We have separate information about bone cancer.

What is bone health?

Healthy bones:

  • provide support and protection for your internal organs
  • work with your muscles to allow your body to move
  • store calcium and other minerals
  • contain bone marrow, which is where your blood cells are made.

Bones are constantly renewing themselves to keep their strength and shape. But factors such as getting older or some cancer treatments can cause bone loss or bone thinning. The bones become less dense and more fragile. They may be more likely to break (fracture).

If the bone density is much lower than normal this is called osteoporosis.

We have more information about bones and bone thinning.

Cancer treatments and bone health

Cancer treatments that reduce the levels of the hormones oestrogen or testosterone can cause bone loss. This includes:

Hormonal therapy for breast cancer

Some drugs that treat breast cancer work by reducing oestrogen levels. They include anastrozole (Arimidex®), exemestane (Aromasin®), letrozole (Femara®) and goserelin (Zoladex®). Taking these drugs for several months or more can cause bone loss and increase the risk of fractures.

Not all hormonal therapies for breast cancer cause bone loss. The drug tamoxifen reduces bone loss in women who take it after the menopause.

Hormonal therapy for prostate cancer

Some drugs for prostate cancer reduce the level of testosterone. These drugs include goserelin (Zoladex®), leuprorelin (Prostap®) and triptorelin (Decapeptyl®, Gonapeptyl Depot®). A side effect of these drugs is bone loss.

Chemotherapy drugs

Some chemotherapy drugs affect the ovaries or testicles. This can reduce the levels of oestrogen in women or testosterone in men. The effect can be temporary or permanent. Having lower than normal levels of these hormones before the age of 50 can lead to bone loss. Your cancer doctor or nurse can tell you if chemotherapy is likely to affect your hormone levels.

A few chemotherapy drugs, such as methotrexate and ifosfamide, may weaken bones. If your treatment includes these drugs, your doctor or nurse will talk to you about this.

Surgery

Hormone levels are reduced if:

  • a man has an operation to remove both his testicles
  • a woman has surgery to remove her ovaries before she has gone through the menopause.

The reduced hormone levels can lead to bone loss.

Radiotherapy to the ovaries

Radiotherapy to the ovaries before the menopause reduces oestrogen levels in women. This increases the risk of bone thinning (osteoporosis).

Radiotherapy to the pelvis

Radiotherapy can cause changes to the bone in the area being treated. It is most likely to happen when women are given radiotherapy to the pelvic area. This may be used to treat cancer of the anus, bladder, womb, cervix or rectum.

Radiotherapy can cause changes to the bone, meaning it cannot cope as well with the normal stresses put on it. This can lead to fractures. Doctors call these types of fractures pelvic insufficiency fractures (PIFs).

Steroid therapy

Some people have steroids as part of their cancer treatment. Commonly used steroids include prednisolone and dexamethasone. High-dose steroid treatment, or taking steroids for three months or more can cause bone loss and increase the risk of fractures.

Targeted therapies

Targeted therapies are drugs that target changes within cancer cells to stop them growing.

Some targeted therapy drugs may affect bone health. These drugs are imatinibnilotinib and dasatinib. They may affect the level of calcium in the blood. If calcium levels are low for a long time, this can cause bone loss. It is important to get the recommended amount of calcium and vitamin D. Your cancer specialist will check your calcium levels with a blood test every 3 to 6 months. If your levels become lower than normal, they can give you treatment to correct this.

Other factors that affect bone health

There are other that factors that can affect your bone health and risk of osteoporosis.

  • Age

    Your bones are strongest when you are in your twenties. Bone loss begins in your thirties. The risk of a fracture due to bone loss increases steadily from the age of 50. Fractures are most common in women over the age of 65 and in men over the age of 75.

  • Gender

    Both men and women can develop osteoporosis, but it is more common in women. This is because after the menopause, women lose bone density more quickly as their oestrogen levels fall. Oestrogen is a hormone that helps keep bones healthy.

  • Physical activity

    Being physically active when you are a young adult helps make your bones stronger and denser. Regular exercise throughout life helps to maintain your bone strength. Weight-bearing exercises such as walking or climbing stairs are particularly helpful for bone strength.

  • Diet

    Eating a balanced diet helps keep bones healthy. It is important to get enough protein, calcium and vitamin D. They help build bones and keep them strong.

  • Family history of osteoporosis

    If one, or both, of your parents have had osteoporosis, you are more at risk of developing it too.

  • Fractures

    If you break a bone after falling from a standing height or less, this is called a fragility fracture. After the age of 50, it can be a sign that you have weaker bones and are more at risk of having a fracture in the future.

  • Weight

    People who have a low body weight are more at risk of fractures than people who weigh more.

    Body mass index (BMI) is a measure of healthy weight. Your BMI is based on your height and weight. Guidelines recommend that for bone health and general health your BMI should be between 19 to 25kg/m2. Your GP or practice nurse can work out your BMI for you.

    You can use this BMI calculator to check your BMI. Speak to your GP or nurse if you are above or below the ‘healthy’ range.

  • Smoking

    Several studies have shown that smoking reduces bone density, weakens bones and increases the risk of osteoporosis. We have more information about giving up smoking.

  • Alcohol

    Drinking alcohol in moderation is not harmful to bone health. But if you often drink more than 21 units a week, your bone density may be reduced, increasing the risk of osteoporosis.

    It is best to keep within the government guidelines for drinking alcohol. There is more information about alcohol and drinking guidelines at drinkaware.co.uk.

    Drinking alcohol also causes a higher risk of falls, which are a common cause of fractures.

  • Illness

    Some illnesses have been linked to lower bone density. These include:

    • diabetes (type 1 and type 2)
    • asthma
    • inflammatory rheumatic diseases, such as rheumatoid arthritis and lupus (SLE)
    • inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis
    • long-term liver or kidney disease
    • thyroid diseases, such as having an overactive thyroid gland
    • eating disorders, such as anorexia.

    If you have a disability that makes walking difficult or makes you less mobile, this can also mean you are likely to have a lower bone density. 

  • Medicines

    Some drugs may increase your risk of fractures and of developing osteoporosis. These include the following:

    Steroids, which are given to treat a number of illnesses, such as rheumatoid arthritis and asthma. They may also be used in some cancer treatments.

    Some anti-epileptic drugs, such as phenytoin. Anti-epileptic drugs are mainly used to prevent fits (seizures) in people who have epilepsy.

 

Tests to check your bone health

If you are at risk of weak bones, you may have tests to check your bone health.

Fracture risk assessment tools

Doctors in the UK use two online tools called FRAX® and QFracture®. These tools check if you have a higher risk of breaking a bone after falling from a standing height or less (a fragility fracture).

Your doctor may use one of these if you:

  • are over the age of 40 and they are concerned about your bone health
  • have risk factors for bone loss.

When your doctor uses the online tool, they will ask about your:

  • height
  • weight
  • medical history
  • possible risk factors for osteoporosis or fragility fractures.

The online tool then works out your risk of developing a fracture. The results will show whether you have a low, intermediate or high risk of a fracture.

DXA scan

Your GP or hospital doctor may also arrange for you to have a scan to check your bone density. This is called a dual energy x-ray absorptiometry scan (DXA scan). It is sometimes called a bone mineral density (BMD) scan.

We have more information about having a DXA scan.

Treatments to protect your bones

You may have drug treatments to protect your bones if:

  • tests show you have low bone density or a high risk of fracture
  • you are having cancer treatments that are known to increase your risk of osteoporosis.

We have more information about drug treatments to protect the bones and possible side effects.

If your GP or hospital doctor thinks you need specialist advice for osteoporosis, they may refer you to a hospital team that specialises in it. These teams may include doctors, nurses and physiotherapists who work closely with occupational therapists and pain specialists.

What you can do to look after your bones

You can make changes to your lifestyle to improve your bone health and reduce your risk of osteoporosis. If you have a high risk of fractures, your doctor may advise you to:

  • eat a healthy, balanced diet
  • get enough sunshine (if this is possible)
  • keep physically active.

These changes are helpful for everyone, not just people affected by cancer. We have more detail in our information about looking after your bones.

Share your experience

If cancer treatments have affected your bone health, you may find it helps to talk about it with other people. Sharing your thoughts and feelings with others can help them too. Just hearing about how you have coped and what you have done to manage your bone health could be very helpful to someone in a similar situation.

There are also opportunities to influence future healthcare by sharing your experiences. Ways you can do this include:

  • joining a patient group or forum
  • volunteering with a cancer charity
  • taking part in research or filling in a satisfaction questionnaire
  • letting NHS staff know what you think about the care you received, or the care you would like to have received.

 

How we can help

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