Avril Harry, RN, BSc Oncology Nursing
Pink Hibiscus Breast Health Specialist
In last week’s article, Dr Rajen Rampaul started the discussion on breast cancer and bone health management.
This week, we will examine this subject area a bit further. As previously discussed, one of the common treatment modalities in the effective management of breast cancer for people that are hormone sensitive is the use of endocrine therapy.
One such agent that is used that has immense implications for bone health are Aromatase inhibitors. Aromatase inhibitors are used most often in postmenopausal women diagnosed with hormone-receptor-positive early breast cancer. Aromatase inhibitors work by preventing the formation of oestrogen. Oestrogen has a protective effect on bone, and reduced levels of the hormone trigger bone loss.
Anyone can get osteoporosis or have bone loss, but it’s most common in older women. The menopausal woman is already at an increased risk for osteoporosis, they have less oestrogen in their bodies and that can cause bone loss. Similarly, bone loss can also be experienced in the younger breast cancer survivor based on breast cancer treatments which can induce early menopause.
As a result of the rising incidence of breast cancer and the improvement of long-term survival rates, bone health and fracture prevention have become important health issues among breast cancer survivors.
Osteoporosis happens when your bone mass and bone density are below normal. If you have osteoporosis, you have a higher risk of breaking a bone. The most common bones to break are the spine, wrist and hip, but just about any bone can break since osteoporosis affects most of your skeleton.
Several strategies can reduce one’s risk for osteoporosis or lessen the effects of the disease in women who have already been diagnosed.
Nutrition: As far as bone health is concerned, a well-balanced diet rich in calcium and vitamin D is important. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that the calcium requirement is met each day, especially in people with a proven milk allergy.
The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily. Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, saltwater fish, and liver.
Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best activity for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, weight training and dancing. Regular exercise, such as walking, may help prevent bone loss and will provide many other health benefits. Recent research suggests that exercise may also reduce breast cancer risk in younger women.
Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, resulting in earlier reduction in levels of the bone-preserving hormone oestrogen and triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets.
Some studies have found a slightly higher risk of breast cancer in women who drink alcohol, and evidence suggests that alcohol can have a negative effect on bone health. Those who drink alcohol heavily are more prone to bone loss and fracture, because of both poor nutrition and an increased risk of falling.
Bone density test: A bone mineral density (BMD) test measures bone density in various parts of the body. This safe and painless test can detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future. The BMD test can help determine whether medication should be considered. A woman recovering from breast cancer should ask her breast specialist whether she might be a candidate for a bone density test.
Medication: There is no cure for osteoporosis. However, several medications are available to prevent and treat this condition. Bisphosphonates, a class of osteoporosis treatment medications, have demonstrated some success in bone health.
Other forms of osteoporosis treatment medication are available and people should consult your primary breast specialist or medical oncologist for advice on these.
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