- 06 Oct, 2020
The cancers that affect bones are the ones that have started in another part of the body and have spread to the bone (secondary bone cancer). The most common types are breast, ovarian, prostate, and lung cancer, which increases the risk of osteoporosis in cancer patients. Also, people are at an increased risk for developing osteoporosis who have received or are actively receiving certain cancer therapies.
In osteoporosis, bone density decreases or "thinning" or weakening of the bone occurs which increases the risk of fracture in women and men:
● Radiation therapy—weakens the bone and can cause osteoporosis.
● Allogenic (receiving a donor’s) stem cell and bone marrow transplants.
● Steroids are known as glucocorticoids.
● Surgical removal of the stomach (gastrectomy).
● Chemotherapy and hormone therapies.
Cancer survivors at risk for osteoporosis should learn to prevent it and have screening.
Bone Health can be improved during cancer treatment by,
● Early detection: A bone density scan can determine bone loss.
● Calcium: Maintains bone health and strength. Calcium decreases as we age, so it's important to replace it in foods or with a supplement.
● Vitamin D: Helps the body absorb and hold on to calcium. It is created in the skin using energy from sunlight and can also be found in vitamin D-fortified foods like milk.
● Bone Strengthening Drugs: such as bisphosphonate slow the rate of bone loss and may even help promote new bone growth.
● Exercise: Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) stimulates the production of bone-forming cells and also helps build muscles.
● Maintain a Healthy Weight: A nutritionally balanced diet is crucial to healthy bones.
They help prevent or treat bone damage from cancer that has spread. It also helps to reduce pain from cancer that has spread to the bone, slow the growth of cancer in the bone and prevent further bone loss and strengthen
the bone to reduce the risk of bone damage, like fractures. The medications include:
Bone strengthening drugs such as bisphosphonate are commonly given into a vein in a drip, from 15 minutes up to 3 hours every 3 to 4 weeks. Some are given as an injection just below the skin or in a tablet form.It is usually prescribed for several years if on hormone therapy for cancer but, if prescribed with other treatments such as chemotherapy or as part of a clinical trial, treatment may be of shorter duration. Bisphosphonate treatment can stop some types of cancer from spreading into the bone. 
Calcium and Vitamin D Supplementation
One should get enough calcium from the diet as our bodies cannot produce calcium enough to support healthy bones. One should aim to get 1000-1200 mg of calcium per day.
It is best to get calcium in a balanced diet, including 4-8 servings of calcium-rich foods a day. If you cannot take in the recommended amount of calcium from the foods then, take calcium supplements.
Often called the "sunshine vitamin" as the skin converts ultraviolet rays from the sun into vitamin D. In general, 10-15 minutes of sun exposure on the hands, arms, and face create the needed amount. But avoiding the sun and using sunscreen limit the UV exposure one gets.
Vitamin D is available in two forms, D2 and D3 and supplements usually contain D3. A multivitamin contains 400 IU and some calcium supplements also include vitamin D. You should aim for 800-1000 IU per day.
Your health care provider may check Vitamin D and calcium blood levels to see if one required the supplements.
Exercise for Bone Health
Exercise helps maintain bone density and improves balance which makes one less likely to fall. During and after the cancer treatment, one may not have enough energy or flexibility as before the treatment started. Even though, try to move as much as one can.
Talk to the doctor before about what types of exercises are okay for now. Physical activity is good for bone health:
● Encourages the production of bone-forming cells.
● Helps increase bone density.
● Helps build muscles, providing more stability for the body.
Weight-bearing exercise is the best for bone health including tennis, football, and running, jogging, and dancing. Regular exercise will provide the greatest benefit.
● 30 minutes each day is recommended.
● Do things that feel good and safe, like walking with friends, gardening, swimming or gentle yoga.
● Try to add in some resistance exercises, like lifting weights and stretching with exercise bands. This builds muscle strength, which helps support your bones.
● When you feel sick, exercise only as much or as strenuously as you feel comfortable.
● Exercise gently, slowly, and for short amounts of time.
● If very tired, try gentle, slow, and brief movements that are comfortable.
● If have trouble sleeping, exercise during the day to help sleep better at night.
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- Bone Health after Cancer, https://www.oncolink.org/print/pdf/8560?print_8560.pdf, last accessed on 7th September 2020.
- Bone Health & Cancer Treatment, https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/bone-health.html, last accessed on 7th September 2020.
- Bone-strengthening drugs, https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/coping-with-side-effects/bone-pain-and-weakened-bones/bone-strengthening-drugs, last accessed on 7th September 2020.
- Bone health and Cancer, https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/coping-with-side-effects/bone-pain-and-weakened-bones/bone-health-and-cancer, last accessed on 7th September 2020.