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Keeping Young Bones Healthy During and After Treatment

Reviewed by: Virginia F. Borges, MD, MMSc

Updated August 21, 2013

When you receive a breast cancer diagnosis as a young woman, you might not be thinking about how it could affect your bone health. Your concerns about treating breast cancer are, understandably, more on your mind. Bone problems seem like a worry to have when you are older and have gone through menopause.

Yet, because you are affected by breast cancer, your bones need extra attention. Breast cancer therapies can cause bone loss in women who are premenopausal, or still having periods, when diagnosed.

There are good ways to protect your bones without limiting your breast cancer treatment. Learning more will help you talk to and work with your healthcare team to support your bones.

Bone Health in Young Women

Bone cells grow, break down and rebuild. This process helps form hard, dense bones that won’t fracture. The cycle continues throughout life. Bones weaken when more cells break down than are rebuilt.

Young women usually have strong bones:

  • Bonemineral density, a measurement of bone strength, reaches its peak between ages 25 and 30.
  • Young women have high levels of estrogen, a hormone needed to rebuild bones.
    • Estrogen levels decline in menopause, causing bone density loss.

Sometimes, premenopausal women have bone problems that providers overlook because of young age. Many young women do not get enough vitamin D, which helps the body absorb bone-building calcium; research shows as many as 74 percent of premenopausal women diagnosed with breast cancer may be vitamin D deficient.

Other factors contribute to bone loss, such as smoking, drinking too much alcohol, family history of osteoporosis, low calcium from diet or supplements, not exercising regularly, and being Caucasian or Asian, among others.

Breast cancer treatment increases bone risks, so before you start treatment your provider will likely recommend you have a baseline bone density test, called a DEXA scan that

  • measures the strength of your bones
  • can help you and your doctor plan for bone protection

How Treatment Affects Young Women’s Bones

Bone tissue and breast tissue both respond to estrogen. In bones, that’s a good thing—estrogen helps keep bones strong. But estrogen also increases the risk of hormone-sensitive breast cancer.

As a premenopausal woman with estrogen receptor-positive breast cancer, you may receive one or more treatments that significantly lower estrogen levels in your body. This reduces the chances of breast cancer recurrence, or return, and death. Treatments include

If you have been diagnosed with another type of breast cancer and are not receiving hormonal therapy or ovarian suppression,chemotherapy will still reduce the estrogen levels in your body. 

Estrogen-blocking treatments may stop periods and cause early menopause. As with natural menopause, early menopause may reduce your bone mineral density. This increases fracture risks in the spine and other bones.

If early menopause from chemotherapy is temporary and your periods return in less than six months, bone loss may be reversed:

  • Women younger than 30 have the greatest likelihood of having periods continue.
  • After age 40, women are more likely to lose their periods permanently, but this depends on the chemotherapy regimen administered.

Compared to older, postmenopausal women:

  • Young women receive estrogen’s bone-strengthening benefits for less time because treatment starts at an earlier age.
  • Therapy-caused bone loss in young women may be more rapid and severe.

Medical Help for Bone Loss

Medicines known as bisphosphonates are commonly used to protect and help rebuild bones.

In premenopausal women, zoledronic acid (Zometa), a bisphosphonate medicine,

  • has been shown to prevent treatment-caused bone loss and improve bone mineral density
  • is also used to prevent bone fracture, pain and disease progression in metastatic (stage IV) breast cancer that has spread to the bones
  • is the subject of ongoing research to determine if it can help prevent recurrence 
  • is given by vein (IV, or intravenously)
  • may produce a very rare, severe side effect, exposure of part of the jawbone without healing, which affects less than 1 in 1,000 women taking the medicine monthly

Other bone-strengthening medicines, including bisphosphonates in pill form, may be given to postmenopausal women.

Vitamin D is needed to help calcium build bones. Sunblock use is strongly advised for everyone, but it blocks the best natural source of vitamin D (sunshine), and food sources cannot provide enough vitamin D to meet your requirements.

Ask your doctor for a vitamin D blood test. If you do not get enough vitamin D, your providers may

  • talk with you about whether vitamin D supplementation could help
  • explain that an over-the-counter dose might not be sufficient during breast cancer treatment
  • prescribe vitamin D at a stronger dose than you could get over-the-counter

Other Ways to Care for Your Bones

You can support healthy bones during treatment and afterward.

  • Make regular, weight-bearing exercise a priority. Choose activities such as
    • running
    • skiing
    • dancing
    • tennis or racquetball
    • brisk walking
    • basketball
    • yard work
    • weight training at gym or fitness center
    • using light free weights or resistance bands
    • yoga or Tai Chi
  • Eat foods that help bones, such as
    • low-fat dairy products, dark green leafy vegetables and fish for calcium
    • oily fish (salmon, sardines) and cheese for vitamin D
  • Some foods may be fortified with nutrients that help bones.
  • Caffeine pulls calcium from bones, so avoid excess use of drinks, foods and medicines with added caffeine.
  • Talk with your doctor about taking calcium and vitamin D supplements.
  • Smoking reduces bone density, so get help for quitting.
  • Heavy alcohol use blocks calcium; if you drink, keep consumption to one drink per day.
  • Avoid long-term steroid use.
  • If you use illicit drugs or misuse prescription drugs, talk with your doctor.

Learn more in LBBC’s Guide to Understanding Bone Health.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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