Treatments and Your Bone Health
Breast cancer treatments affect your body’s ability to make or use estrogen to stop cancer cells from growing and multiplying. But lowering the amount of your hormones or stopping their creation altogether may also cause your bones to lose density faster and put you at higher risk for osteoporosis. For this reason, it is especially important to watch your bone health during and after treatment.
There are ways you can help improve your bone health if you know it may be affected by treatments. Speak to your healthcare provider about what you can do to lessen the risk of bone loss on your own or, if necessary, through medicine.
If you are still having regular periods, which means you are premenopausal, or are still having periods but they are only occasional, called perimenopausal, then chemotherapy may contribute to bone loss. Cell damage to your ovaries may interrupt your menstrual cycle and your body’s ability to make estrogen. Because estrogen has a role in rebuilding bones this could lead to lower bone density.
Women who were younger when treated may have a regular period again when chemotherapy treatment ends. If you are one of these women your bone density may recover too, with the help of some healthy lifestyle choices or medicines.
Chemotherapy will stop periods in some women permanently. In this case your body is not likely to recover the same ability to rebuild bone. But you can still maintain good bone health through diet and exercise. You can also work with your doctor to monitor your bone density and get medicine, if needed. Check out our page on improving your bone health to learn more.
If tests show the breast cancer is estrogen receptor-positive, you will likely take hormonal therapy to lower the risk of the cancer returning. Hormonal therapy will weaken your body’s ability to make or use estrogen and this will affect your bone health. Some common hormonal therapies are:
- Tamoxifen, a daily pill given to block cancer cells from taking in estrogen. Premenopausal women have experienced bone loss on tamoxifen. But, because it can sometimes act like estrogen, tamoxifen has been found to protect bones in women who are postmenopausal.
- Aromatase inhibitors (AI), a type of hormonal therapy that interrupts the body’s ability to convert other hormones into estrogen for postmenopausal women. Letrozole (Femrara), anastrozole (Arimidex) and exemestane (Aromasin) are the three most commons AIs and each has been associated with bone loss.
- Raloxifene (Evista) was developed as a treatment for bone health in women with osteoporosis, but it recently has been approved as a medicine to reduce the risk of invasive breast cancer for postmenopausal women considered “high-risk” but who have not been diagnosed.
Another treatment option for women with breast cancer that grows in response to estrogen is to stop the function of the ovaries. You may get surgery to have them removed (oophorectomy) or medicine to stop them from making estrogen, called ovarian suppression.
Like hormonal therapies, oophorectomy and ovarian suppression will lower your risk of recurrence but may also contribute to significant bone loss. The drop in estrogen levels experienced with the stopping or removal of your ovaries will cause you to experience menopause-like symptoms and the possible bone loss that comes with them. Speak with your doctors about the side effects of any treatment they recommend and how to best watch for or prevent them.