Bone health and metastatic breast cancer

Bone health is a concern to all of us as we age. But as a person living with metastaticinfo-icon breast cancer, you may have extra worries about bone pain, thinning breaks, or fractures, which can result from both cancer treatment and the spread of breast cancer to the bones.

Chemotherapyinfo-icon medicines and hormonal therapies, especially the aromatase inhibitors, can affect bone densityinfo-icon. As you and your doctor discuss your treatment options for metastatic breast cancer, ask about possible bone complications and ways to lower your risk.

It may feel discouraging to have to worry about bone health along with everything else on your plate. But paying attention to your bone health will allow you to keep active.

Bone Complications in Metastatic Breast Cancer

Having tumors in your bone can cause the bone to become weak and break. Some women learn they have metastaticinfo-icon breast cancer in the bone, called bone metastases, when they experience new bone pain or fracture a bone and an x-ray shows the cancer.

Your risk for having bone problems because of your treatment for metastatic breast cancer depends on many factors. Most of those factors you have little control over. They include

  • the type of treatment you are getting
  • any past cancer treatment
  • your age
  • your menopausal status
  • your ethnic background
  • your family medical historyinfo-icon and
  • your personal overall health history

Managing Bone Complications in Metastatic Breast Cancer

Common treatments to address bone problems in metastaticinfo-icon breast cancer are:

  • Bisphosphonates strengthen and protect the bones and treat bone pain, or both. They can also lower levels of calcium in the blood, called hypercalcemiainfo-icon, if they are too high due to the tumorinfo-icon’s effect on the bone, the tumor itself or as a side effectinfo-icon of treatment. Two medicines approved for metastatic breast cancer are zoledronic acidinfo-icon (Zometainfo-icon) and pamidronateinfo-icon (Aredia).
  • Targeted therapies treat bone pain and lower the risk of bone complications, such as breaks and fractures. One medicineinfo-icon approved for metastatic breast cancer is denosumabinfo-icon (Xgevainfo-icon), a RANK ligand inhibitor that works to prevent bone-related problems in people with bone metastasisinfo-icon.  
  • Supplemental calcium and vitamin D allow targeted therapies and bisphosphonates to work best
  • Radiation therapyinfo-icon strengthens bone or treats pain from a tumor
  • Strontiuminfo-icon-89, a radioactiveinfo-icon chemical given by IV, can treat bone pain
  • Steroids treat pain and decrease swelling
  • Surgeryinfo-icon stabilizes a weak bone with a rod

Your providers will want to monitor you for some side effects you could have with bisphosphonates and denosumab. The one of greatest concern to most women is osteonecrosis of the jawinfo-icon, or exposed bone in the jaw that does not heal. All bisphosphonateinfo-icon treatment can cause ONJ, but your risk for it is higher when you take bisphosphonates for a long time for metastatic disease. Before you start taking a bisphosphonate, see your dentist. During your treatment, make sure you speak with your oncologyinfo-icon team if you need any invasive dental work done, such as a tooth extraction.

Bisphosphonates can also cause kidney problems, which in rare cases leads to kidney failure. To check for problems, your providers will monitor the creatinine level in your blood. Healthy kidneys filter creatinine, a waste product, from your blood. If your kidneys aren’t working as well as they should, your blood will have a higher level of creatinine.

Your doctor will be able to tell you about the pros and cons of these treatment options and what follow-up monitoring may be needed required.

There are also some nonmedical steps you can take to reduce your risk for bone fractures. Among them:

  • Weight-bearing exercise. Even a short, brisk walk each day will help keep your bones strong. Dancing, low-impact aerobics and racquet sports are also good.
  • Strength-training exercise. Exercising with free weights, resistance bands or in a swimming pool can help improve strength. Be sure to check with your doctor before starting a new form of exercise.
  • Nutritioninfo-icon. A well-balanced diet with sufficient calcium and vitamin D promotes good bone heath. Talk to your doctor if you are considering taking supplements.
  • Avoid smoking and limit alcohol, as both can lead to bone loss.
August 31, 2015

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