June 2017 Ask the Expert: Bone Health
It’s important to have strong, healthy bones. But breast cancer can make that harder. Some breast cancer treatments can weaken bones. And if breast cancer becomes metastatic, the bones are where it’s most likely to spread.
In June, Living Beyond Breast Cancer expert Adam Brufsky, MD, PhD, answered your questions about bone health and breast cancer. He addressed issues people with all stages of disease face, like keeping bones healthy during breast cancer treatment and, for those with metastatic disease, preventing and treating bone pain throughout long-term treatment.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
Generally in two situations:
- When someone has bone metastases we give zoledronic acid every 3 months to block complications like bone fracture, worsening pain or need for radiation
- Data from the OPTIMIZE trial recently changed how we give zoledronic acid in metastatic breast cancer. We used to give it monthly, but now every 3 months is the standard.
- In early stage breast cancer we give zoledronic acid every 6 months to reduce bone loss from aromatase inhibitors as well as to prevent bone metastases
I like to give my patients a year-long break after 5 years. You can get what is called atypical fracture of the femur (from brittle areas at the top of the femur bone) after 5-7 years of using zoledronic acid.
Are you on filgrastim (Neupogen) or pegfilgrastim (Neulasta) as well? Those medicines are often given with chemotherapy to lower the risk of infection, and can sometimes cause bone pain. Eribulin rarely can cause pain as well. We recommend, if possible, to try ibuprofen, perhaps the night after getting chemo.
Foods high in calcium.
Any exercise that has weight bearing, including running. Just be careful with the amount of weight.
Your doctor should check your vitamin D level. If low, you can take vitamin D and the achiness can go away. Some people try taking glucosamine chondroitin.
We like to stop after 5 years, since other complications may arise with long-term use, such as bone fractures.
Yes, it works regardless of how menopause comes about.
It can be tough to tell what's causing it, but if you have pain that continues to increase, your doctors should do more tests before other steps are taken.
No one knows for sure, but it may have to do with certain receptors that breast cancer and bones both share.
Estrogen receptor-positive breast cancer tends to spread to bone more commonly than other types.
Possibly. Chemo can cause osteoporosis, especially if it results in menopause.
Generally if there is a bone about to fracture from a metastasis we put a strengthening rod in it. We check x-rays for signs that a fracture is likely.
Surgery is a local treatment. It is not used to treat breast cancer cells that may be spreading throughout the body.
Radiation is used for pain, and also to reduce tumor size and prevent bones from fracturing because of metastases.
It is a local treatment. It is not used to treat breast cancer cells that may be spreading throughout the body.
For reasons we do not understand, bones of the ribs, spine, hips, and sternum seem to be more involved.