Why would breast cancer and osteoporosis be connected? The two seem to be two completely unrelated conditions. Breast cancer is changes in the breast tissues. Osteoporosis, on the other hand, is the loss of bone mineral density which results in the bones becoming weaker.
Here’s the answer: breast cancer and osteoporosis are linked due to their common risk factors. [ 1 ]
Both breast cancer and osteoporosis tend to affect women more commonly after menopause. Also, clinical research studies have revealed that the incidence of osteoporosis is higher in women with breast cancer.
And importantly, chemotherapy, as well as hormonal treatments received by women for the management of breast cancer, can increase their risk of osteoporosis [ 2 ] so women need to be aware of treatment-induced osteoporosis so that appropriate measures can be taken to reduce the risk when treating for breast cancer.
The link between breast cancer and osteoporosis
Hormonal therapies used to treat different forms of cancers including breast, uterine, and ovarian cancers can worsen bone loss in women. The risk of these side effects of breast cancer treatment is higher in both premenopausal (before menopause) and postmenopausal (after menopause) women. [ 3 ]
These therapies, aimed at slowing down the growth of cancer mass, can lower or block the production of female reproductive hormones like estrogens and testosterone that play a key role in keeping the bones strong. Reduced levels of estrogens can trigger bone loss. [ 4 ] [ 5 ]
Changes to the production levels of these hormones during breast cancer treatment can inhibit the process of bone formation and be linked to the onset of osteoporosis. Let us try to explain some of these factors more completely:
Chemotherapy
Chemotherapy is the administration of drugs that destroy cancer cells. Chemotherapy can be highly effective in reducing the growth and spread of breast cancer.
However, some chemotherapeutic drugs can also affect the functions of hormone-producing ovaries in women and make them reduce production of estrogens (estrogens and estrogen refer to estrone, estradiol, and estriol – the chemically similar hormones in the group) and progesterone which can lead to early menopause.
Menopause refers to the phase in a woman’s life when we stop getting menstrual periods. Those changes in estrogen and progesterone levels stop the menstrual cycles. Early menopause and the reduced estrogen levels due to breast cancer treatment can lead to the loss of bone density. [ 6 ]
Research studies have also shown that chemotherapy itself can accelerate bone loss in postmenopausal women. The rapid decline in estrogen production due to chemotherapy can make the bones weaker and more porous in ranges indicating osteoporosis.
Ovarian Suppression
Some women with breast cancer are advised to have surgery to remove their ovaries. This treatment is recommended when the breast cancer cells are sensitive to the estrogens produced by the ovaries. The removal of ovaries can control estrogen production which can prevent the growth of breast cancer.
But the loss of estrogen production induced by this surgery can promote bone loss and lead to reduced bone density. Since estrogen is essential for bone formation, the reduced estrogen levels during breast cancer treatment can trigger the development of osteoporosis.
We know. It’s a Catch 22, isn’t it?
Tamoxifen
Tamoxifen is a drug used in the treatment of breast cancer to block the action of estrogens on cancer cells. In premenopausal women, tamoxifen may lead to reduced bone density, especially when it is combined with ovarian removal or suppression.
But in postmenopausal women tamoxifen may slow down bone loss and reduce the risk of osteoporosis.
Aromatase Inhibitors
Aromatase inhibitors are the medications used in breast cancer treatment, particularly in postmenopausal women, to reduce the estrogen levels. In some cases, the use of aromatase inhibitors is combined with ovarian suppression to promote faster recovery of patients. It makes sense then that having these two treatments together may reduce bone density as the low estrogen levels worsen the bone loss. [ 7 ]
Management of breast cancer-linked Osteoporosis
Several strategies could reduce women’s risk of osteoporosis while undergoing treatment for breast cancer. The idea is to minimize the effect of reduced estrogen levels and adopt healthy ways to restore bone strength. Here are some steps you can take to help avoid osteoporosis while undergoing treatment for breast cancer. [ 8 ]
Nutrition
A well-balanced nutritious diet rich in calcium and Vitamin D can help women develop stronger bones. The best natural sources of calcium include dairy products and green leafy vegetables.
Sunlight is the best source of Vitamin D but it is also present in abundance in foods like saltwater fish, egg yolks, and liver. It’s very difficult to get to the recommended daily allowance of Vitamin D alone so you may also use calcium and Vitamin D supplements to make sure your body has enough of these nutrients.
Click here to find easy recipes that can improve your nutrition.
Exercise
Just like muscles, bones are also living tissues that respond to exercises by becoming stronger. We should all do simple resistance or “weight bearing” exercises to strengthen our muscles and bones.
Aerobic exercises like walking, running, cycling, swimming, and climbing stairs don’t just improve bone health but also reduce obesity, which is a risk factor associated with breast cancer. Resistance exercises and easy strengtheners like lifting weights can also improve our bones. These exercises can also reduce stress and can lead to more restful sleep.
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Healthy lifestyle
Smoking can reduce estrogen levels and worsen the risk of osteoporosis as well as breast cancer. Evidence suggests that excessive alcohol intake can also have a negative impact on the health of bones and breasts. We all know that we should avoid these bad habits to have good health.
Bone density test
Your doctor may prescribe bone mineral density (BMD) tests regularly to assess your bone health during breast cancer treatment. This will help you both get an idea of the effect of cancer treatment on their bones and allow them to adopt effective strategies to inhibit the progress of osteoporosis. [ 9 ]
Let’s wrap it up.
Sadly, women in treatment for breast cancer are more likely to develop osteoporosis. Chemotherapy for breast cancer can affect bone resorption while the aromatase inhibitors may reduce estrogen levels thus triggering the loss of bone density.
So we need to be aware of the consequences of breast cancer treatment as well as the benefits and follow appropriate strategies to improve their bone health. Combine your treatment plan with good dietary and lifestyle habits – even more essential during breast cancer treatment. Here’s to your good health!
References:
- https://pubmed.ncbi.nlm.nih.gov/23413388/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322683/
- https://pubmed.ncbi.nlm.nih.gov/21413864/
- https://pubmed.ncbi.nlm.nih.gov/21772329/
- https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/osteoporosis/?region=qc
- https://pubmed.ncbi.nlm.nih.gov/12798453/
- https://pubmed.ncbi.nlm.nih.gov/18757208/
- https://breastcancernow.org/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/side-effects/bone-health-osteoporosis
- https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-breast-cance
