Bones May Take a Beating During Cancer, Treatment

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By Bayan Raji, Staff Writer

You may think the skeletal system is pretty stable, supporting the body but not changing much over the years.

Not so. The skeleton always is changing, and it's important, too. The skeleton is the body's source of calcium; without it the brain couldn't function.

"Bone health should be a concern for everyone, especially cancer patients," says Robert Gagel, M.D., professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson.

Cancer, treatment are culprits
Some cancer treatments may lead to increased bone loss. These include:

•    Breast cancer treatment
•    Targeted therapy treatment
•    Prostate cancer treatment
•    Immunosuppressive agent treatment

Certain cancers, such as multiple myeloma, stimulate bone loss and inhibit formation of new bone.

Early menopause robs bones
Chemotherapy for breast cancer often induces early menopause (the end of a woman's menstrual cycles). Menopause leads to a deficiency in estrogen, which may cause bone loss. Many breast-cancer patients develop bone loss at a younger-than-normal age, which increases their risk of osteoporosis.

"If we don't do something to prevent bone loss at the beginning of treatment, a 45-year-old woman might begin to have bone fractures in 20 years," Gagel says.

Men are affected also
Testosterone in men helps protect bone, much like estrogen does for women. Although
several therapies are available to treat prostate cancer, they all lower testosterone levels.

In most cases, men begin with higher bone density than women, so it takes longer for them to reach levels of bone loss that might lead to fractures. However, the problem should be addressed.

Drugs deliver double punch
Patients who have bone marrow transplants and take immunosuppressive drugs, such as glucocorticoids, face two problems. High doses of these drugs, meant to decrease the risk of the body rejecting the transplant, may:

•    Increase the rate of bone breakdown
•    Decrease the rate of bone formation

Cancer patients often have decreased appetites, and if they receive chemotherapy they may be nauseated as well. As a result, they may not eat well, which may cause a calcium deficiency.

"If we don't take in enough calcium in our diet, our body will withdraw it from the skeleton. If unchecked, this will lead to osteoporosis," Gagel says.

Vitamin D is crucial
Many patients also have vitamin D deficiencies, either because they do not get enough in their diet, or they have liver or kidney failure so their body does not make it.

Vitamin D enables the body to absorb calcium from foods and supplements. While the minimum daily requirement is set at 400 to 600 IUs (international units), many researchers suggest it should be much higher.

Fifty percent of the population in the United States is vitamin D deficient, Gagel says.
This means that, even if they are getting the daily recommended amount of calcium, they are absorbing only about half of it.

Bone up on health
Take your bone health seriously. You may be able to prevent serious problems down the road if you:

•    Add calcium-rich foods to your diet
•    Exercise regularly

Gagel recommends that patients speak to their doctors about any bone health concerns. Ask if you should:

•    Take calcium supplements
•    Check your vitamin D level
•    Have a bone density test

M. D. Anderson resources
Bone Health
Department of Endocrine Neoplasia and Hormonal Disorders

Additional resources
Chemotherapy Causes Bone Loss in Young Women (American Cancer Society)
Calcium (American Cancer Society)

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