Osteoporosis

Osteoporosis is a condition that causes your bones to weaken and become very fragile. Knowing what some of the symptoms are can help you manage osteoporosis and prevent further bone loss.

Osteoporosis: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Osteoporosis is a disease that is characterized by bone loss. Primary osteoporosis is the result of a normal physiologic process—usually aging and/or menopause. Secondary osteoporosis is due to bone loss from a medical condition or a treatment side-effect. Some cancer survivors may experience secondary osteoporosis as a side effect of cancer and treatment. This may occur concurrently with primary osteoporosis, depending on the individual’s age and other factors.

Because there is bone loss, osteoporosis causes the bones to be weak and fragile—sometimes fracturing with little or even no impact. Osteoporosis is sometimes called “a silent disease” because it can exist for years without symptoms. Many people do not realize that they have this condition until a bone is broken or fractured.

Osteoporosis is treatable, but not curable. It is important to be aware of your risks for developing osteoporosis. This can increase your chances of detecting any symptoms early and getting effective treatment.

Who is at risk for osteoporosis?

Risk factors for secondary osteoporosis can be related to the type of cancer you had, your treatment, or the way your body responded to treatment. Specifically, risks may exist for survivors of certain types of cancers and treatments that could spread to the bone such as:

• Breast cancer
• Prostate cancer
• Multiple myeloma (cancer that occurs in the antibody-producing white blood cells)
• Other solid tumor types such as lung, testicular, ovarian and endometrial (uterine wall) cancers

Treatment for some cancers, such as breast or prostate cancer, can include blocking or eliminating certain hormones in your body. Blocking sex hormones (testosterone or estrogen) helps to slow the growth of cancer cells. However, the sex hormones also help protect the bones. If your body is deprived of these hormones, osteoporosis can develop. This does not mean that you should not receive this type of treatment because it may be the most effective way to treat your type of cancer. If you received or will receive this type of treatment, talk with your health care provider about things that can be done to prevent or minimize bone loss.

If you develop osteoporosis, it does not mean that the health care team did not do a good job treating your cancer. The primary goal of your health care team is to treat your cancer in the most effective way possible. They can now work with you to manage any aftereffects you might experience.

There are also risk factors for osteoporosis that may not be related to cancer or treatment including:

• Health problems such as hyperthyroidism, rheumatoid arthritis or diabetes
• Family history of breast cancer
• Small body frame or low body weight
• Advanced age
• Being female--osteoporosis is more likely to occur in women, especially after menopause
• Ethnicity--Caucasians and Asians generally have a higher risk
• Low testosterone levels in men
• Certain medications that are taken for a long time
• Low intake of calcium and vitamin D
• Too much caffeine
• Inactivity or too little exercise
• Smoking
• Drinking too much alcohol

What are the symptoms and signs of osteoporosis?

Bone loss related to osteoporosis typically happens slowly over time. An individual can have osteoporosis and not experience any symptoms. Talk with your health care provider if you think you are at risk for osteoporosis, even if there are no symptoms. Ask about the screening tests that can be used to determine if osteoporosis is affecting you.

Symptoms of osteoporosis may include:

• Weight loss
• Stooped posture
• Curving of the upper back (Dowager's hump)
• Bone tenderness
• Loss of one or two inches in height
• Bone break or fracture

If you experience any of these symptoms, it does not always mean that you have osteoporosis. Be certain to discuss your concerns with your health care team to get help determining why this is happening.

The most common and widely used test for osteoporosis is called the DEXA (dual energy x-ray absorptiometry) scan. This test measures the amount of calcium in bone, typically at the hip and lower spine. It is recommended for individuals who may be at risk for osteoporosis such as women who are 65 or older and men who are 70 or older, some cancer survivors, and anyone over the age of 50 who has a newly fractured bone.

The DEXA scan should be repeated every couple of years to check whether your bone density has changed. Your T-score compares your results to healthy bones of young adults. The following table shows the range of T-scores that are used to assess risk:

Normal T-score	-1 to +1
Osteopenia (pre-osteoporosis)	-1 to -2.5
Osteoporosis	-2.5 or lower
Severe osteoporosis	-2.5 or lower with one or more fractures

Osteopenia is diagnosed when the bone mineral density is lower than what is considered to be normal. Many health care providers think that it may be a precursor to osteoporosis. However, many people diagnosed with osteopenia will never develop osteoporosis.

Talk with your health care team about your risk for developing osteoporosis. It usually happens after age 65. However, it may happen sooner if you received treatment that puts you at high risk for bone loss. The more risk factors you have, the higher your chances of developing osteoporosis at some point during your life. Because the condition can develop slowly, it may be difficult to determine exactly when it might affect you or when you might notice symptoms.

What can be done to minimize the risk of experiencing osteoporosis?

Osteoporosis can be minimized and controlled, but not cured. This means that once you know you have this condition, you can work with your health care team to develop ways to slow down any bone loss.

Blood and urine tests may be used to see how much osteoporosis is affecting your bones and how you are responding to any treatment for osteoporosis.

The following list suggests ways to help minimize your risk of developing osteoporosis:

• Stop smoking
• Drink little or no alcohol
• Excercise
• Maintain a healthy weight
• Include calcium in your diet
• Include Vitamin D in your diet
• Include Vitamin K in your diet
• Limit caffeine and Vitamin A
• Avoid falls
• Talk with your health care provider about medications that can help decrease bone loss
• Discuss alternative therapies with your health care team

This doument was produced in collaboration with:
Catherine Sargent MS, RN, BC, AOCN
Oncology Clinical Nurse Specialist

Works Cited

Slovik, DM (Ed). Osteoporosis: A Guide to Prevention and Treatment. Harvard Medical School Special Health Report. Harvard Health Publications. Boston, MA 2010

Body, J. (Ed.) Tumor Bone Diseases and Osteoporosis in Cancer Patients: Pathophysiology, Diagnosis, and Therapy. New York: Marcell Dekker, 2000.

Crandall, C. "Parathyroid Hormone for Treatment of Osteoporosis." Archives of Internal Medicine 162 (2002): 2297-2309.

Kanis, J. "Diagnosis of osteoporosis and assessment of fracture risk." Lancet 359 (2002): 1929-1936.

Smith, M. "Diagnosis and Management of Treatment Related Osteoporosis in Men with Prostate Cancer." Cancer 97 (2003): 789-795.

Tosteson, A., Grove, M., Hammond, C., Moncur, M., Ray, T., Hebert, G., Pressman, A., & Ettinger, B. "Early Discontinuation of Treatment for Osteoporosis." The American Journal of Medicine 115 (2003): 209-215.

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Osteoporosis: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Strategies to Avoid Osteoporosis	Actions You May Want to Consider
Stop smoking	Try using the nicotine patch or gum Seek out community offered smoking cessation programs Practice deep breathing exercises Try working with a hypnotist although this has not been fully proven to work
Drink little or no alcohol	Seek professional or community programs if unable to control alcohol intake
Include healthy behaviors into your lifestyle	Stress management Exercise that is right for your recovery needs Diet that is right for your recovery needs Decrease amount of caffeine in your diet
Maintain a healthy weight and improve your muscle strength and bone density	Walking, jogging, or running for 30 minutes three times a week Daily stretching Yoga or Tai Chi Swimming, water aerobics Dancing Join gym
Include enough calcium in your diet	Recommended calcium intake depends on your age and your health issues. For individuals age 51 or older the recommended intake is 1200 mg per day Foods high in calcium include milk, cheese, yogurt, ice cream, fortified orange juice, tofu, broccoli, collard greens, kale and sardines
Include enough Vitamin D in your diet	Recommended Vitamin D levels range between 400-1,000 IU per day Foods high in Vitamin D include eggs, certain fish, breads, and cereal
Include enough Vitamin K in your diet	Current recommendations are 120mcg per day for men and 90mcg per day for women. Foods high in Vitamin K include spinach, broccoli, Brussels sprouts, collard greens and other leafy green vegetables. Be careful to keep your Vitamin K intake consistent if you are on warfarin (Coumadin) since Vitamin K can affect the way that this drug works.
Try to avoid falls	Put enough lighting in all rooms and outside to help you see when it’s dark Secure or remove throw rugs in your house that might make you trip Use hand rails in bathroom and on stairs Use a cane or walker when appropriate or necessary Don't be afraid to ask for help
Talk with your health care provider about medications that can help decrease bone loss	Hormone Replacement Therapy Bisphosphonates Calcitonin Raloxifene
Discuss alternative therapies with your health care team	Soy supplements Low-dose progesterone Electromagnet therapy – not proven

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Osteoporosis: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONG Cancer Navigation Center
www.LIVESTRONG.org/GetHelp

Email:	Cancer.Navigation@LIVESTRONG.org
Phone:	1.855.220.7777 (English and Spanish)
	Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

The Navigation Center provides free, confidential one-on-one support to anyone affected by cancer. This is not a medical facility, but rather a center that provides the following support services:

• Emotional Support—assistance coping with a cancer diagnosis, help accessing support groups, as well as peer-to-peer connections
• Fertility Risks and Preservation Options—information on fertility risks and help accessing discounted rates for fertility preservation options
• Insurance, Employment and Financial Concerns—information on employment rights and benefits, financial assistance and debt management, including insurance and billing issues as well as medication co-pay assistance

In addition to professional cancer navigators on staff, LIVESTRONG partners with specialty organizations such as Patient Advocate Foundation, Imerman Angels, Navigate Cancer Foundation and EmergingMed to provide support services.

National Osteoporosis Foundation (NOF)
www.nof.org

Email:	Send email through the website
Phone:	1-800-231-4222

The National Osteoporosis Foundation (NOF) promotes improved bone health through awareness, education, advocacy and research. The NOF works to prevent osteoporosis promote lifelong bone health, help improve the lives of those affected by osteoporosis and related fractures and to find a cure. The website offers information on the prevention, diagnosis and treatment of osteoporosis. The NOF sponsors both online and community support groups for men and women of all ages. It offers educational materials and information for patients, families, health professionals and the general public.

National Cancer Institute (NCI) — National Institutes of Health
www.cancer.gov

Online:	The LiveHelp online chat service is available Monday through Friday from 8:00 a.m. to 11:00 p.m. Eastern Time.
Email:	Send an email through the website.
Phone:	1-800-422-6237
	Information specialists answer calls Monday–Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.

The National Cancer Institute's website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment and financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using the website and can tell you about NCI’s printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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