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.
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Osteoperosis: 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
Some cancer survivors may experience osteoporosis as a side effect of cancer and treatment. This is a condition that thins and weakens bones and causes them to become very fragile. 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 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 helps kill the 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 doctor 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
- 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
- Too little or too much exercise
- Smoking
- Drinking too much alcohol
What are the symptoms and signs of osteoporosis?
Bone loss related to osteoporosis happens slowly over time. An individual can have osteoporosis and not experience any symptoms. Talk with your doctor 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
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 over age 65 and for menopausal women of any age because they may be at risk for osteoporosis.
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 doctors 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
- Include healthy behaviors into your lifestyle
- Maintain a healthy weight and improve your muscle strength and bone density
- Include calcium in your diet
- Include Vitamin D in your diet
- Evaluate your risk for falls
- Talk with your doctor about medications that can help decrease bone loss
- Discuss alternative therapies with your health care team
This document was produced in collaboration with:
Catherine Sargent MS, RN, BC, AOCN
Oncology Clinical Nurse Specialist
Works Cited
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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Osteoperosis: 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.
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Strategies to Avoid Osteoporosis
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Actions You May Want to Consider
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| 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 more calcium in your diet |
- Supplemental calcium is 1500 mg per day for those 65 years and older and 1000 mg per day for those under 65 years of age
- Foods high in calcium include milk, cheese, yogurt, ice cream, fortified orange juice, tofu, broccoli, collard greens, kale and sardines
|
| Include more Vitamin D in your diet |
- Supplemental Vitamin D 200 to 800 IU per day
- Foods high in Vitamin D include eggs, certain fish, breads, and cereal
|
| Try to avoid any falls that might cause broken bones |
- 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 doctor 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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Osteoperosis: Additional Resources
The resources listed below provide more detailed information and support services to help you with osteoperosis. Please read the Detailed Information and Suggestions document for more information and questions to ask.
LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare
Email: Send email through the LIVESTRONG website.
Phone: 1-866-673-7205
1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.
LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.
National Osteoporosis Foundation (NOF)
www.nof.org
Email: Send email through the website.
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.
U.S. Institutes of Health - National Cancer Institute (NCI)
www.cancer.gov
Online: Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)
Email: Send an email through the "Need Help?" section of the website
Phone: 1-800-422-6237
TTY for deaf and hard of hearing callers: 1-800-332-8615
Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local 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, 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 this Web site 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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Osteoporosis: Detailed Information
Some survivors may experience a side effect called osteoporosis. Osteoporosis is a condition that thins and weakens your bones and causes your bones to become very fragile. Osteoporosis is sometimes called a silent disease because it can exist for years without symptoms. You may not realize you have osteoporosis until you break or facture a bone.
Osteoporosis is a treatable condition. If you experience osteoporosis, it isn’t because your health care team didn’t do a good job treating your cancer. Your health care team’s primary goal was to treat your cancer. Now, they can work with you to prevent or manage any late effects you might experience.
While it may seem frustrating at times to have to worry about health conditions after you have survived something like cancer, it’s important to be aware of your risks for developing late effects like osteoporosis and watch for symptoms. This will increase your chances of early detection.
Who is at risk for osteoporosis?
There are many different risk factors for osteoporosis that are related to the type of cancer you had, your treatment or the way your body responded to treatment. There are also risk factors for osteoporosis that aren’t related to cancer or treatment.
Survivors diagnosed and treated for any cancers that could spread to the bone are at risk, including those diagnosed with:
- Breast cancer
- Prostate cancer
- Multiple myeloma (cancer that happens in white blood cells that produce antibodies)
- Other solid tumors such as lung, testicular, ovarian and endometrial (uterine wall) cancers
The treatment for some cancers, like breast cancer or prostate cancer, can include blocking or eliminating certain hormones in your body. Blocking the sex hormones helps kill the cancer cells. But these sex hormones also help protect the bones. If your body is deprived of these hormones, osteoporosis can happen. This does not mean that you shouldn’t have received treatment that blocks your hormones because that may have been the best way to treat your cancer. Even if you received treatment that blocked your hormones, there are things you can do to prevent or minimize bone loss.
There are also some risk factors for osteoporosis that may affect survivors but aren’t necessarily related to cancer or its treatment.
Some general risk factors for osteoporosis are:
- Health problems such as hyperthyroidism, rheumatoid arthritis or diabetes
- A history of breast cancer in your family
- Small body frame or low body weight
- Old age
- Being female – more likely to occur in women
- Ethnicity – Caucasians and Asians have a higher risk
- Low testosterone level in men
- Certain medications taken for long period of time
- Low intake of calcium and vitamin D
- Drinking too much caffeine
- Too little or too much exercise (i.e. people who are bedridden or marathon runners)
- Smoking
- Drinking too much alcohol
What are the symptoms and signs of osteoporosis?
Some symptoms of osteoporosis may include:
- Weight loss
- Stooped posture
- Curving of the upper back or Dowager’s hump
- Bone tenderness
- Loss of one or two inches in height
If you experience these symptoms, it doesn’t mean that you have osteoporosis. Discussing your symptoms with your health care team can help you determine the cause of your symptoms.
Bone loss related to osteoporosis happens slowly over time. Sometimes, you may have osteoporosis and not experience any symptoms. If you think you are at risk for osteoporosis but don’t have any symptoms, you might want to talk to your health care team about some of the tests that they can use to determine if osteoporosis is affecting you.
The most common and widely used test for osteoporosis is called the DEXA scan. This test measures the amount of calcium in bone, typically at the hip and lower spine. It is recommended for individuals over age 65 or menopausal women of any age who may be at risk for osteoporosis. The DEXA scan should be repeated every couple of years to check whether your bone density has changed. A T-score compares your results to healthy bones of young adults.
This chart shows what a T-score may look like:
| Normal T-score |
-1 to +1
|
|
Osteopenia
(Low bone mass)
|
-1 to -2.5
|
|
Osteoporosis
|
-2.5 or lower
|
|
Severe osteoporosis
|
-2.5 or lower with one or more fractures
|
Blood and urine tests may also be used to see how much osteoporosis may be affecting your bones and how you are responding to any treatment for osteoporosis.
When does osteoporosis begin to affect survivors?
Osteoporosis usually happens after age 65 but 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 osteoporosis can develop slowly, it may be difficult to determine exactly when it might affect you or when you might notice symptoms. You can discuss your risk for developing osteoporosis with your health care team at any time during your survivorship.
Is there a cure for osteoporosis?
There is no cure for osteoporosis. However, osteoporosis can be minimized and controlled. This means that once you know you have osteoporosis, you can work with your health care team to develop ways to slow down your bone loss.
What can be done to minimize the risk of experiencing osteoporosis?
Below is a brief list. For more information, see Suggestions.
Here is a list of suggestions to help minimize your risk of osteoporosis:
- Stop smoking
- Drink little or no alcohol
- Include healthy behaviors into your lifestyle
- Maintain a healthy weight and improve your muscle strength and bone density
- Include more calcium in your diet
- Include more Vitamin D in your diet
- Evaluate your risk for falls
- Talk with your doctor about medications that can help decrease bone loss
- Discuss alternative therapies with your health care team
This document was produced in collaboration with:
Catherine Sargent RN, MS, AOCN
Oncology Clinical Nurse Specialist
Works Cited
Body, J. (Ed.). Tumor Bone Diseases and Osteopororis 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: 209-215.
Email this story
|
Osteoporosis: Suggestions
|
Strategy
|
Suggestions
|
|
Stop smoking.
|
- Try using the nicotine patch or gum.
- Seek out community offered smoking cessation programs.
- Practice deep breathing exercises.
- Work with a hypnotist - not 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 more calcium in your diet.
|
- Supplemental calcium is 1500 mg per day for those 65 years and older and 1000 mg per day for those under 65 years of age.
- Foods high in calcium include milk, cheese, yogurt, ice cream, fortified orange juice, tofu, broccoli, collard greens, kale and sardines.
|
|
Include more Vitamin D in your diet.
|
- Supplemental Vitamin D is 200 to 800 IU per day.
- Foods high in Vitamin D include eggs, certain fish, breads and cereal.
|
|
Try to avoid any falls that might cause broken bones.
|
- 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 doctor 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
|
Email this story
|
Osteoporosis: Additional Resources
The resources listed below provide more detailed information and support services to help you with osteoporosis. Please read the Detailed Information and Suggestions document for more information and questions to ask.
Click a resource for more information:
National Osteoporosis Foundation (NOF)
www.nof.org
| Email: |
Send email through the Web site. |
The National Osteoporosis Foundation (NOF) promotes improved bone health through awareness, education, advocacy and research. 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 Web site offers information on the prevention, diagnosis and treatment of osteoporosis, including tips on preventing falls, choosing clothing that draws attention from the physical changes caused by osteoporosis, and five steps to bone health. NOF sponsors both online and community support groups for men and women of all ages and offers educational materials and information for patients, families, health professionals and the general public.
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LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare
| Email: |
Send email through the Web site. |
| Phone: |
1-866-235-7205 |
| |
Case managers take calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (EST). Voicemail is available after hours. |
LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.
The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.
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National Cancer Institute (NCI)
www.cancer.gov
| Email: |
Send an email through the "Need Help?" section of Cancer.gov. |
| Phone: |
1-800-4-CANCER (1-800-422-6237) |
| |
TTY for deaf and hard of hearing callers: 1-800-332-8615 |
| |
English-speaking and Spanish-speaking information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time. |
| Online: |
Immediate online assistance is available (in English only) through LiveHelp, an instant messaging system for typing in questions and receiving responses from information specialists. You can access LiveHelp from the "Need Help?" section of the Cancer.gov homepage Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST). |
Cancer.gov, the National Cancer Institute Web site, provides accurate, up-to-date information on many types of cancer and the challenges cancer can bring. You can also use the site to search for information by cancer type or topic, and you can access information about treatment-related issues. Information about financial and insurance matters is also included. You can learn how clinical trials work and search for a clinical trial in your area. This site has a detailed dictionary of cancer terms. Web site information and publications are available in Spanish.
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