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Osteoporosis is a disease in which bones become fragile and more likely to break due to gradual leaching of calcium from the bones. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These fractures occur typically in the hip, spine, and wrist. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. Women are four times more likely than men to develop the disease.  There is no known link between breast cancer itself and osteoporosis, or between the direct effects of chemotherapy and osteoporosis. The main problem is that chemotherapy for early breast cancer may induce early menopause. Once bones are deprived of oestrogen, which happens after the menopause, they tend to thin out. In addition, certain hormonal therapies may increase bone thinning. These include the “medical menopause” hormone injections, like Zoladex (for which the evidence remains preliminary), and the aromatase inhibitors like Arimidex and Femara. Diet There are steps you can take to significantly reduce your risk. Getting enough dietary calcium is important at any age to help keep bones strong. Adult men and women need 1200 milligrams of calcium per day, while women near or past menopause should have 1,500mg daily. By far the best source of calcium is dairy food. For example, two slices of low-fat cheese contains about 350 mg of calcium, about 1/3rd your daily requirement. Whilst calcium is found in certain vegetables, nuts and legumes, these foods may contain other substances that interfere with calcium absorbtion. The view that dairy foods contribute to breast cancer risk is absolute nonsense and I strongly advise against the “dairy-free” diet. Try to have two-to-four good servings of dairy food daily, but be sure to choose the low fat varieties to keep the cholesterol in check. Fish with edible bones, such as sardines and salmon also contain high calcium levels. It is important to maintain a healthy weight to height ratio. And avoid dramatic diets or binge eating. Excessive weight gain and weight loss can both promote bone loss. Exercise Supporting your own weight while you exercise – walking, playing tennis, doing aerobics, or even line dancing, forces the bones to maintain density and strength. For further notes CLICK HERE Sunlight Staying outside three times a week for 30 or 40 minutes for your exercise will also provide you with sufficient sunlight to ensure your vitamin D levels aren’t wanting. Our bodies use vitamin D to absorb calcium. Take care, however, to avoid excessive sun exposure. Don’t smoke Smoking significantly enhances the risk of bone loss, apart from all its other disastrous effects on health. Seek medical help, don’t delay. Quit now! Smoking is probably a far greater risk to you than the risk of breast cancer recurrence. Drug treatments to prevent osteoporosis Clinical trials are in progress to evaluate the use of bisphosphonate drugs (CLICK HERE) in the prevention of osteoporosis in women taking aromatase inhibitors as adjuvant therapy for early breast cancer. These trials are likely to be positive. For example, an injection of the drug zolendronate ("Zometa") twice yearly may prevent osteoporosis, but is still being evaluated. Women who are menopausal, whether naturally, or because of chemotherapy, should have a baseline bone mineral density (BMD) measurement performed. This should be repeated every two years. This is particularly important for women who are taking aromatase inhibitors as preventative protection afer early breast cancer ("adjuvant hormonal therapy"). These include "Arimidex", "Femara" and "Exemestane". In certain case, such as young, fit, low-risk women who are active and have no risk factors for osteoporosis, bone density measurements may be less imperative. Evidence-based guidelines on this matter are still awaited. Watch this site. The "gold standard" method for measuring bone mineral density is dual x-ray absorptiometry (DXA) of the spine and hip. This test can be completed within a few minutes and involves a simple X-Ray procedure. The radiation exposure is approximately one tenth of that of a normal chest x-ray. Risk for osteoporosis is identified by the “T” score. T score represents the number of standard deviations by which the patient's BMD differs from that of the mean for healthy young women. Thus, a woman who has a BMD equivalent to that of an average healthy young woman has a T score of 0.0, and a woman whose BMD is 2 standard deviations lower than an average young woman has a T score of minus 2.0. Unfortunately, Bone Mineral Density measurement is only on the Australian Medicare for those with proven osteoporosis (fractures). It costs about $90.00. Calcium Supplements Calcium supplements are recommended for those at high risk of osteoporosis who have a deficient dietary intake. I usually use Caltrate, which provides 600 mg of calcium. The normal dose is 2 tablets daily. Vitamin D Use only under medical instruction. Bisphosphonates There are two of these on the market in Australia:
Unfortunately they are only on the PBS for patients who have already experienced a fracture from osteoporosis, which seems fairly crazy. Patients who want to pay for the drug will be up for around $60.00 per month. They are only indicated for women who have evidence of bone thinning on analysis of bone density. Raloxifene (“Evista”) Raloxifene is a drug rather like tamoxifen. It is used to treat osteoporosis in women who do NOT have a history of breast cancer. It has mildly oestrogen-like effects and could potentially stimulate breast cancer cells. | What's New | FAQ Page | Living with chemotherapy | Dietary Advice | Exercise | The Flu Vaccine | Insomnia | Marijuana | Alternative Medicine | Managing Menopause | Advice to Carers | Breast Cancer | Pain | Useful Tips | Chemotherapy: The What and How | MRI Screening | | Your Cancer Information | | Return Home | New Patients | Services and Clinics | Useful Links | Contact Us | Download Page | Cancer Information | |
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