What’s Your Bone Density?

An often-overlooked part of managing our maturing bodies is keeping our bones strong and healthy. This is especially important for breast cancer survivors since some of the medications you take can weaken your bones. In this week’s post we’ll cover the causes of bone loss, who is at risk, and what you can do to keep your bones strong.

The most common cause of bone loss is surviving past the age of 30. That’s right.  Bone loss is a normal part of aging.  As you grow your bone is constantly going through a process called remodeling which involves destroying and building bone. This process continues throughout life. Before the age of 30, you make more bone than you break down, and after the age of 30, you break down more bone than you make.

Since surviving past 30 is generally a good thing, what are some of the causes of bone loss that we might actually want to change? Here are some things that impact bone health that you have control over:

• Poor diet - one that is low in calcium (got milk?), low in vegetables, or high in alcohol consumption
• Smoking
• Lack of exercise

And, of course, there are some things that you don’t have control over that put you at risk for weaker bones:

• Family history of osteoporosis
• Race – white or Asian
• Small body frame
• Menopause – the drop in estrogen levels can result in significant bone loss
• Being female – we start with less bone mass than men
• Medications

So, you can probably tell from that list that breast cancer survivors are at increased risk for bone loss. You’ve most likely got at least three of those factors on the list.  First is being female. Second is being post-menopausal. This applies to most of you, and if you weren’t menopausal before diagnosis, treatment probably put you there. Third is medications. For those of you who had hormone positive breast cancer, you are likely to end up on an aromatase inhibitor at some point. These medications are supposed to decrease the levels of estrogen in your body to keep the cancer from growing, but one side effect is bone loss. Interestingly, tamoxifen, which is given to pre-menopausal women with hormone positive cancer, may actually work to improve bone health.

But don’t despair. There are plenty of things you can do to help strengthen your bones. The most important of these is to know what your baseline is with regard to your bone health. Fortunately, there is a simple test that can tell you how strong your bones are so that you and your doctor can determine just what you need to do to maintain and improve your bone health. This is called a bone density test or DEXA scan (find out more about this test by clicking here). This is not the same as a bone scan which is done to look for cancer that has spread to the bone. This test is specifically for assessing your bone health. 

Now that you know where you are starting, here are some of the things that you can do to strengthen your bones:

• Take calcium and vitamin D. The vitamin D is necessary to help absorb the calcium. Your doctor can measure the vitamin D levels in your blood to determine how much you should be taking. Have your doctor help you with the amount of calcium you should be taking as well. The Institute of Medicine recommends 1200 mg per day of dietary calcium (which means calcium from diet and supplements). If you have some calcium in your diet, you may only need about 500 or 600 mg of a supplement.
• Don’t smoke.
• Don’t drink alcohol excessively.
• Exercise – both cardio and resistance training. The stress that you put on your bones by being active helps with the remodeling process and makes your bones stronger.
• Eat a healthy diet with plenty of vegetables and some dairy. Calcium can come from food sources other than dairy products.
• If your bone density test shows significant bone loss (or if your doc determines you are at significant risk), you may need a medication to help prevent bone loss.

As a breast cancer survivor, you are at risk for bone loss. Get a bone density test so that you have a baseline and know how much treatment to get started on. Take your calcium and vitamin D. Don’t smoke or drink to excess. Exercise. Eat a healthy diet.