Osteoporosis after Childhood Cancer


Certain cancer treatments can cause survivors of childhood cancer to lose bone strength at younger ages resulting in osteoporosis, or low bone mineral density.

What Is Osteoporosis?

Osteoporosis is a disorder resulting from too little new bone formation or too much bone loss, causing bones to become weak. Most people do not have symptoms, especially in the early stages. But as bones become weaker, risk for fractures goes up. Osteoporosis can occur in any bone, but most often it affects the wrists, hips, spine, and leg bones.

Osteoporosis is diagnosed by measuring the density of your bones with special x-ray techniques, called DEXA or bone density scans.

Am I at Risk?

Osteoporosis is more common in people with these characteristics:

  • Female sex (especially after menopause)
  • Family history of osteoporosis
  • Caucasian or Asian race
  • Small, thin frame
  • Older age

Smoking, diets low in calcium or high in salt, too little weight-bearing exercise, and too much caffeine, alcohol, or soda may also increase risk.

Osteoporosis risk is also higher in people who have had cancer. These specific treatments and conditions increase risk.

Table 1: Cancer-related Treatment and Conditions that Raise Risk for Osteoporosis 

Treatments

Conditions that result from treatment

Other medical treatments

Corticosteroids (such as prednisone and dexamethasone)

Low levels of male or female hormones

Certain anticonvulsants (phenytoin and barbiturates)

Methotrexate

Growth hormone deficiency

Antacids that contain aluminum (Maalox® or Amphogel®)

Radiation to weight-bearing bones (such as legs, hips, spine)

High levels of thyroid hormone

Medications such as Lupron (used for treatment of early puberty and endometriosis)

 

Chronic graft-versus-host disease that requires lengthy corticosteroid treatment

High doses of heparin (used to prevent blood clots)

 

Long periods of being inactive, such as from bed rest

Cholestyramine (used to control blood cholesterol)

If you are taking any of these medicines and are worried about bone health talk with your doctor. Don’t change your dosage or stop taking them without talking with your doctor first. 

What Can I Do to Keep My Bones Strong?

You can help reduce your risk for osteoporosis by following these tips:

Exercise Regularly 

 

  • Regular weight-bearing exercise (such as brisk walking, dancing, and jogging) helps to develop and maintain healthy bones.
  • Higher-impact weight-bearing exercises are especially good for bone health. This includes hopping, jumping rope, and jogging.
  • Resistance exercises, such as weight lifting, also help build strong bones. They are particularly important for the bones of your upper body including your arms and shoulders.

If you have problems with your heart, bones, or joints talk with your doctor before starting a new exercise program.

 

Eat a Diet High in Calcium  

A diet high in calcium is important to help prevent osteoporosis. Most experts recommend that adults get 1000 to 1200 mg a day. 

Table 2: Recommendations for Adequate Dietary Calcium Intake in the United States 

 

Age

Recommended Calcium Intake

1-3 years

500 mg per day

4-8 years

800 mg per day

9-18 years

1300 mg per day

19-50 years

1000 mg per day

51-70+ years

1200 mg per day

Source: Dietary Reference Intakes for Calcium, National Academy of Sciences, 1997 

To get the recommended amount of calcium, your diet must be rich in dairy products (milk, cheese, yogurt) and leafy green vegetables. You might opt to take over-the-counter calcium supplements to help boost your calcium intake.

Table 3: Common Foods with Good Sources of Calcium 

 

Food 

Serving Size 

Calcium Content 

Number of Servings to Equal Calcium in 1 Cup of Low-Fat Milk 

Dairy Food 

Whole milk 

1 cup 

246 mg 

1.0 

Low-fat (1%) milk 

1 cup 

264 mg 

1.0 

Nonfat milk 

1 cup 

223 mg 

1.2 

Yogurt, nonfat, fruit variety 

6 oz 

258 mg 

1.0 

Frozen yogurt, vanilla, soft serve 

½ cup 

103 mg 

2.6 

Cheese 

1 1-oz slice 

202 mg 

1.3 

Nondairy Food 

Salmon, sockeye canned, drained, with bones 

3 oz 

203 mg 

1.3 

White beans, cooked, boiled 

1 cup 

161 mg 

1.6 

Broccoli, cooked 

1 cup chopped 

62 mg 

4.3 

Collards, cooked, boiled, drained 

1 cup chopped 

266 mg 

1.0 

Foods Fortified with Calcium 

Calcium-fortified orange juice 

1 cup 

300 mg 

0.9 

Calcium-fortified soy milk 

1 cup 

200 -500mg 

0.5 - 1.3 

Selected fortified breakfast cereals 

¾ - 1 cup 

100 mg 

2.6 

Source: U.S. Department of Agriculture Research Service, 2005;

You can find more information about calcium-rich diets from the National Osteoporosis Foundation at http://www.nof.org/aboutosteoporosis/prevention/calcium and from the National Dairy Council at www.nationaldairycouncil.org

Get Adequate Vitamin D 

For your body to absorb calcium you need to have enough vitamin D. In general, 200 units daily is recommended. Many dairy products contain vitamin D and your skin makes it naturally when exposed to sunlight. Because too much vitamin D can be harmful you should check with your doctor before taking vitamin D supplements.

Should I Be Screened for Osteoporosis?

Your doctor can advise you about the need for bone density testing after going over your treatment history and factors that increase your risk for osteoporosis. Childhood cancer survivors who are at risk for osteoporosis should receive a bone density scan when they enter long-term follow-up. Future scans may be needed to monitor bone density. 

What If I Have Osteoporosis?

People with osteoporosis should discuss treatment options with their doctors. Medicines can treat low bone density. If you have low levels of certain hormones, you may also need hormone replacement therapy. 

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