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Certain cancer treatments can cause survivors of childhood cancer to lose bone strength at younger ages resulting in osteoporosis, or low bone mineral density.
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.
Osteoporosis is more common in people with these characteristics:
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
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)
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.
You can help reduce your risk for osteoporosis by following these tips:
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
Recommended Calcium Intake
500 mg per day
800 mg per day
1300 mg per day
1000 mg per day
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
Number of Servings to Equal Calcium in 1 Cup of Low-Fat Milk
Low-fat (1%) milk
Yogurt, nonfat, fruit variety
Frozen yogurt, vanilla, soft serve
1 1-oz slice
Salmon, sockeye canned, drained, with bones
White beans, cooked, boiled
1 cup chopped
Collards, cooked, boiled, drained
Foods Fortified with Calcium
Calcium-fortified orange juice
Calcium-fortified soy milk
0.5 - 1.3
Selected fortified breakfast cereals
¾ - 1 cup
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.
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.
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.
Read more about Bone Health...