Aprobado por la Junta Editorial de Cancer.Net, 10/2022

Osteoporosis is the most common type of bone disease. It develops when the body breaks down more bone tissue than it can replace. As a result, bones become weak and fragile. This makes them more likely to fracture or break.

Cancer can contribute to bone weakness and fracture risk when it starts in the bone or spreads to the bone. Cancer treatments, such as chemotherapy or hormone therapy, can also cause osteoporosis. If you already have osteoporosis, some cancer treatments can make it worse.

If you have any symptoms of osteoporosis, or are concerned about your bone health during cancer, talk with your health care team. Relieving side effects and symptoms is an important part of cancer care and treatment. This is called palliative or supportive care. It helps people with any type or stage of cancer feel better.

What are the symptoms of osteoporosis?

Osteoporosis does not happen suddenly. Often, people do not notice it until they have pain, often related to a fracture, loss of height or stooped posture, or loss of function. Some people mistake the signs of serious bone problems for arthritis, another bone disease that affects the joints.

Talk with your health care team about any symptoms you may experience, including:

  • Back pain

  • Unusual loss of height over time

  • Stooped posture or curved upper back

  • Painful joints or stiffness

  • Breaking a bone more easily than expected, such as after a minor injury

What causes osteoporosis when you have cancer?

Bones are always growing. Your body reuses old bone to create new bone throughout your lifetime. As we age, our bodies are less able to replace the cells needed to repair and rebuild bone tissue. Bones may become thin and develop holes, which is called bone loss.

Osteoporosis is a common condition in adults over age 65, especially women. Certain kinds of cancer and cancer treatment can also cause osteoporosis or make it worse.

Certain kinds of cancer, cancer that has spread to the bone, and some cancer treatments can increase your risk of fracture, cause osteoporosis, or make it worse. These include:

  • Cancer that starts in the bone

  • Cancer that has spread to the bone, including breast cancer, prostate cancer, multiple myeloma, and lung cancer

  • Certain types of chemotherapy

  • Hormone therapy for breast or prostate cancer, which can reduce levels of hormones that contribute to bone mass and density

  • Cancer treatments that cause menopause at an earlier age than expected

What other risk factors lead to osteoporosis?

Other risk factors for osteoporosis include:

Sex and age. Women over age 65 are at a higher risk of osteoporosis than men. The risk of osteoporosis is especially high after menopause because of lower levels of estrogen. Estrogen is a hormone that helps maintain bone density.

Smoking and chronic heavy alcohol use. Both smoking and drinking a lot of alcohol have both been shown to cause osteoporosis.

Family history. You are at a higher risk of developing osteoporosis if you have close family members with osteoporosis. Tell your doctor if you have a family history of osteoporosis.

Nutrition problems. You are at a higher risk of developing osteoporosis if you do not get enough of certain nutrients like calcium and vitamin D.

Physical inactivity. People who are on long-term bed rest or who are inactive are more likely to get osteoporosis. People with cancer may be unable to exercise or find it more difficult to exercise. Talk with your health care team about how to add more physical activity into your daily routine.

Body size. People who are thin or have a small frame are more likely to get osteoporosis.

Medications. Steroid therapy, synthetic thyroid hormone therapy, and some drugs for heartburn can lead to osteoporosis.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed by measuring bone mass. The most common test used to measure bone mass is a bone density scan. This is also called a dual energy X-ray absorptiometry (DEXA) scan. You may have this test before, during, and after cancer treatment.

A bone density scan measures the strength of the bone by looking at the amount of calcium it contains. Usually the scan will focus on your hip or lower spine. Depending on how low your bone mineral density is, your doctor may diagnose osteopenia or osteoporosis. Osteopenia is mild bone loss.

How is osteoporosis treated?

Treatment for bone loss often involves the use of bone-modifying drugs. These drugs slow the rate of bone thinning. They may also reduce new bone damage and promote healing.

People who have bone pain from metastatic cancer also often receive these drugs.

Bone-modifying drugs include:

  • Bisphosphonates, which block the cells that destroy bone, called osteoclasts

  • RANK ligand inhibitors, such as denosumab (Prolia, Xgeva)

Your doctor may recommend seeing a dentist before bone-strengthening treatment begins. But before having any dental procedures, tell your dentist you are receiving treatment with a bone-modifying drug.

Osteonecrosis of the jaw is a condition possibly linked with bone-modifying drugs. It is an uncommon but serious condition. The symptoms include pain, swelling, and infection of the jaw; loose teeth; and exposed bone.

How to manage bone loss and its side effects

In addition to taking medication to treat osteoporosis, there are other things you can do to manage any bone loss and its effects. Osteoporosis is also preventable. If you are at a higher risk, talk to your health care team about how you can prevent bone loss.

Taking calcium or vitamin D. Your doctor may recommend taking calcium or vitamin D to maintain healthy bones. Talk with your health care team before starting any vitamin or mineral supplement.

The United States National Institutes of Health recommendations for calcium and vitamin D are:

  • Vitamin D: 600 to 800 international units (IU) per day

  • Calcium supplements: 1,000 to 1,200 milligrams (mg) per day

  • Calcium supplements for women before menopause: 1,000 mg per day

  • Calcium supplements for women after menopause: 1,200 mg per day

Exercise and nutrition. Physical activity can also prevent bone loss. Walking, dancing, stair climbing, and tai chi are low impact, weight-bearing exercises that put stress on your bones. This triggers the body to make cells that form bone. Regular weight-bearing exercise also builds strong muscles, which can help your balance. Your doctor can recommend an exercise plan based on your needs, physical abilities, and fitness level. Eating a well-balanced diet is also important for bone health. Being underweight can contribute to bone loss and fractures.

Falling is the main cause of fractures for people with osteoporosis. Many factors can increase the risk of falling, including:

  • Poor vision

  • Shoes that do not fit well

  • A cluttered living space

  • Mental health difficulties

  • Drowsiness related to pain medicine

  • Poor concentration or focus

To help prevent falls, try exercises to improve your balance. Before starting any exercises, talk with your health care team. They can direct you to helpful resources and help you find an exercise program that is right for you.

Preventing fractures from bone loss

Fractures or bone breaks cause pain and movement problems. These problems can interfere with a person’s daily life. People with bone cancer or cancer that has spread to the bones are more likely to experience fractures.

Other risk factors for fractures related to osteoporosis:

  • Older age

  • Smoking

  • Excessive alcohol use

  • A history of fractures as an adult

  • Having mobility problems

  • Being at risk for falls

  • Long-term use of steroid drugs called glucocorticoids

  • A low level of testosterone, or hypogonadism

  • Your parents have a history of hip fracture

  • Being postmenopausal

  • Low body weight

Talk with your health care team about whether you have a high risk of fractures and how to lower your risk. You can learn more about ASCO’s recommendations for preventing and managing osteoporosis-related fractures on a separate website.

Questions to ask the health care team about bone health and cancer

Consider asking your health care team these questions about your bone health after a cancer diagnosis:

  • Am I at a greater risk of developing osteoporosis?

  • Are bone problems a a common side effect of the cancer I have or the cancer treatment I will receive?

  • Will I need any tests to diagnose bone thinning or other bone problems?

  • What treatment options are available for osteoporosis or other bone problems I am experiencing?

  • Who should I talk to about osteoporosis or other side effects I am experiencing?

  • How can I get in touch with them during business hours and after hours?

  • What are ways I can prevent falls at home?

  • Are there other things I can do at home to maintain my bone health and overall health?

Related Resources

What is Metastasis?

ASCO Answers Fact Sheet: When Cancer Spreads to the Bone

More Information

Bone Health and Osteoporosis Foundation: Osteoporosis

CancerCare: Caring For Your Bones When You Have Cancer (PDF)

LIVESTRONG: Osteoporosis