Protecting your bones after cancer treatment

Bones are living tissue that is constantly broken down and rebuilt. Hormones, especially oestrogen in women and testosterone in men, help keep this balance. Several parts of cancer treatment can tip the balance towards bone loss, making bones thinner and more likely to break. Chemotherapy can bring on early menopause in women, which causes rapid bone loss. Hormone treatments for breast cancer, such as aromatase inhibitors like letrozole, anastrozole and exemestane, and ovarian suppression, lower oestrogen further. Hormone treatment for prostate cancer lowers testosterone and can cause significant bone loss in men. Long courses of steroids, used with some chemotherapy or for lymphoma and myeloma, weaken bones. Reduced activity during treatment, poor appetite, low vitamin D and calcium, and some cancers themselves add to the problem.

Bone thinning usually causes no symptoms until a bone breaks, often the wrist, hip or spine, sometimes after only a minor fall. A spinal fracture may cause back pain, loss of height or a stooped posture. This is why checking bone health in people at higher risk is important. A bone density scan, often called a DEXA scan, measures bone strength using a low dose of X-rays. Your doctor may recommend a scan if you had early menopause, are taking hormone treatments, used steroids for a long time, or have other risk factors such as older age, low body weight, smoking, a family history of hip fracture or previous fractures.

Bones can be protected. Weight-bearing exercise, such as walking, climbing stairs and strength training, stimulates bone building. Enough calcium from foods such as milk, curd, paneer, ragi, sesame seeds and green leafy vegetables, and enough vitamin D from sunlight or supplements if advised, support bones. Avoiding tobacco and limiting alcohol help. If bones are thin, doctors may prescribe bone-strengthening medicines such as alendronate, zoledronic acid or denosumab. These are individual decisions made by your doctor. This page explains the general picture; your team can assess your bone health.

Bone loss is often silent

The first sign may be a fracture after a minor fall.

Scans can check bone strength

A DEXA scan measures bone density for people at higher risk.

Bones can be protected

Exercise, calcium, vitamin D and medicines where needed help.

It cannot tell you whether your bones are thin or whether you need medicines. A bone density scan and your doctor's assessment can answer that.

It also cannot advise on calcium or vitamin D supplements for you. Too much can be harmful, so follow your doctor's advice.

Preventing falls

Preventing falls is as important as strengthening bones. Keep floors clear, use good lighting, wear supportive footwear, install grab rails where needed, and do balance exercises. Nerve damage from chemotherapy can affect balance, so extra care may be needed.

Bone medicines and dental health

Some bone medicines rarely affect the jaw bone, especially after dental extractions. Have a dental check before starting if possible, keep up good oral hygiene, and tell your dentist you take bone medicines.

Men and bone health

Bone thinning is often thought of as a women's problem, but men on hormone treatment for prostate cancer, or on long steroid courses, are also at risk.

Young women with early menopause

Women who reach menopause early after chemotherapy may be advised hormone replacement, if safe for their cancer, to protect bones and heart. This depends on the cancer type, so ask your oncologist.

Bone health in childhood survivors

Children treated with steroids or radiotherapy may have lower bone strength as adults. Activity and nutrition during growth are important.

Cancer in the bone

Bone pain can also be caused by cancer in the bone. Persistent or night-time bone pain should always be checked.

Understanding bone density results

Bone density scan results are often reported as scores comparing your bones with those of healthy young adults. Your doctor will explain whether your bones are normal, mildly thinned or significantly thinned, and what that means for treatment. They also consider age, fractures and other risks.

Bone health while on hormone treatment

People taking aromatase inhibitors or hormone treatment for prostate cancer may have bone density checked at the start of treatment and at intervals during it, as advised by their doctor. Bone-strengthening medicines may be recommended if bone loss is significant.

Vitamin D in India

Despite plentiful sunshine, low vitamin D is common in India, because of indoor lifestyles, skin coverage and diet. A blood test can check levels, and supplements may be advised.

Exercise examples

Brisk walking, stair climbing, dancing, and strength exercises such as squats, wall push-ups and resistance bands help build bone. Yoga and tai chi improve balance. Start gently and build up.

Posture and back care

Good posture, lifting safely with bent knees, and avoiding sudden twisting reduce strain on a weakened spine.

Protein and bone health

Enough protein from dal, eggs, milk, fish or chicken supports bone and muscle strength.

Caffeine and salt

Very high caffeine and salt intake may add to calcium loss. Moderation is sensible.

Long-term follow-up of bones

Bone health is a long-term issue. Keep your scan reports and ask when the next check is due.

Your family doctor's role

Your family doctor can help monitor bone health, check vitamin D and arrange scans, especially after hospital follow-up ends.

Bone health for older adults

Older adults benefit from falls prevention, vision checks and a review of medicines that cause dizziness, alongside bone treatment.

What to do next

Ask whether you are at risk and whether a bone density scan is needed, stay active with weight-bearing exercise, eat calcium-rich foods, check vitamin D, avoid tobacco and limit alcohol, prevent falls, and discuss bone medicines with your doctor if needed.