Bone density and chemotherapy

It can, mostly indirectly. The biggest cause of bone loss after cancer treatment is a fall in sex hormones. Chemotherapy can bring on early menopause in women, which removes the protective effect of oestrogen on bones. Hormone treatments such as letrozole, anastrozole and exemestane for breast cancer, and treatments that lower testosterone for prostate cancer, speed up bone loss. Repeated or long courses of steroids, and a few chemotherapy medicines such as methotrexate, also weaken bones.

Thinning of the bones, called osteoporosis when it is significant, causes no symptoms until a bone breaks, often the wrist, hip or spine after a minor fall. That is why people at higher risk may be offered a bone density scan, called a DEXA scan, which is quick, painless and uses a very low level of X-rays. Simple steps such as weight-bearing exercise, enough calcium and vitamin D, and stopping smoking protect bones, and medicines to strengthen bones can be given when needed.

Treatment-induced menopause is the key risk

Women who lose periods because of treatment, especially at a younger age, lose bone faster than natural menopause.

Men are affected too

Hormone treatment for prostate cancer and steroids put men at real risk of bone loss.

Cancer in the bone is different

Bone pain from cancer spreading to the bone is a separate problem that needs its own assessment.

It cannot tell you whether your bones are thinning. Only a bone density scan, with your age and risk factors, can show that. It also cannot tell you whether you need bone-strengthening medicine, which depends on your scan results, fracture risk and treatment.

It cannot advise on calcium or vitamin D doses. Too much can cause problems, including kidney stones, so take supplements only as advised by your team.

Bone-strengthening medicines

Medicines such as zoledronic acid, alendronate or denosumab may be offered to protect bones. Your team will explain benefits and side effects.

See a dentist first

Some bone-strengthening medicines rarely cause jaw bone problems. A dental check before starting, and good mouth care, reduce the risk.

Back pain needs assessment

Sudden back pain may be a spinal fracture from thin bones, or cancer in the bone. Both need prompt checks.

Height loss can be a clue

Losing height or developing a stoop may mean small spinal fractures. Mention it to your doctor.

Scans may be repeated

People on long-term hormone treatment may have bone density scans repeated at intervals.

Young women need extra thought

Early menopause at a young age has long-term effects on bones and heart. Ask about options to manage menopause safely after your cancer.

Children and teenagers

Treatment during growth years can affect peak bone strength, so long-term follow-up may include bone checks.

Diet alone may not be enough

A balanced diet helps, but people at high risk often also need supplements or medicines.

Talk about menopause symptoms

Hot flushes, vaginal dryness, poor sleep and joint aches after treatment-induced menopause affect quality of life. Some menopause treatments are not suitable after certain cancers, but many options exist. Ask your team what is safe for you.

Joint pain on hormone tablets

Aromatase inhibitors often cause aching joints and stiffness. Exercise, pain relief advice and sometimes a change of tablet can help. Do not stop the tablets without talking to your oncologist.

Protein and overall nutrition

Bones and muscles need protein as well as calcium. Include dal, eggs, milk products, pulses, fish or meat as your diet allows, especially if your appetite has been poor.

Posture and safe movement

If you have thin bones, avoid heavy lifting and sudden twisting or bending forward. A physiotherapist can show safe ways to exercise and move.

Keep a record of fractures and scans

Note any broken bones since treatment, even from minor falls, and keep copies of bone density scan reports. A fracture after a small fall is an important clue that bones may be thin, and future doctors will want to know about it when planning care.

Ask whether bone checks continue after treatment

Bone loss from hormone treatment continues for as long as the treatment does. Ask how often scans will be repeated and who will arrange them once you finish regular oncology visits.

What to do next

Ask whether your treatment affects your bones and whether a bone density scan is advised. Stay active with weight-bearing exercise, get enough calcium, ask about vitamin D, prevent falls, stop smoking, see a dentist before bone medicines, and report sudden back or bone pain promptly.