Chemotherapy and Aromatase Inhibitors Can Cause Bone Loss

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A study shows more evidence that bone loss is a significant risk for women who are receiving or have received chemotherapy or an aromatase inhibitor to treat breast cancer. Doctors refer to bone loss as osteoporosis and the thickness of bones as bone density. On average, the bone density of women who received chemotherapy or an aromatase inhibitor was similar to that of older women who had not been treated for breast cancer.

Some chemotherapy medicines can have a direct effect on your bone health. But many women who get chemotherapy have significant bone loss because the chemotherapy causes early menopause. During menopause, your estrogen levels drop, which can lead to significant bone loss. Bone loss may begin while you're still having treatment and continue after treatment is done.

The aromatase inhibitors, a type of hormonal therapy, are: Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole). Aromatase inhibitors work by preventing the formation of estrogen. The loss of estrogen can lead to bone loss during treatment. Aromatase inhibitors are used most often in postmenopausal women diagnosed with hormone-receptor-positive, early breast cancer.

If you're receiving chemotherapy or an aromatase inhibitor, there are steps you can take to keep your bones as healthy as they can be during and after treatment:

  • Eat a healthy diet that includes lots of fruits and vegetables and is low in fat. It's good for your bones and your overall health. Ask your doctor about whether you are getting enough calcium, vitamin D, and magnesium. These nutrients are vital for healthy bones. The study reviewed here found that many of the women weren't getting enough vitamin D.
  • Get moving. Exercise and weight bearing activities are important for bone health at any age.
  • Don't smoke. Smoking can lead to bone loss.
  • Avoid alcohol. Heavy drinking also can lead to bone loss.
  • Monitor your bone health. If you've received or are receiving chemotherapy or an aromatase inhibitor, your bone health should be monitored as if you were older than your real age. This is usually done with a bone density test.
  • Explore your options. Treatment plans can be changed. If you're worried about the effects of treatment on your bones, ask if you can change your treatment plan. Tamoxifen is another type of hormonal therapy that sometimes can be used instead of an aromatase inhibitor. Tamoxifen can actually improve bone health, but it doesn't seem to work as well as the aromatase inhibitors to reduce the risk of the breast cancer coming back. Tamoxifen also has its own set of undesirable side effects, including hot flashes.

Visit the Breastcancer.org Bone Health section to learn more.

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