- Question from DonnaMS: I'm BRCA2 positive and have had a bilateral mastectomy (with nodes removed on one side) and a hysterectomy. I'm currently on Arimidex, and since I'm only 43, am concerned about bone loss. In addition to taking calcium, what specific exercises should I be doing to counteract the effects of bone loss? Can I do weight-lifting (weight bearing) exercises due to the removed nodes and the risk of lymphedema?
You should talk to your health care provider if possible before you get started. You're so young and your bones are young, so the best thing you could do is start with gentle weight lifting, and progress from there. Monitor your progress and see how you do.
Strength training along with walking seems to be the most potent type of activity for improving bone health and reducing the risk of fracture. We have a lot of information and free resources at our website, http://www.strongwomen.com. Calcium is very important, and any women over the age of 40 should consider taking a calcium supplement, but Vitamin D is equally important and many women haven't got the message yet about how important it is. Eating well — lots of fruits and vegetables — is good for your bones. Don't smoke, of course, and don't drink more than one alcoholic drink a day.
Julie Gralow, M.D.
With respect to the calcium, it's great that Dr. Nelson mentioned Vitamin D to help calcium absorption. If you are postmenopausal, about 1,500 mg of calcium a day is recommended. If you take it all at once, you absorb it less than if you split the dose into three times a day. What I find works best is chewable calcium, and I keep it with me in my purse or pocket. A couple of times a day, I take some and chew it to get more absorption and in the chewable form, I'm more likely to take it. So some good calcium, Vitamin D, and weight bearing exercise will help.
Following the bone density and knowing where you stand is important, so periodically ask your doctor to do a DEXA scan to see where the bones are compared to other women of your own age. That way you can get a sense of what your fracture risk is and how much work needs to be done.
Sometimes we do have to take medication from the drug family called bisphosphonates to increase bone density. So, a woman in her 40s taking Arimidex might benefit from a drug in this class, and the way to tell would be to do a DEXA scan every year. It's clear that the treatments we're currently giving for breast cancer are becoming more and more effective, but they're causing more and more osteoporosis. So it's great to survive your breast cancer, but not to reduce your bones and get a hip fracture at a young age.
- Judith Sachs I know there is a calcium chewing gum. Does it really work?
- Miriam Nelson Calcium comes mainly in two different formulas: calcium carbonate or calcium citrate. Both of those types of calcium help the bones. So it doesn't matter if it's chewable or in a gum or orange juice or a supplement. The difference is that calcium citrate is generally absorbed a bit better than calcium carbonate. You also don't need to take calcium citrate with a meal. One of the better benefits is that you don't get gas with calcium citrate, and a fairly large percentage of women do get gas from calcium carbonate. All calcium helps with bones; a lot of it is how you take it and what you tolerate best.
On Wednesday, January 18, 2006, our Ask-the-Expert Online Conference was called Physical Activity and Breast Cancer. Miriam Nelson, Ph.D., Julie Gralow, M.D., and moderator Judith Sachs answered your questions about the many issues related to physical activity and breast cancer.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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