Breast Cancer Treatment and Bone Loss

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Certain breast cancer treatments can speed up bone loss or cause you to lose more bone than you normally would:

Chemotherapy: Some chemotherapy medicines can have a direct effect on your bone health. In other situations, some women who are close to menopause and get chemotherapy may have significant bone loss because the chemotherapy causes early menopause. If chemotherapy pushes your body into menopause, bone loss may begin while you're still having treatment and continue after treatment is done.

Aromatase inhibitors (a type of hormonal therapy):

  • Arimidex (chemical name: anastrozole)
  • Aromasin (chemical name: exemestane)
  • 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.

Ovarian shutdown using medication or surgically removing the ovaries: Ovarian removal causes irreversible menopause. Your bone density may drop suddenly after ovaries are removed. Ovarian shutdown using medicine temporarily stops your ovaries from producing estrogen.

Other hormonal therapy medicines known as SERMs (selective estrogen receptor modulators) can actually help protect your bones by slowing bone loss. SERMs are:

  • tamoxifen
  • Evista (chemical name: raloxifene)
  • Fareston (chemical name: toremifene)

If an aromatase inhibitor or chemotherapy would have benefits for you, talk to your doctor about ways to protect your bones during treatment. This is especially important if you have any of the risk factors for bone loss:

  • being older
  • being postmenopausal
  • being small and thin
  • a family history of osteoporosis or broken bones
  • having low bone mass (osteopenia)
  • smoking
  • not getting enough calcium or vitamin D
  • not exercising
  • having more than 2 alcoholic drinks several times a week
  • having one of the following medical conditions:
    • hyperthyroidism or hyperparathyroidism
    • chronic lung disease
    • inflammatory bowel disease
    • Cushing's disease
    • multiple sclerosis
    • arthritis

Different hormonal therapy and chemotherapy medicines can be used in your treatment plan, depending on your unique situation. And your treatment plan can change over time based on your needs, the benefits you're getting, and any side effects you may have. If you're worried about the effects of treatment on your bones, ask if you can change your treatment plan.

You'll probably have a baseline DEXA scan before you start treatment with hormonal therapy or chemotherapy. If you don't, talk to your doctor to see if having one makes sense for you. During follow-up visits during treatment, ask your doctor about your bone health and whether protective measures are right for you.

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