Ways to improve your bone health

Bone health can be affected by some breast cancer treatments and by metastatic breast cancer in the bone.

Most people with lowered bone density do not have any symptoms. Often the first sign is when they fracture (break) a bone.

It’s important to discuss bone health with your doctor early on, especially if you take, or are about to start, one of the treatments that affect bone health.

You can take steps to rebuild and strengthen bone and avoid further bone loss. This can help prevent fractures and osteoporosis.

Monitoring your bone density

Your doctor may refer you for a bone mineral density test, sometimes called a BMD, DXA or DEXA test.

This test is painless. It measures bone density at the hip and spine using low-dosage X-rays. It is quite different from a whole body bone scan that you may have as part of your diagnosis or follow-up.

Your breast cancer specialist or GP  can refer you for a bone mineral density scan. You may be eligible for a Medicare rebate, but often you must pay an out-of-pocket cost. Ask the imaging clinic about eligibility before you make the appointment so you know what your costs may be.

The risk of osteoporosis and osteopenia

The hormone oestrogen helps to protect bones, so treatments that reduce or stop oestrogen from working can reduce bone density. Bone density refers to the thickness and strength of bone.

When bones lose their strength and density, this is called ‘osteoporosis’. It can cause bones to become fragile, brittle and more likely to break.

Treatments may increase your risk but there are other risk factors:

• age
• a family history of osteoporosis or fractures
• low bone mass (‘osteopenia’)
• diabetes, coeliac disease or Crohn's disease
• some medications, usually long-term use such as corticosteroids for arthritis
• low body weight
• poor nutrition and a diet low in calcium

Your breast cancer specialist, GP or nurse can give you information about reducing your risk.

Some people have lower bone density, but not low enough to be classed as osteoporosis. This is called ‘osteopenia’. If you have osteopenia, you may have a higher risk of fractures and may go on to develop osteoporosis.

Diet and nutrition

A balanced diet supports good bone health. Your doctor may recommend food or supplements, or they may refer you to a dietitian.

Calcium is essential for building and maintaining healthy bones. Foods high in calcium include dairy products, oily fish such as sardines or salmon, and dark green leafy vegetables. The recommendation for women over 50 is 1200 to 1300mg of calcium per day. That's about 3 to 4 serves of calcium-rich foods per day.

Vitamin D helps your body absorb calcium, which promotes bone health. To increase your vitamin D levels:

• spend time in the sun, but be SunSmart.
• eat foods such as oily fish (sardines, herring and mackerel), liver and egg yolks. Some margarine, milks and cereals also have small amounts of vitamin D added.
• take vitamin D supplements.

Magnesium helps your body regulate calcium and vitamin D. It’s in green vegetables, nuts, seeds, legumes, whole grains and avocados.

Your GP may recommend supplements of calcium and vitamin D. If you are concerned about your calcium or vitamin D levels, have a chat with your doctor.

Alcohol

Drinking alcohol has been shown to lower bone density. Regularly alcohol consumption also increases the risk of developing breast cancer.

The less you drink, the lower your risk of harm from alcohol. Follow the National Health and Medical Research Council (NHMRC) recommendation.

Smoking

Smoking is known to lower bone density. Giving up smoking will improve your bone health, as well as your general health. If you want to quit, your GP can help you work out a plan to improve your chances.

Quitline offers free phone advice, support and resources to help you.

Exercise and physical activity

Regular exercise is a very effective way to increase bone density and reduce your risk of fractures.

The types of exercises that may be helpful include:

• weight-bearing exercises such as walking, jogging, netball, tennis and dancing
• resistance training exercises including free weights and weight machines found in gyms.

The Australian Government recommends 2.5 hours of exercise every week. Read their physical activity and exercise guidelines for your age group.

Medication

If your treatment is known to reduce bone density, your doctor may prescribe medication that helps to strengthen bones.

Read about common Bone-strengthening medications.

In postmenopausal women, bone-strengthening medication can help reduce the risk of breast cancer returning. Your breast cancer specialist may discuss this with you.

If you have osteopenia and are taking an aromatase inhibitor, the doctor may discuss treatment to help reduce your risk of fracture.