Breast cancer treatment linked to osteoporosis
Victoria Colliver
Updated 4:20 pm, Tuesday, December 11, 2012
Nancy Agronin, whose osteoporosis is linked to breast cancer treatment years ago, now teaches a Sit and Be Fit class. Photo: Michael Short, Special To The Chronicle / SF
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At 70, Nancy Agronin has already suffered fractures from two falls - injuries that she attributes to having undergone intensive chemotherapy for breast cancer 17 years ago.
Her first fall came at age 65, seven years after her cancer diagnosis. Bone density screening at the time revealed that she had osteoporosis, which causes bones to become porous and fragile and puts her at a risk of fractures six times greater than average.
In February, she fell again, breaking a bone in her upper shoulder and tearing muscle by bracing herself. The San Carlos woman said her doctors did not discuss the effect of chemotherapy on her bones when she was treated for cancer. And although she admitted that wasn't at the top of her priorities at the time, she's certain her cancer treatment and her osteoporosis are linked.
"I really didn't realize the long-term effects of the chemotherapy," said Agronin, a retired registered nurse who is conscious about her health and exercises regularly.
For many women treated for breast cancer, the risk of bone deterioration and future fragility comes almost as an afterthought. When faced with combatting a potentially deadly disease, jeopardizing future bone health is a concern, but not the biggest fear. In fact, it may not even be addressed before or during cancer treatment.
But with a growing population of patients expected to survive decades after cancer treatment, concerns about attending bone weakness are also increasing - especially with greater use of antihormonal therapies on top of chemotherapy, radiation and other treatments that contribute to bone density loss.
While more doctors are starting to address bone health, even during treatment, others can be so focused on the disease that they don't address the patient's overall health.
"For someone dealing with a devastating diagnosis and what can be a horrendous treatment process, it makes no sense at all to worry about those things in the moment," said Dr. Randall Stafford, director of the program on prevention outcomes and practices at the Stanford Prevention Research Center.
But Stafford said patients' bone and other health issues should be addressed more quickly. "For many breast cancer survivors, they really do get to the point where their breast cancer should recede as a prominent issue in their medical care, and yet sometimes it doesn't," he said. Bone health is an issue primarily in breast cancer patients because the majority of women have tumors that feed off the female hormone estrogen.
Estrogen at risk
Women's estrogen - and by definition their bones - may be assaulted on multiple fronts. They may undergo treatments that force them into menopause, accompanied or followed by antiestrogen therapies. These drugs can also have a deleterious effect on bones.
Studies have shown an increase in fracture risk among postmenopausal women because of low bone density and accelerated bone loss after chemotherapy.
"The minute you take away the estrogen, you basically start going through pretty accelerated bone loss," said Kathleen Cody, executive director of the Foundation for Osteoporosis Research and Education, an Oakland nonprofit, and American Bone Health, its public education arm.
Likewise, the male hormone testosterone also supports bone health. So men taking hormone-blocking drugs - known as androgen-deprivation therapy - for prostate cancer also face the risk of osteoporosis. Men typically get osteoporosis at a much later age than women, but these hormonal therapies fast-forward that chance.
"We're very attentive of the side-effect issues, especially now that men are living longer and longer on treatment," said Dr. Matthew Cooperberg, assistant professor of urology at UCSF and a urologic cancer expert at the UCSF Helen Diller Family Comprehensive Cancer Center.
Read more: http://www.sfgate.com/health/article/Breast-cancer-treatment-linked-to-osteoporosis-4109613.php#ixzz2FKiRjvdc
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