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Cancer and Bone Health

Cancer can have dramatic, yet often hidden consequences for bone health. If you or a loved one is undergoing cancer treatment, learn how cancer and its treatment affect your bones to help prevent or limit bone deterioration. 

What are the bone connections?

Hypercalcemia — Calcium is an important building block of bone. Cancer cells release a hormone that can speed up the rate at which bones release calcium, causing a serious condition called hypercalcemia, or a high level of calcium in the blood. Hypercalcemia is treatable but should be dealt with when diagnosed. Symptoms of hypercalcemia in cancer patients include nausea, loss of appetite, thirst, frequent urination, constipation, irregular heartbeat, excessive sleepiness, confusion, and in rare cases, coma.

Vitamin D Deficiency — The body needs an adequate level of vitamin D to absorb calcium. Vitamin D deficiency is particularly widespread among cancer patients. Vitamin D deficiency contributes to muscle pain and fatigue and interferes with normal production of proteins necessary for cell division and growth.

Treatment-Related Bone Loss and Bone Metastasis — Several of the most common types of cancers—prostate, breast, and lung cancer—can metastasize, or spread, to the bone even 15 to 20 years after the original cancer is found. These common cancers also have treatment-related bone loss. Your doctor should monitor your bone health during treatment and may consider giving you a bisphosphonate drug to reduce fracture risk. 

Multiple Myeloma — The type of cancer that has the most direct effect on bone health is multiple myeloma, which results from malignant changes in the white blood cells found in bone marrow. This cancer interferes with the bone’s ability to repair itself, causing fractures in up to 60% of patients. Recent studies reveal new treatments for multiple myeloma, bringing hope that the morbidity and mortality of the disease will decrease.

Osteonecrosis of the Jaw — ONJ is a rare dental condition primarily found among cancer patients. ONJ occurs most often after a major dental procedure in which the bone in the jaw that does not heal after eight weeks of appropriate dental care. While no definitive proof yet exists, correlations have been made between ONJ and cancer patients treated with high doses of intravenous bisphosphonate drugs (most often pamidronate and zoledronic acid) used to help prevent the breakdown of bone related to cancer.

What You Can Do

  • Cancer patients should talk with their doctors about ordering blood tests to measure calcium and 25-hydroxyvitamin D to ensure that the levels are normal (25‑hydroxyvitamin D = higher than 35 ng/ml but lower than 100 ng/ml; calcium = higher 8.8 mg/100 ml. but lower than 10.2 mg/100ml).
  • Patients undergoing chemotherapy, radiation, and hormone therapy are advised to get bone density tests before starting treatment and every one to two years as these common cancer treatments can weaken bones.
  • Patients should get a routine dental examination prior to starting a bisphosphonate drug. It is also important for patients to maintain good oral hygiene and be alert for the symptoms of ONJ. If possible, invasive dental procedures such as extractions, implants, and jaw or gum surgery should be avoided during bisphosphonate therapy and dentures should be well-fitted. Should invasive dental procedures be required, they should ideally be done prior to starting treatment with bisphosphonates. It is extremely important that patients with potential symptoms or signs of ONJ be evaluated by an oral surgeon as soon as possible and withdrawal of bisphosphonate therapy seriously considered.

As healthcare professionals and patients themselves begin to understand more about the intricate relationship between cancer and bone, there is increasing hope that those faced with these complications will lead longer, fuller lives. 

Handforth C, D’Oronzo S, Coleman R, Brown J. “Cancer Treatment and Bone Health.” Calcif Tissue Int. 2018;102(2):251-264.

Endocrine Society. “Oral Complications Are Rare in Older Women Treated for Osteoporosis.” Endocrine News, Feb 2019

Revised: 02/27/2019

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