Keeping Your Bones Healthy
During childhood and into young adulthood, bone formation usually occurs faster than bone loss, causing bones to grow and become heavier (more dense). As a person gets older, the process of bone removal gradually overtakes bone formation, and bones slowly lose strength as part of the normal aging process. However, loss of bone strength may occur at earlier ages in childhood cancer survivors because of certain cancer treatments. Loss of bone strength may result in a condition known as osteoporosis, which is sometimes referred to as "low bone mineral density."
Osteoporosis: A Silent Disease
Osteoporosis is a disorder resulting from too little new bone formation or too much bone loss, causing bones to become weak. Most people do not have symptoms, especially in the early stages. However, as bones become weaker, the risk for fractures increases. Osteoporosis may occur in any bone, but most commonly affects the wrists, hips, spine, and leg bones.
How is osteoporosis diagnosed?
Although osteoporosis may be suspected based on a patient's symptoms and risk factors, the diagnosis is made by measuring bone density with special x-ray techniques, called DXA or bone density scans. These scans do not expose patients to large amounts of radiation, and generally take less than 20 minutes to perform. People who have osteoporosis should discuss treatment options with their healthcare provider. Medications, such as bisphosphonates and calcitonin, are available specifically for the treatment of low bone density. In addition, if you have low levels of sex hormones, or low levels of growth hormone (GH), you may also benefit from hormone replacement therapy.
What are the risk factors for osteoporosis?
Osteoporosis is more common in people with the following characteristics: . Female (especially after menopause) . Family history of osteoporosis . Caucasian or Asian race . Small, thin frame . Older age The following factors may also increase the risk of osteoporosis: . Smoking . Diet low in calcium ● Lack of weight-bearing exercise . Too much caffeine, alcohol, or soda . A diet high in salt Additional causes of osteoporosis in people who have had cancer may include: A history of treatment with: . Corticosteroids (such as prednisone and dexamethasone) Radiation to weight-bearing bones (legs, hips, spine) . Conditions resulting from cancer treatment, including: . Low levels of sex hormones . GH deficiency . High levels of thyroid hormone . Chronic graft-versus-host disease requiring prolonged therapy with corticosteroids . Prolonged periods of inactivity (bed rest) Other medical treatments, including: . Certain anticonvulsants (phenytoin and barbiturates) . Aluminum-containing antacids (such as Maalox® or Amphogel®) . Medications such as Lupron (used for treatment of early puberty and endometriosis) . High doses of heparin (used to prevent blood clots), especially with prolonged use . Cholestyramine (used to control blood cholesterol) Many of the medications on this list are essential treatments for certain medical conditions. If you are taking any of these medications, do not change your dosage or stop taking your medication without consulting with your healthcare provider.
What lowers the risk of osteoporosis?
Fortunately, there are many things you can do to reduce the risk of osteoporosis. Regular weight-bearing exercise (such as brisk walking, dancing, and jogging) helps to develop and maintain healthy bones. Bicycling and swimming are excellent exercises for general fitness, but these are NOT weight-bearing exercises, and they do not help to build strong bones. Exercises that are especially good for bone health include higher-impact weight-bearing activities, such as hopping, jogging and jumping rope. Resistance exercises, such as light weightlifting, also help to build strong bones and are especially important for bones of the upper body, including the arms and shoulders. If you have problems with your heart, or have painful bones or joints, be sure to discuss your individual health status and cancer treatment history with your healthcare provider before starting any new exercise program. A diet high in calcium also is important in preventing osteoporosis. Most healthcare professionals recommend 1000–1500 mg a day, which means a diet rich in dairy products (milk, cheese, yogurt) and leafy green vegetables. Talking with a dietitian may help you design a healthy diet. Over-the-counter calcium supplements also may be useful. See Tables 1 for recommended daily calcium intake. Additional information about calcium-rich diets is available at www.usdairy.com/ dairy-nutrition/products. Vitamin D is needed to absorb calcium. Your skin makes this vitamin naturally when exposed to sunlight. Many dairy products also contain vitamin D. In general, at least 400 units of Vitamin D is recommended daily. You should not take more than 800 units of Vitamin D per day unless your health care provider has recommended a higher dose for you. Taking too much vitamin D may be harmful, so it's important to check with your healthcare provider before taking any vitamin D supplements.
What screening is recommended?
After reviewing your treatment history and risk factors, your healthcare provider can advise you regarding the need for bone density testing. For those at risk, a baseline bone density scan is recommended for childhood cancer survivors when they enter long-term follow-up (2 or more years after completion of therapy). Follow-up scans may be needed for ongoing Copyright 2023 © Children's Oncology Group. All rights reserved worldwide. tment of childhood, adolescent, and young adult cancer monitoring of bone density in some patients.
Table 1: Recommendations for Adequate Dietary Calcium Intake in the United States (National Institutes of Health Office of Dietary Supplements (NIH ODS) Calcium Fact Sheet for Health Professionals) Written by Julie Blatt, MD, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; and Lillian R. Meacham, MD, Children's Healthcare of Atlanta - Egleston, Atlanta, GA. Reviewed by Kayla L. Foster, MD, MPH; Sarah Ford, MS, PA-C; and Melissa Acquazzino, MD, MS. Additional health information for childhood cancer survivors is available at www.survivorshipguidelines.org Note: Throughout this Health Links series, the term "childhood cancer" is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthoo Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young adulthood. Disclaimer and Notice of Proprietary Rights Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Gancers and accompanying were developed by the Children's Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children Group's Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces. To cancer patients (ff children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have medical condition and do not rely on the Informational Content. The Children's Oncology Group is a research organization and does not provide individualized medical care or To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other le for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other re follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider. No endorsement of any specific tests, products, or procedures is made by Informational Content, the Children's Oncology Group, or affiliated party or member of the Onildren' No Claim to Accuracy or Completeness: While the Children's Oncology Group has made every attempt to assure that the Informational Content is accurate and complete as of the warranty or representation, express or implied, is made as to the accuracy, reliability, completeness, relevance, or timeliness of such Informational Content. No Liability on Part of Children's Oncology Group and Related Parties/Agreement to Indemnify and Hold Harmless the Children's Oncology Group and Related Parties: No Iability Children's Oncology Group or any affiliated party or member thereof for damage resulting from the use, review, or access of the Informational Content. You agree to the follo "Indemnified Parties" include authors and contributors to the Informational Content, all officers, directors, representatives, employees, agents, and members of the Children organizations; (i) by using, reviewing, or accessing the Informational Content, you agree, at your own expense, to indemnify, defend and hold harmless Indemnified Parties fr damages (including attorneys' fees and coets) resulting from any and all claims, causes of action, suits, proceedings, or demands related to or arising out of use, review or Proprietary Rights: The Informational Content is subject to protection under the copiright law and other intellectual properly law in the United States and worldwide. The Ch excursive copyright and other right, title, and interest to the Informational Content and claims all intellectual property rights available under law. You hereby agree to he all copyright and intellectual properly rights for the benefit of the Children's Oncology Group by taking additional action at a later time, action which could include sign limiting dissemination or reproduction of Informational Content.