Risk factors

All Blood cancers - Leukemia, Lymphoma and Multiple myeloma have negative effects on your bone health. They are associated with increased risk of developing osteoporosis and fractures. All age groups and both sexes are affected. Development  of osteoporosis with blood cancers may be due to the malignancy itself or may be an unwanted side effect of the treatment.

You may be treated with radiation therapy or treatment with methotrexate or steroids. These treatments make you prone to osteoporosis. Even treatment with stem cell transplantation, which results in cure in many patients and increases survival duration in others, is associated with increased bone loss. This is especially seen in the 6-12 months after the transplantation.

Along with the risk associated with the therapy, there are other modifiable and non-modifiable factors for osteoporosis. You may be able to tell from your clinical risk factors whether you are more likely to get weak bones. Being aware of all these risk factors allows you to get screening and interventions before you develop a fracture.

Let's watch the following video. It is from the Bone Disease Program of Texas and it's available in its entirety at: https://www.mdanderson.org/research/departments-labs-institutes/programs-centers/bone-disease-program-of-texas/about-osteoporosis.html

[The video is from the Bone Disease Program of Texas. It is available at: https://www.mdanderson.org/research/departments-labs-institutes/programs-centers/bone-disease-program-of-texas/about-osteoporosis.html ]

The possibility of bone loss is of special concern for cancer patients because they sometimes feel too ill to eat well resulting in a decrease of calcium and Vitamin D intake. Some chemotherapy drugs lower estrogen levels which leads to menopause and speeds up breakdown of the bones. Hormonal therapies as well as removal of ovaries or testes can speed up bone loss. Cortisone-like drugs can affect bone health and radiation therapy can weaken the bones. Because cancer patients are living longer than in the past, bone health has become even more important.

We have a number of patients who are at high risk for fracture. We can set out with women who are already because of estrogen deficiency have a significant risk for developing osteoporosis. But on top of that, women with breast cancer are placed on drugs that target an enzyme and results in further lowering of estrogen levels. The good news is that those drugs prevent deaths from breast cancer and have very quickly become the standard of therapy for breast cancer. The bad news is that women who take these drugs have a variety of symptoms related to largely estrogen deficiency and importantly, lose bone at a very rapid rate.

Other groups of patients are also at high risk for bone loss including men with prostate cancer

Prostate cancer in most cases will be initially treated with drugs that lower …. serum testosterone levels or male hormone levels. And while we don’t think of men as having problems with osteoporosis and fractures, the fact is men lose bone more rapidly than do women past the age 70 years. Another group where bone loss is a very significant problem are those cancers where glucocorticoids or cortisone-like drugs are used to treat the cancer. They cause not only an increase in the breakdown of bone but they also cause a reduction in the formation of new bone and as a result patients with glucocorticoids frequently develop fractures while under treatment.

These group of patients include those who are treated for several types of leukemia, lymphoma, those who receive bone marrow transplant and are frequently treated with cortisone-like drugs and also patients with myeloma. In these groups of patients, it is important for physicians to identify the problem early so that treatment can prevent larger problems later on.


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