Risk factors

If you are a prostate cancer survivor or a current patient, you may be treated with removal of testicles or chemotherapy drugs that decrease androgen. When fewer androgens reach the prostate cancer cells, the cells shrink, so, that is good.

These drugs help treat your cancer but at the same time they increase your risk of osteoporosis. If you already have osteoporosis, your cancer treatment will make it worse and the risk of getting fracture will increase.

There are other aspects that make you more likely to get weak bones. Some you cannot change. These are called non-modifiable risks. Some you can control. These are called modifiable risks. You may be able to tell from your clinical risk factors if you are more likely to get weak bones.

Let's look at the ways you can improve bone health and protect yourself.

The following video comes from the Bones Disease Program of Texas and it is 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 comes from the Bone Disease Program of Texas and its available at the program website 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 bone. 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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