Osteoporosis 101: What you need to know
Naomi Aaronson MA OTR/L CHT

Osteoporosis is a silent disease in which bones become porous and weak, thus becoming more likely to fracture. Ostepenia means less bone loss than osteoporosis. However, if you have osteopenia, you are more likely to develop osteoporosis.
Bones in the pelvis, spine, hip, wrist and the arm are most vulnerable. There are usually no symptoms until after being diagnosed post fracture. It is better to know about it to prevent it!!

Women who have had breast cancer may be at higher risk due to several factors such as early menopause, chemotherapy, and hormonal therapies. Chemotherapy drugs such as doxorubicin and methotrexate can cause early menopause. With early menopause, estrogen levels decrease . Since estrogen has a protective effect on bone, reduced levels can lead to bone loss. In addition, breast cancer stimulates cells that break down bone called osteoclasts. Hormonal drugs such as Tamoxifen have been shown to decrease bone density in pre-menopausal women , but increase bone density in post menopausal women. In addition, some studies have shown that Aromatase Inhibitors such as anastrozole or letrozole may lead to bone loss. Other risk factors include having a small frame, using certain medications, not getting enough calcium, advancing age, family history, cigarette smoking, sedentary lifestyle, and alcohol use.

Lifestyle Management

Your doctor may prescribe several medications which include calcitonin, SERMS,or bisphosophonates. However, we will focus on other approaches for this article.

1) Osteoporosis testing- Ask your doctor if you are a candidate for a DEXA test which measures your bone density at different spots in the body including the hip and lumbar spine. This will determine if you are at risk and where. This is important to know.
2) Improve your general health- Stop smoking and limit alcohol intake which will help to improve your well being.

3) Nutrition- Eat a well balanced diet rich in calcium and vitamin D including dark green leafy vegetables (kale, spinach) and low fat dairy ( yogurt, cheese) There are many products fortified with calcium including orange juice and cereal. Be sure to see a nutritionist if you have any other medical issues or dietary concerns. In addition, the Institute of Medicine recommends 1000 mg. of calcium for men/women between 19 and 50 years of age which increases to 1200 mg. when over 50 years of age. Vitamin D is recommended at 800-1000 IU per day. See your physician if you have osteopenia/osteoporosis and fall into the younger age bracket.

4) Exercise- Since bone is living tissue that responds to exercise by becoming stronger,weight bearing exercise is best if at risk. This includes jogging, skipping, stair climbing, lifting weights and aerobic dancing. These are exercises that force the body to work against gravity. Although swimming is wonderful exercise for breast cancer survivors, it is not weight bearing. Consistent weight lifting and weight bearing exercise 2-3x per week is advised along with balance training for fall prevention. Aerobic exercise such as jogging, skipping and jumping are recommended for osteoporosis prevention. The BEST Study (University of Arizona Bone Estrogen Strength, 2004) recommends the wall squat, military press, leg press, seated row, and back extension for strengthening. In addition, flexibility exercises to the chest, hamstrings, and upper back are important in prevention and improving posture. If you have osteoporosis/osteopenia avoid jarring high impact movements such as jumping or skipping and perform treadmill walking( on an incline if possible). If at lymphedema risk, start with light weights (see breast cancer rehabilitation).

5) Contraindicated exercises- If you have osteopenia/osteoporosis you should avoid the following exercises. These include exercises that pull, flex( bend towards the body) and twist the neck and spine. For example, sit-ups, roll-ups and spinal twists (Pilates) and plough and pigeon (yoga) are some that are not advised . If you participate in Pilates or yoga which are wonderful for balance and core stability, be sure to inform your instructor. Ask for modifications to the postures as a precaution. Abdominal strengthening should be performed without lifting the neck and shoulders off the floor.

It is best to see your physician before beginning any exercise program. A rehabilitation professional such as an occupational/physical therapist familiar with the implications of breast cancer treatment can design a safe exercise program for you. Exercise is important both in breast cancer prevention and recovery. If you have osteopenia/osteoporosis remember that prevention is necessary with this ''silent disease'' to keep you moving on in recovery.

Be sure to have doctor's permission before beginning this or any exercise program.

References
What Breast Cancer Survivors Need to Know About Osteoporosis (2005)
www.niams.nih.gov/bone
The BEST Exercise Program for Osteoporosis Prevention (2004) University of Arizona DSWFitness Tucson, Arizona
Cancer and Osteoporosis www.usnovartisoncology.com

Resources
To see if you are at risk for osteoporosis, please take this survey.

Osteoporosis and Related Bone Diseases National Resource Center 800 624-2663



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