Bone Health: Steps to a healthy skeleton

by Sue Ott, MD, Associate Professor, Division of Metabolism, University of Washington School of Medicine

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. People who have had cancer treatment may be at increased risk for osteoporosis and bone fracture for several reasons. Many of these reasons are unavoidable - for example, the medications used to treat the cancer and any loss of estrogen or testosterone can harm bones but are necessary to fight the cancer. Your doctor can monitor your bones if you are on these treatments, and sometimes other medicines to protect the skeleton can be provided. 

Other risk factors for osteoporosis and bone fracture include inactivity, poor nutrition and unhealthy habits (smoking cigarettes or drinking more than 2 alcoholic beverages a day). The most important step a cancer survivor can take to improve the skeleton is to literally take steps! Whether by walking, dancing, or climbing stairs, these steps send messages to the bone cells to improve strength. We call these activities "weight-bearing," but this does not mean you have to go to a gym and lift weights. Instead, try to spend more time walking instead of driving, standing instead of sitting, climbing stairs instead of taking elevators. 

Appropriate nutrition is another strategy that can reduce one's risk for osteoporosis or lessen the effects of the disease. The most important aspect of nutrition for healthy bones is the total number of calories consumed. Weight loss causes bone loss, even in overweight people. Of course, we do not advise everybody to aim for obesity (although that would help the bones) but many men and women are actually underweight, and it would be healthy to gain weight by eating more calories. 

Calcium and vitamin D are other important considerations for healthy bones. Calcium is a mineral found in many foods and used by the body to help strengthen bones and teeth. The recommended total daily amount of calcium is 1200 mg, which can include calcium from foods as well as supplements. Vitamin D is a fat-soluble vitamin that is important because it helps maintain blood levels of calcium and is necessary for bone and tooth structure. Most cancer survivors in Seattle should be taking 800 to 1000 units of vitamin D per day. Also, it is important to note that this vitamin is formed in the skin on exposure to sunlight, so unless you are on vacation to a sunny place you will want to pay attention to how much vitamin D you are getting through your diet.  Excess calcium and vitamin D should be avoided; getting too much does not help and might cause side effects like kidney stones or calcium deposits.

We encourage all cancer survivors to take these steps for a healthy skeleton.