Illustration showing link between osteoporosis and cancer
Credit: Tatiana Ayazo

Osteoporosis is a condition that causes bones to become weak, brittle, and break more easily. And it’s common: Osteoporosis is thought to affect more than 200 million people across the globe 

If you have cancer, it’s important to educate yourself about this bone condition, as research shows that cancer is a major risk factor for bone loss and fractures, which can result in osteoporosis. Here’s what to know. 

The Link Between Cancer and Osteoporosis 

While cancer itself can affect bone health, cancer treatments also play a role in osteoporosis.  

Estrogen-Blocking Therapy 

Research shows that osteoporosis is closely linked to estrogen deficiency.  

“Breast cancer patients receive medications known as aromatase inhibitors to lower the risk of cancer recurrence,” says Jeena Varghese, MD, an endocrinologist in the Department of Endocrine Neoplasia and Hormonal Disorders at The University of Texas MD Anderson Cancer Center. “These medications decrease or eliminate estrogen in the body, and estrogen deficiency causes bone loss in women.”  

Evidence suggests that the bone loss that occurs with the use of aromatase inhibitors (as well as other cancer drugs) can eventually lead to osteoporosis.  

Testosterone-Blocking Therapy 

“Similarly, in men, treatments causing low testosterone in the body can also result in bone loss,” says Varghese. “This is most common in men with prostate cancer when they receive testosterone lowering therapy or androgen deprivation therapy.” 

Research shows that survivors of testicular cancer may also experience testosterone deficiency, which increases the risk of osteoporosis. 

That’s because testosterone is known to help maintain bone mineral density in men. 

Chemotherapy 

“Chemotherapy can also cause women to undergo menopause at an early age, which also results in estrogen deficiency and bone loss,” explains Varghese. 

Research shows that chemotherapy-induced menopause increase osteoporosis risk —  and it also impacts fertility, menopausal symptoms, cardiovascular disease risk, and quality of life. 

Steroids 

There’s well-established evidence that steroid use contributes to osteoporosis risk. 

“Steroids are used as a part of chemotherapy regimens and to treat symptoms of cancer or side effects of cancer therapy,” says Varghese. “Prolonged use of oral steroids can cause bone loss and muscle loss, which can also increase risk of osteoporosis.” 

Radiation Therapy 

“Radiation therapy is used to treat many cancers,” says Varghese. “Bones that are in the field of radiation can become weak and brittle.” 

While radiation is linked with an increased risk of osteoporosis, researchers are looking into protective techniques that may help inhibit radiation-induced bone loss, though more studies are needed.   

Osteoporosis Risk Factors 

Aside from cancer treatment-related risk factors, many other factors also play a role in the development of osteoporosis. These can be broken into two groups: uncontrollable and controllable risk factors. 

Uncontrollable risk factors for osteoporosis include:  

  • Gender: Osteoporosis is more common in women, especially in perimenopausal women. 
  • Ethnicity: Osteoporosis is more common in Caucasian and Asian women. 
  • Age: The older you get, the higher your risk of developing osteoporosis. 
  • Family history: If an immediate family member, like a parent, has osteoporosis, your risk of developing it increases. 

Controllable risk factors, or those you can modify, include: 

  • Medications: Long-term use of steroids or anticonvulsants can contribute to osteoporosis. 
  • Diet: Low calcium and vitamin D intake may contribute to osteoporosis risk. 
  • Inactivity: Not exercising regularly, or being inactive, can weaken your bones. 
  • Weight: Being underweight (or having a small body frame) can impact bone health. 
  • Smoking: Smoking cigarettes makes you more prone to osteoporosis and bone fractures. 
  • Alcohol: Excessive alcohol consumption impacts how the body absorbs calcium and vitamin D, both of which are critical for healthy bone development. 

By familiarizing yourself with the many risk factors tied to osteoporosis, you can have an informed conversation with your healthcare provider about your personal risk and what you can do to protect your bones. 

Osteoporosis Symptoms  

Osteoporosis is sometimes referred to as a “silent” condition. That’s because it often has no symptoms.  

As it progresses, it can lead to symptoms like  

  • Back pain 
  • Sudden back pain 
  • Joint pain 
  • Changes in posture 
  • Stooping or loss of height 

But most people aren’t aware they have osteoporosis until they fracture or break a bone. That’s why it’s so important to be aware of osteoporosis and take steps to protect your bone health. 

How to Manage Cancer and Protect Your Bones  

“Lifestyle plays a very important role in optimizing bone health and reducing the risk of fractures,” says Varghese. Start with these tips. 

Eat a Healthy, Nutritious Diet 

Cancer and its treatments can impact your appetite and make it difficult to eat or drink. But proper nutrition is important both during and after cancer treatment, helping you feel better and heal and recover faster. Research shows that poor dietary habits can also contribute to the progression of osteoporosis, but following healthier eating habits may help slow disease progression.  

When you can, plan to eat a well-balanced diet full of fruits, vegetables, fish, whole grains, and legumes. Also, aim to get plenty of calcium and vitamin D — which can be found in dairy products like milk, cheese, and yogurt — to help preserve bone strength. 

“If you’re not able to get this by diet, we encourage patients to take supplements to meet their daily requirements,” says Varghese. “However, taking more than what the body needs is not recommended.”  

Women ages 50 and under and men ages 70 and under should aim to get 1,000 mg of calcium each day and increase intake to 1,200 mg each day once women reach age 51 and men reach age 71. The recommended vitamin D intake is 400-800 IU a day for most adults under age 50, and 800-1,000 IU a day for those 50 and up. Talk to your health care provider to determine what’s right for you. 

Be Mindful of Weight Loss 

Weight loss is common with cancer. It can be related to the cancer itself or its treatments. Cancer-related weight loss is often referred to as cachexia, which can intensify symptoms and the physical demands of treatment. What’s more: Being underweight can also weaken bone health and increase your risk of osteoporosis.  

Consider working with a registered dietitian or nutritionist to help you work toward reaching and maintaining a healthy weight, both to help with cancer and to promote bone health. 

Stay Active 

“Decrease in activity while undergoing cancer treatment can result in loss of muscle mass, which in turn, can cause bone loss, increased risk of fall, and subsequently fractures,” notes Varghese.  

When you’re feeling up to it, start to slowly incorporate more exercise into your day. Try to build up to at least 150 minutes of moderate activity a week — even if it’s broken up into several 10-minute sessions.  

Aim to incorporate a mix of activities. “Exercise that promotes strength training and balance is very important not only to maintain bone mass but also to prevent falls,” says Varghese. Research has found that resistance exercises in particular can help preserve bone health and muscle mass. 

“If you are unable to exercise on your own, physical therapy can be beneficial,” says Varghese.  

Quit Smoking and Drinking

Both smoking and alcohol intake are known risk factors for cancer — and when you have cancer, these habits can affect how well your treatment works as well the severity of your treatment side effects.  

Smoking can also contribute to weakened bones and increase fracture risk. Research shows that chronic, excessive alcohol consumption increases osteoporosis risk. Heavy drinking has also been linked with a decrease in bone density and weakened bones.  

Talk to your doctor about your smoking and drinking habits. Together, you can develop a plan to cut back or quit for your health.  

Prioritize Sleep 

Cancer and its treatments can affect your sleep and lead to issues like insomnia or an abnormal sleep-wake cycle. According to research, getting five hours of sleep or less each night may impact bone mineral density and increase osteoporosis risk in postmenopausal women. Evidence shows poor sleep quality, insomnia, and sleep disturbances may also increase fall and fracture risk. 

Aim to get seven to nine hours of quality sleep each night — though your body may require more rest while undergoing cancer treatment. If you’re having trouble prioritizing sleep, talk to your doctor. 

When to Talk to Your Doctor About Bone Health 

Because there are often no symptoms of osteoporosis until a bone breaks, routine screening can help prevent osteoporosis. Screening is easy and only takes five to 10 minutes. Early detection can help you take proper steps to prevent fractures and promote bone health.  

Routine screening for osteoporosis should be done:   

  • After age 65 for women, 70 for men, or sooner depending on your personal risk factors 
  • Every one or two years, or more often depending on your health  
  • After a bone fracture in those over age 50 
  • When taking new medication associated with low bone mass or bone loss 

Talk to your doctor at your next health exam about getting screened for osteoporosis.  

This article was made possible with support from Amgen. 

American Bone Health. How Often Should I Get Tested? https://americanbonehealth.org/bone-density/how-often-should-i-have-a-bone-density-test/.  

American Cancer Society. Alcohol Use and Cancer.  https://www.cancer.org/healthy/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html.  

American Cancer Society. Physical Activity and the Person with Cancer. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html.  

American Society of Clinical Oncology. Nutrition Recommendations During and After Treatment. https://www.cancer.net/survivorship/healthy-living/nutrition-recommendations-during-and-after-treatment.  

American Society of Clinical Oncology. Weight Loss. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/weight-loss. 

Bone Health & Osteoporosis Foundation. Evaluation of Bone Health/Bone Density Testing. https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/.  

Bone Health & Osteoporosis Foundation. Food and Your Bones — Osteoporosis Nutrition Guidelines. https://www.bonehealthandosteoporosis.org/patients/treatment/nutrition/.

Bone Health & Osteoporosis Foundation. Get the Facts on Calcium and Vitamin D. https://www.bonehealthandosteoporosis.org/patients/treatment/calciumvitamin-d/get-the-facts-on-calcium-and-vitamin-d/.  

Bone Health & Osteoporosis Foundation. Osteoporosis Exercise for Strong Bones. https://www.bonehealthandosteoporosis.org/patients/treatment/exercisesafe-movement/osteoporosis-exercise-for-strong-bones/  

Briot K, et al. Glucocorticoid-induced osteoporosis. RMD Open. April 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613168/.  

Canadian Cancer Society. Osteoporosis. https://cancer.ca/en/treatments/side-effects/osteoporosis. 

Cauley JA, et al. Characteristics of Self-Reported Sleep and the Risk of Falls and Fractures: The Women’s Health Initiative (WHI). November 2018.  https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.3619.  

Cleveland Clinic. When (and Why) Should I Start Screening for Osteoporosis? https://health.clevelandclinic.org/when-and-why-should-i-start-screening-for-osteoporosis/  

Drake MT, et al. Osteoporosis and Cancer. Current Osteoporosis Reports. September 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783531/.   

Hong AR, et al. Effects of Resistance Exercise on Bone Health. Endocrinology and Metabolism (Seoul). December 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/.  

Ji M-X, et al. Primary osteoporosis in postmenopausal women. Chronic Diseases and Translational Medicine. March 2015. doi: https://doi.org/10.1016/j.cdtm.2015.02.006.  

Martin HL, et al. Predicting chemotherapy-induced menopause using baseline and post-chemotherapy anti-Müllerian hormone levels: Results of a pilot study. Cancer Reports. March 2021. doi: https://doi.org/10.1002/cnr2.1342. 

Mayo Clinic. Bone health: Tips to keep your bones healthy. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060  

Mayo Clinic. Osteoporosis. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968.  

National Cancer Institute. Sleep Disorder (PDQ). https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq.  

National Institute on Aging. Osteoporosis. https://www.nia.nih.gov/health/osteoporosis.  

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis. https://www.niams.nih.gov/health-topics/osteoporosis. 

NIH Osteoporosis and Related Bone Diseases National Resource Center. Smoking and Bone Health. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/bone-smoking.  

Ochs-Balcom HM, et al. Short Sleep Is Associated With Low Bone Mineral Density and Osteoporosis in the Women’s Health Initiative. November 2019.  https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3879.  

Ondrusova M, et al. Testosterone deficiency and bone metabolism damage in testicular cancer survivors. American Journal of Men’s Health. August 2016. https://journals.sagepub.com/doi/10.1177/1557988316661986.  

Personal interview with Jeena Varghese, MD, an endocrinologist in the Department of Endocrine Neoplasia and Hormonal Disorders at The University of Texas MD Anderson Cancer Center.  

Shigehara K, et al. Testosterone and Bone Health in Men: A Narrative Review. Journal of Clinical Medicine. February 2021.   https://pubmed.ncbi.nlm.nih.gov/33540526/.  

Sözen T, et al. An overview and management of osteoporosis. European Journal of Rheumatology. https://eurjrheumatol.org/en/an-overview-and-management-of-osteoporosis-132921.  

Shapiro CL. Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments. Cancers https://www.mdpi.com/2072-6694/12/11/3094.  

University of Iowa Hospitals & Clinics. Tips for better sleep for cancer patients. https://uihc.org/educational-resources/tips-better-sleep-cancer-patients.  

Wang X, et al. Alcoholism and Osteoimmunology. Current Medicinal Chemistry. 2021. doi: https://doi.org/10.2174/1567201816666190514101303. 

West Virginia Department of Health & Human Resources. Osteoporosis Risk Factors. wwdhhr.wv.gov/hpcd/FocusAreas/osteoporosis/Pages/Osteo-Risk-Factors.aspx.  

Xu C, et al. Dietary Patterns and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. The American Journal of Clinical Nutrition. January 2020. doi: https://doi.org/10.1093/ajcn/nqz333. 

Yan Z, et al. High-specificity protection against radiation-induced bone loss by a pulsed electromagnetic field. Science Advances.  doi: https://doi.org/10.1126/sciadv.abq02.