Managing Cancer and Bone Health for Survivors

Cancer and Bone Health: 15 Evidence-Based Ways to Protect Your Bones

a couple of weeks ago
/ cancer
/ By David Emerson

Managing cancer and bone health. While fighting the specific cancer that we are diagnosed with is the main focus of cancer patients and survivors, it is not the only health challenge we face.

What is the best way to protect bone health during cancer treatment?

The best approach combines conventional therapies when appropriate, regular weight-bearing exercise, adequate vitamin D and calcium, sufficient dietary protein, fall prevention, and selected evidence-based complementary therapies. Patients taking bone-strengthening medications should also receive regular dental monitoring because of the risk of osteonecrosis of the jaw.

I was diagnosed with an incurable blood cancer called multiple myeloma in 1994. I underwent induction chemotherapy as well as radiation therapy, all in an effort to control my blood cancer.

After almost 30 years of surviving multiple myeloma, I’ve learned that beating cancer isn’t enough. Preserving bone strength may determine whether you remain independent decades after treatment. Maintaining bone health is also necessary for cancer patients and survivors of other types of cancer.

In an effort to enhance the strength of my bones, I underwent bisphosphonate therapy for several years. After several years undergoing a therapy called Aredia, a type of bisphosphonate, I decided to discontinue it and focus on evidence-based non-conventional bone health therapies.

Bone health is critical for long-term cancer survival. Or should I say that many cancers metastasize to the bone, causing damage? It’s important, therefore, for cancer survivors to maintain bone health.

Having undergone conventional bone-strengthening therapy, a class of drugs called bisphosphonates, I became familiar with the short-term, long-term, and late-stage side effects caused by bisphosphonate therapy.

Because bisphosphonate therapy causes so many side effects, I decided to research evidence-based but non-conventional bone health therapies. The bone health therapies below are supported by research but not approved by the Food and Drug Administration for bone health.

I have undergone most of the bone health therapies listed below for the past 30 or so years.

DAVID EMERSON

Cancer Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Cancer Causing Bone Loss – What Cancer Treatment Affects Bone Density

Frequently Asked Questions about Cancer and Bone Health:

Can chemotherapy weaken bones? Yes, chemotherapy can weaken bones. It accelerates the loss of bone mineral density, which increases the risk of osteopenia (mild bone loss), osteoporosis, and fractures. [1, 2]
Can radiation cause osteoporosis? Yes, radiation can cause bone density loss—a condition known as radiation-induced osteoporosis. Radiation therapy damages the cells that build and maintain bones (osteoblasts) while increasing the activity of cells that break bone down (osteoclasts). This localized bone loss significantly increases the risk of fragility fractures in the treated area. [1, 2, 3, 4, 5, 6]
Should cancer survivors take calcium? Cancer survivors may benefit from calcium, especially if treatments like hormone therapy or chemotherapy have weakened bones. However, supplements are not safe for everyone. Always consult your oncologist or an oncology dietitian before starting, as certain cancers (such as multiple myeloma) or treatments can increase the risk of dangerous, elevated blood calcium levels (hypercalcemia). [1, 2, 3, 4, 5, 6]
Is vitamin D recommended during cancer treatment? Yes, vitamin D is often recommended, but it must be personalized. It supports bone health, which is critical since some treatments cause bone loss, and there is evidence it may help mitigate side effects like fatigue and neuropathy. Some studies even suggest it can enhance the effectiveness of certain chemotherapies. [1, 2, 3, 4]
Can exercise improve bone density? Yes, working out is one of the most effective ways to build and maintain bone density. When you place mechanical stress on your skeleton through resistance and impact, bone-building cells are stimulated to create new tissue, making bones denser and less prone to fractures. [1, 2, 3]
What foods strengthen bones after cancer? To rebuild and protect bone density after cancer (or during treatment), focus on a diet rich in calcium, vitamin D, and protein. Aim to include dark, leafy greens, dairy products or fortified plant milks, and fatty fish in your meals, and consider eating five to six prunes daily to help prevent bone breakdown. [1, 2, 3, 4, 5]
What cancers commonly spread to bone? Breast, lung, and prostate cancers account for roughly 70% of all cases of cancer that metastasize to the bone. Other common malignancies that frequently spread to the skeleton include kidney cancer, thyroid cancer, multiple myeloma, and melanoma. [1, 2, 3, 4]
Are bisphosphonates safe long term? Bisphosphonates are generally safe and highly effective for the first 3 to 5 years. However, long-term use (beyond 5 years) can increase the risk of rare but severe side effects, such as atypical femur fractures and osteonecrosis of the jaw (ONJ). To minimize risk, doctors often recommend a “drug holiday” after 3 to 5 years. [1, 2, 3, 4, 5]

Therapy	Evidence	Conventional or Complementary
Bisphosphonates	Strong	Conventional
Denosumab	Strong	Conventional
Resistance exercise	Strong	Complementary
Vitamin D	Strong	Complementary
Calcium	Strong	Complementary
Curcumin	Emerging	Complementary
Green tea	Emerging	Complementary
Probiotics	Emerging	Complementary
Yoga	Moderate	Complementary
Whole body vibration	Moderate	Complementary

Conventional bone management

Bone density testing (DEXA)

A DEXA (Dual-Energy X-ray Absorptiometry) scan is a quick, painless imaging test that measures bone mineral density. It is the gold standard for diagnosing osteoporosis, assessing your risk of future bone fractures, and monitoring bone health over time. [1, 2, 3, 4]

Denosumab (Xgeva/Prolia)

Denosumab is a monoclonal antibody that targets RANKL to prevent bone breakdown, though Xgeva and Prolia are not interchangeable. Xgeva is given monthly to prevent skeletal events in cancer patients, while Prolia is given every 6 months for osteoporosis. Both require calcium monitoring and carry risks for low calcium. [1, 2, 3, 4, 5, 6]

Bisphosphonate Therapy-

While bisphosphonates are a component of the standard-of-care therapy program for all newly diagnosed MM patients, they do increase the risk of short- and long-term side effects, including:

Renal Damage
Osteonecrosis of the jaw- (ONJ)
Low-energy Fractures
Bone and joint pain,
others (read more 4)

Bisphosphonate therapy has been shown to reduce the risk of skeletal-related events (SRE). While bisphosphonate or denosumab use may be needed to stabilize the bone health of the newly diagnosed MM patient, according to research, the longer the patient undergoes bisphosphonate therapy, the greater the risk of side effects.

FDA-approved therapies such as bisphosphonates and denosumab remain the cornerstone of bone protection for many cancer patients because they reduce fractures and other skeletal-related events. Complementary therapies should be viewed as additions—not replacements—for appropriate medical treatment.

Non-conventional bone management

Nutrition-

Dietary approaches for bone health: lessons from the Framingham Osteoporosis Study

“Dietary approaches can be an important strategy for the prevention of osteoporosis. Emerging evidence indicates that diet at the level of vitamins, minerals, food groups and dietary patterns play an important role in skeletal health. ..” (read more 5)

Exercise-

The effect of weight-bearing exercise on bone mineral density: A study of female ex-elite athletes and the general population

“This study confirms long-term weight-bearing exercise as an impor-tant factor in the regulation of bone mass and fracture prevention. (read more 6)

Effects of whole body vibration exercises on bone mineral density of women with postmenopausal osteoporosis without medications: novel findings and literature review

“Among the twelve articles analyzed, seven of them have shown an improvement of the BMD of some bone of postmenopausal women exposed to whole body vibration exercises not associated to medications; as well as modifications in biomarkers…” (read more 7)

Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss

“No yoga-related serious injuries were imaged or reported. Bone quality appeared qualitatively improved in yoga practitioners…” (read more 8)

Nutritional Supplementation

Curcumin-

Therapeutic Advantages of Treatment of High-Dose Curcumin in the Ovariectomized Rat

“The present study results demonstrate that high-dose curcumin has therapeutic advantages over low-dose curcumin in terms of an antiresorptive effect on bone remodeling and improved bone mechanical strength.” (read more 9)

Resveratrol-

Effects of Resveratrol on Bone Mineral Density in Ovariectomized Rats

“In conclusion, the present study demonstrated that a daily resveratrol intake in adult ovariectomized rats reduced bone turnover and also reverse a previous bone loss…” (read more 10)

Green Tea Extract-

Green Tea and Bone Metabolism

“Ingestion of green tea and green tea bioactive compounds may be beneficial in mitigating bone loss of this population (elderly) and decreasing their risk of osteoporotic fractures…” (read more 11)

Melatonin-

Melatonin Effects on Hard Tissues: Bone and Tooth

“Due to its ability to regulate bone metabolism, enhance bone formation, promote osseointegration of dental plant and cell and tissue protection, melatonin may used as a novel mode of therapy for augmenting bone mass in bone diseases characterized by low bone mass and increased fragility, bone defect/fracture repair and dental implant surgery…” (read more 12)

DEHYDROEPIANDROSTERONE (DHEA)

Effects of DHEA replacement on bone mineral density and body composition in elderly women and men.

“The results provide preliminary evidence that DHEA replacement in those elderly women and men who have very low serum DHEAS levels can partially reverse age-related changes in fat mass, fat-free mass, and BMD, and raise the possibility that increases in IGF-I and/or testosterone play a role in mediating these effects of DHEA…”(read more 13)

VITAMIN D3

Effectiveness and safety of vitamin D in relation to bone health.

“In most trials, the effects of vitamin D and calcium could not be separated. Vitamin D(3) (>700 IU/day) with calcium supplementation compared to placebo has a small beneficial effect on BMD, and reduces the risk of fractures and falls al-though benefit may be confined to specific subgroups…” (read more 14)

Vitamin K

Vitamin K and bone health:

“There is a consistent line of evidence in human epidemiologic and intervention studies that clearly demonstrates that vitamin K can improve bone health. The human intervention studies have demonstrated that vitamin K can not only in-crease bone mineral density in osteoporotic people but also actually reduce frac-ture rates. Further, there is evidence in human intervention studies that vitamins K and D, a classic in bone metabolism, works synergistically on bone density…” (read more 15)

CALCIUM

Calcium: Gotta Have It for Healthy Bones!

“Milk and other calcium-rich foods are an important part of a bone-healthy lifestyle that can not only reduce the risk of fractures as you get older, but may also protect against certain cancers…” (read more 16)

MAGNESIUM

Magnesium May Help Prevent Hip Fractures.

“Magnesium is a crucially important mineral for optimal health, performing a wide array of biological functions, including playing an important role in bone health…” (read more 17)

FOLIC ACID

Vitamin B12, folic acid, and bone.

“Vitamin B12 and folic acid deficiency are associated with a higher serum concentration of homocysteine. A high serum homocysteine is a risk factor for fractures…” (READ MORE 18)

CBD OIL

No bones about it: Cannabis may be used to treat fractures.

“A new study explores another promising new medical application for marijuana. According to the research, the administration of the non-psychotropic component significantly helps heal bone fractures…” (read more 19)

Collagen

Surviving Multiple Myeloma: Collagen Aids Bone Health

“Collagen hydrolysate has a positive therapeutic role in osteoporosis and osteoarthritis: potentially increasing bone mineral density, having a protective effect on articular cartilage and, primarily, providing symptomatic relief of pain.” (read more 20)

Thymoquinone (Black Seed Oil)

Nigella sativa: A Potential Antiosteoporotic Agent

“NS or TQ has shown potential as a safe and effective antiosteoporotic agent. However, more studies on the effects of NS or TQ using various animal osteoporotic models are required. Once the antiosteoporotic effectiveness of NS or TQ has been established, human studies can be carried out…” (read more 21)

Probiotics

Probiotic supplements and bone health in postmenopausal women: a meta-analysis of randomised controlled trials

“Conclusions We conclude cautiously that supplementation with probiotics could increase lumbar BMD. More RCTs are recommended to validate or update these results…” (read more 22)

To learn more:

FOOTNOTES

Managing cancer and bone health Managing cancer and bone health Managing cancer and bone health Managing cancer and bone health managing cancer and bone health.

Our Mission

Cancer and Bone Health: 15 Evidence-Based Ways to Protect Your Bones

What is the best way to protect bone health during cancer treatment?

Cancer Causing Bone Loss – What Cancer Treatment Affects Bone Density

Frequently Asked Questions about Cancer and Bone Health:

Conventional bone management

Bone density testing (DEXA)

Denosumab (Xgeva/Prolia)

Non-conventional bone management

Nutrition-

Dietary approaches for bone health: lessons from the Framingham Osteoporosis Study

To learn more:

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