Osteoporosis in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Osteoporosis is the most common type of bone disease. It develops when more bone tissue is broken down by the body than can be replaced, resulting in bones becoming weak and fragile and more likely to fracture (break). These fractures may cause pain and disability that can interfere with your child’s daily life.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
There are usually no symptoms in the early stages of bone loss, but once osteoporosis has caused the bones to become weak and brittle, the person may experience:
- Back Pain, often caused by a compression fracture or collapsed vertebra
- Loss of Height over time
- Stooped Posture or a curved upper back
- Broken Bones that happens more easily than expected, such as after a minor injury
Osteoporosis is not only caused by cancer or cancer-related treatments; many individuals get osteoporosis as they grow older because as we age our bodies lose the ability to replace the cells needed to repair and rebuild bone tissue, and bones may become thin and more porous as a result.
Other factors that can contribute to loss of bone mass include:
- Cancer Metastasis (spread) to the bone, which causes bones to weaken in certain places. Breast cancer, prostate cancer, multiple myeloma, and lung cancer are the most common causes of bone metastases.
- Chemotherapy – some types of chemotherapy can cause osteoporosis
- Radiation Therapy – Radiation can cause bones affected by the treatment to thin (e.g. radiation to the pelvis may increase the risk of pelvic and hip fractures for women age 65 and older). This risk may be greater for women who had osteoporosis before treatment.
- Womanhood – Women have a higher risk of osteoporosis than men. In excess of 80% of individuals diagnosed with osteoporosis are women. The risk is especially high for women after menopause, when the levels of oestrogen in a woman’s body drops significantly.
- Hormone Therapy for breast or prostate cancer. These treatments reduce levels of oestrogen or testosterone, and contribute to loss of bone mass and density.
- Heavy Smoking and excessive alcohol consumption
- Family History of osteoporosis
- Other Medications, including synthetic thyroid hormone therapy, steroid therapy, drugs for heartburn, and various other commonly prescribed medications
- Long-Term Bed Rest and inactivity
- Poor Nutrition and not getting enough calcium and vitamin D
- Race and Ethnic Background. Individuals who are white or Asian have an increased risk of developing osteoporosis.
Bone mass loss does not happen overnight, but it often goes unnoticed until a person experiences pain, loss of function, or a fracture. If your child experiences back pain, painful joints, or stiffness, tell your doctor or nurse as soon as possible. Warning signs of more serious bone problems are often mistaken for arthritis-like symptoms.
The most common test used to measure bone mass is a dual energy x-ray absorptiometry (DEXA) scan or bone density scan, and it may be done before, during, and after cancer treatment. This test will allow your child’s doctor to measure the strength of the bone, usually the hip or the lower spine, based on the amount of calcium it contains.
Depending on how low your child’s bone mineral density is compared to normal, the doctor may diagnose osteopenia (mild bone loss) or osteoporosis.
Osteoporosis and other bone complication treatments more often than not involve the use of bone-modifying drugs like bisphosphonates which slow the rate of bone thinning and may reduce new bone damage and promote bone healing. Bisphosphonates are also sometimes given to patients who experience bone pain related to the spread of cancer.
One possible condition associated with bone-modifying drugs is osteonecrosis of the jaw, which is an uncommon but serious condition. The symptoms of osteonecrosis of the jaw include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. As a result, your child’s doctor may recommend that they see a dentist before any type of bone-strengthening treatment begins. It is also important to tell your child’s dentist that they are receiving treatment with a bisphosphonate or other bone-modifying drug before having any dental procedure.
Management of osteoporosis and its complications may also include:
- Calcium and Vitamin D Supplements: Calcium and Vitamin D Supplements may help for your child’s condition, but it is important that you speak to your child’s doctor before giving them any kind of supplement.
- Exercise: Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) places stress on the bones, which triggers the body to make cells that form bone. Regular weight-bearing exercise also builds strong muscles, which can help your child’s balance when playing, walking and doing other activities. Your child’s doctor or healthcare team should be able to help you create an appropriate exercise plan for your child based on their needs, physical abilities, and fitness level.
- Maintain a Healthy Weight: Eating a well-balanced diet is vital for your child’s good bone health; being underweight can contribute to bone loss and fractures.
- Preventing Falls: The main cause of fractures for people with osteoporosis is falling. Poor vision, shoes that don’t fit well, mental impairment, a cluttered living space, drowsiness related to pain medication, and poor concentration can increase your child’s risk of falling. To help prevent falls, try to get your child to do exercises that will improve their balance.