Expect Questions About Bone Loss Among Younger Breast Cancer Survivors

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Women diagnosed with breast cancer at age 50 or younger had twice the risk of developing either osteoporosis or osteopenia after adjuvant treatment than did women of the same age who did not have cancer, according to a study led by researchers from Johns Hopkins Bloomberg School of Public Health, Baltimore.1 The risk was 2.7 times higher for women receiving chemotherapy plus hormone therapy than for cancer-free women, and it was 3.83 times higher for women receiving chemotherapy plus aromatase inhibitors. In addition, the risk was 2.72 times higher with aromatase inhibitors alone and 2.48 times the risk with chemotherapy plus tamoxifen. Tamoxifen alone did not increase the risk.

In an interview with The ASCO Post, the study’s senior author, Kala Visvanathan, MD, MHS, discussed some modifications to help individual patients reduce the risk of bone loss. Dr. Visvanathan is Director of the Clinical Cancer Genetics and Prevention Service at the Johns Hopkins Sidney Kimmel Cancer Center and Professor of Oncology and Epidemiology at Johns Hopkins Bloomberg School of Public Health.

She stressed that these modifications should not involve reducing treatment for breast cancer, but rather lifestyle factors, such as increasing physical activity and perhaps taking vitamin D or calcium supplements. The recommended daily allowances for women to maintain bone health between the ages of 19 and 70 are 600 mg/d for vitamin D and 1,000 mg/d for calcium.2 Women with more severe bone loss might benefit from the addition of prescription bone agents, Dr. Visvanathan added.

Watch for Osteopenia, Too

“This study identifies the importance of looking not just at the significant bone loss of osteoporosis, but also osteopenia, particularly in younger women, because you don’t expect severe osteoporosis yet, and you might be missing people with bone loss,” Dr. Visvanathan said. “The concern is that if the trajectory continues, what is the risk over time? What is the long-term impact? When these young women are older, is their risk for fracture higher?”

“If we don’t ask about osteopenia, or we don’t look for it, we won’t see it,” she added. Then these early changes might manifest 10 years later as osteoporosis or fractures. “If you identify someone with osteopenia, you can then take steps to minimize their risk such as to encourage exercising, minimizing alcohol intake, ensuring they have adequate vitamin D levels, and if warranted and/or osteopenia persists, referral to an endocrinologist.”  

DISCLOSURE: Dr. Visvanathan has institutional patents, royalties, or other intellectual property with Cepheid.


1. Ramin C, May BJ, Roden RBS, Orellana MM, Hogan BC, McCullough MS, Petry D, Armstrong DK, Visvanathan K: Evaluation of osteopenia and osteoporosis in younger breast cancer survivors compared with cancer-free women: A prospective cohort study. Breast Cancer Res 20:134, 2018.

2. Ross AC, Manson JE, Abrams SA, et al: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know. J Clin Endocrinol Metab 96:53-58, 2011.

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