Bone Health After Breast Cancer
Arline Kallick: Hello everyone. We are happy to have you with us this evening. Our call will begin with tonight's speaker followed by the question and answer session, and then we will end with small group discussions, and please consider during the question and answer portion that other people are waiting online to ask a question, so try to limit your question. This can't be a private consultation. If we go into the group at the end of the program, before you have an opportunity to ask your question you can address it in the group or you can call the Y-ME 24-hour Hotline at 800-221-2141 and our website is www.y-me.org . Registration for ShareRing calls can be done online, and we will have transcripts online of each ShareRing call available around a week following the call.
Tonight's topic is Bone Health After Breast Cancer. Our speaker is Dr. Michele Glasgow. Dr. Glasgow is the Director of the Midwest Orthopedic Institute Osteoporosis Center in De Kalb , Illinois . She is an orthopedic surgeon and a breast cancer survivor. We welcome Dr. Glasgow this evening.
Dr. Michele Glasgow: Hello Arline. Thank you.
I feel very privileged to be able to participate in the program tonight and the topic is: The Diagnosis and Treatment of Osteoporosis as It Relates to Patients Who Have Had Breast Cancer. I thought that I would just take the opportunity to talk a little bit about osteoporosis and what exactly this entity is. Osteoporosis is a disease of bone where the actual quantity, the quantitative stuff that bone is made of diminishes. Generally it occurs fully over time but can be very accelerated during menopause. The strength of our bone relates not only to the amount of bone that we have but also to the structural quality of bone and those are two separate features. We have recently in the last decade become much more aware of osteoporosis because we actually have an easy way to diagnose it which is bone density machines which are available in most communities at this time. So we know a lot more about osteoporosis and the trend of osteoporosis as we age.
In men, typically bone loss occurs very slowly, about ½% per year after they reach skeletal maturity at about 30 years old. But in women we lose bone after the age of 35 a little bit more rapidly than men, at about 1% per year and that can greatly increase around menopause and you can lose 2% to 3% or 4% per year for five years of more around the menopause. That coupled with the fact that women usually have much less bone mass to start with than men means that women generally tend to be at high risk for fracture. So we start off as mature adults with about a third less bone than our matching male counterpart.
And there are many things that we can do early in our lives to help build bone and things that we can counsel our children and our friends to do and that involves good levels of activity, weight bearing exercises, good diet with plenty of calcium. Generally calcium should be around 1,000 to 1,200 milligrams in a young adult and then when we are postmenopausal we want to increase that yet a little bit more. So diet is very important and also avoidance of things that are toxic to bone like cigarettes, excessive alcohol use and it is also important to understand that there are certain genetics that go into osteoporosis and sometimes there are changeable factors, things that we can control and then there are other things that we can't control like our ethnicity, the Caucasians and Asians tend to have a higher chance of osteoporosis. We can't control our age of course. Our genetics, as I mentioned, the risk factors of having close relatives who have had osteoporotic fractures increases the risk of fracture in ourselves because it is a genetic predisposition. So there are many things that we can do and there are some things that we cannot do to prevent osteoporosis.
I had a particular interest in osteoporosis because I'm an orthopedic surgeon and I started to see patients in practice with hip fractures that were obviously severely debilitated by their injuries. Many people die from hip and spine fractures over the course of the first year. In fact the mortality rate with a hip fracture is still about 20% and about a third of patients with hip fractures wind up losing the ability to function independently and wind up in nursing homes. So osteoporosis is a huge factor in our lives. As we go through life there are many things that we can do to prevent this, as I mentioned, but the primary diagnostic test is I would gather that most people would agree is very important. So understanding what you can do to prevent it and then if you are at risk of getting a DEXA scan is very helpful.
The other thing that I wanted to talk about was the fact that I myself am a breast cancer survivor, so I have gone through chemotherapy and radiation therapy and had the ill effects of that and the benefits of that. I developed breast cancer in my early 40s. I had a chemically induced menopause. I have followed my bone density since beginning chemotherapy through the present time and I have tried to be very proactive with my bone density. I do think however that many patients may not be aware of the implications of chemotherapy and estrogen status on their bones, especially because there are more and more young people who are being diagnosed with breast cancer, hopefully at early stages. So it doesn't always come to mind in terms of thinking about your overall health over the course of the decades hopefully that you will survive from your initial cancer.
So we have seen that the hormonal treatments and chemotherapies have had a profound positive effect on the survival of breast cancer and as we see patients surviving longer we see patients have more loss of bone, especially when the chemotherapy agents induce an early menopause. So these are all factors that we need to think about and be proactive in terms of treatment. I defer quite a bit to of course the oncologist in terms of treatment after chemotherapy. But there are many studies now that have suggested that bisphosphonates may be very instrumental in helping women preserve bone and maybe even having some direct anti-tumor effects. That is a very exciting field right now and there is a lot of literature coming out about this topic. But for the purposes of what a patient can do or what a person with breast cancer can do on their own - Activity and good diet are extremely important.
Arline Kallick: Can you maybe get into a little bit about some of the drugs that are being used for osteoporosis and for the woman who has had breast cancer.
