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Bone Late Effects

Most childhood cancer survivors do not experience bone problems as a result of their therapy. But certain treatments for childhood cancer may cause a loss of bone strength.  

This loss is especially concerning because bones normally grow and become heavier during childhood and adolescence.

Osteoporosis is a disease marked by reduced bone mass and bone quality.

Osteoporosis is a disease marked by reduced bone mass and bone quality.

Loss of bone strength may result in a condition called osteoporosis later in life. Osteoporosis is a disease marked by reduced bone mass and bone quality. Bones become weak and are more likely to break.

Cancer Treatments That Can Cause Bone Loss

Other Medical Treatments That Can Cause Bone Loss

  • Certain anticonvulsant medicines (phenytoin and barbiturates)
  • Antacids with aluminum (such as Maalox® or Amphogel®)
  • Medications for treatment of early puberty and endometriosis, such as Lupron Depot®
  • High doses of heparin (used to prevent blood clots), especially with prolonged use.
  • Cholestyramine (used for blood cholesterol)

Other Risk Factors

Risk factors one cannot change

  • Women of Caucasian and Asian race
  • Older age. Risk increases with age.
  • Small and thin body size
  • Family history of osteoporosis. It tends to run in families.

Risk factors that one can change

  • Low levels of sex hormones. Estrogen in women and testosterone in men play a role in keeping bones strong even after growth is completed.
  • Smoking
  • A diet low in calcium
  • Lack of Vitamin D. It is needed to absorb minerals like calcium and phosphorus in bone. 
  • Lack of weight-bearing exercise
  • Too much caffeine, alcohol, or soda
  • A diet high in salt

Bone Problems That May Occur

Bones become weak because the body makes too little new bone tissue or has too much bone loss. Bones can become thinner and more likely to break easily. Osteoporosis can happen in any bone. It most commonly affects the wrist, hips, spine, and leg bones.

For most people, bone mass peaks during their 20s. After that time, people begin to lose bone. Some childhood cancer patients can begin losing bone mass earlier because of certain treatments.

Signs and symptoms

Osteoporosis is sometimes called a “silent” disease. It can exist for years without any obvious signs or symptoms. However, signs and symptoms can include:

  • Loss of height over time
  • A stooped posture
  • Bone fractures from minor injury

What Survivors Can Do


It is recommended that childhood cancer survivors at risk for low bone strength because of treatment and other predisposing conditions have at least one bone mineral density test as part of their evaluation for long-term health problems related to cancer and its treatments. The most commonly used bone mineral density test is the dual X-ray absorptiometry, which is also called DXA (or DEXA). This test uses special X-ray techniques to measure bone thickness and the patient’s risk of breaking a bone.  Based on the results, the doctor can advise about ways to improve bone strength and when to have follow-up studies. 


People can take action to lower the risk of osteoporosis.

  • Participate in regular weight-bearing and resistance exercise. This type of activity puts pressure on the bones and builds bone density. Examples include:
    • Light weightlifting
    • Walking
    • Hiking
    • Jogging
    • Climbing stairs
    • Tennis
    • Dancing
    • Jumping rope
  • Don’t smoke.
  • Don’t drink alcohol in excess.
  • Eat a diet high in calcium.
  • Get enough Vitamin D.

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Reviewed: June 2018