Bone Loss and Osteoporosis in Childhood Cancer Survivors

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.

Loss of bone strength may result in a condition called osteoporosis later in life.

Childhood cancer survivors can take steps to help prevent bone strength loss.

Cancer treatments that can cause bone loss

Corticosteroids (such as prednisone and dexamethasone)
Methotrexate
Radiation to weight-bearing bones (legs, hips, spine)

Conditions that may lead to bone loss

Low levels of female or male hormones
Growth hormone deficiency
High levels of thyroid hormone
Chronic graft-versus-host disease requiring prolonged therapy with corticosteroids
Prolonged periods of inactivity (bed rest)

Other medical treatments that can cause bone loss

Certain anticonvulsant medicines (such as phenytoin sodium 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 to reduce blood cholesterol)

Other risk factors

Risk factors one cannot change

Women of Caucasian and Asian race (especially after menopause)
Older age. Risk increases with age.
Small and thin body size
Family history of osteoporosis

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 after cancer treatment

Bones become weak because the body makes too little new bone tissue or has too much bone loss. Bones can become thinner. They are more likely to break easily.

Osteoporosis can happen in any bone. It most commonly affects the wrist, hips, spine, and leg bones. Sometimes osteoporosis is called “low bone mineral density.”

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 of osteoporosis

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

Some signs and symptoms of osteoporosis may include:

Loss of height over time
A stooped posture
Bone fractures from minor injuries.

What survivors can do for bone health

Know your risks and monitor your health

Childhood cancer survivors should have annual checkups.

Share a copy of your Survivorship Care Plan with your physician. The plan includes details about your cancer treatment and information about health problems that may occur because of your treatment.

Recommended screenings for bone density

If you are at risk, your provider will likely recommend a baseline bone density scan when you begin long-term follow-up care.

The most commonly used bone density test is the dual X-ray absorptiometry, which is also called DXA. 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.

Prevention

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 and get enough Vitamin D. For more information, read Calcium and Vitamin D: Important at Every Age from the National Institutes of Health.

For more information, visit the Children’s Oncology Group’s Keeping Your Bones Healthy Health Link.

—
Together does not endorse any branded product mentioned in this article.

—
Reviewed: June 2020

Childhood Cancers

Blood Disorders

Infectious Diseases