Bone changes

Throughout our lives, old bone cells are broken down and replaced with new bone cells. This helps them keep their strength and shape. As we get older, our bones gradually become thinner and more fragile (less dense).

As a teenager or young adult, your bones are still developing and growing. Having some cancer treatments at a young age may sometimes cause bones to start aging earlier than usual. There are things you can do to help protect your bones. If you are worried about this, you can talk to your cancer doctor or nurse.

What can affect bone density?

It is important to remember that your treatment is carefully planned to limit side effects as much as possible. Not all cancer treatments affect the bones. But treatments that can affect the bones include:

• steroids, such as prednisone or dexamethasone, if you have them for a long time
• some types of chemotherapy drugs
• radiotherapy
• surgery to remove a bone tumour.

Sometimes, other things can affect bone density, such as hormone changes. But your doctors can give you hormone replacement medication to manage this. Other types of medicines may also affect bone density.

Keep taking all the medicines that your cancer doctor has prescribed for you. You can speak to your cancer doctor if you’re worried about any side effects. 

Other things that can affect your bones 

• having a family history of weakened bones (osteoporosis)
• having an illness that reduces bone health, such as inflammatory bowel disease, diabetes,
• coeliac disease or eating disorders
• not walking and moving around enough.

Sometimes radiotherapy can affect how well the blood flows to small areas of bone. This means that over time the bone doesn’t get enough nutrients and oxygen. This can slowly weaken the bone and sometimes cause a small area to break down. If this happens, it can cause pain and arthritis (inflammation) in that area. Occasionally, there may be more risk of a bone breaking as it may be weaker than usual.

People who have radiotherapy near the jaw area are at more risk of jaw and dental problems. It’s important to take extra care of your teeth during and after treatment.

Testing your bone density

If your cancer doctor thinks the treatment you had might affect your bones, they may arrange a bone density (DEXA) scan. The scan is painless and only takes a few minutes. You can wear your usual clothes if they don’t have any metal zips or buttons.

During the scan, you lie on your back on a couch. A scanner moves above your body. At the same time, a beam of low dose x-rays is passed through the part of your body being scanned. The scanner measures how much radiation passes through your bones. This shows whether you have normal bone density. The amount of radiation is very low.

Your doctor might give you some types of medicines to help strengthen your bones.

Calcium and vitamin D

If you’ve had treatment that increases the risk of bone thinning, your doctor might give you calcium and vitamin D supplements. 

Bisphosphonates

Bisphosphonates are types of drugs that help to prevent or slow down bone loss. Your doctor might give you bisphosphonates:

• to prevent bone loss caused by cancer treatment
• if you’re at risk of getting a broken bone (fracture)
• to prevent or treat a cancer that has spread to the bone (secondary cancer).

You usually have bisphosphonates as tablets. But you can also have them as a drip (infusion) into a vein.

Being more physically active

Doing regular physical activity or exercise when you are a young adult helps to make your bones stronger and thicker (denser). Regular exercise throughout your life will help to maintain your bone strength.

Choose something you enjoy so you’re more likely to carry on with it. The best exercises for your bones are weight-bearing exercises. These include walking, climbing stairs, dancing, hiking and gentle weightlifting. 

Eating a balanced diet

Eating a balanced diet and having enough calcium helps keep your bones healthy. It’s important to get enough vitamin D, as it helps your body absorb calcium. You can get vitamin D from sunlight but remember not to get too much sun exposure. 

Not smoking or drinking too much alcohol

It will help to protect your bones if you do not smoke or drink too much alcohol. Both these things can affect bone density.