Areas of Expertise:
- Orthopedic oncology, including the diagnosis and surgical treatment of bone and soft tissue tumors
- Diagnosis and treatment of osteoporosis
- Minimally invasive surgical treatment of gouty tophi
- Knee and hip joint reconstruction and joint replacement surgery
- General orthopedics
- Fracture and trauma care
- Degenerative joint diseases
Following a cancer diagnosis, it is natural for patients to focus
entirely on tumor treatment. However, an often-overlooked side effect of cancer
therapy is its impact on bone strength. In fact, cancer treatment-induced bone
loss often progresses much faster than normal age-related bone decline. If left
unaddressed, osteoporosis and related fractures can compromise mobility, lower
quality of life, and disrupt cancer therapies.
To support patients through their treatment journey, the Osteoporosis Center at Far Eastern Memorial Hospital (FEMH)
offers dedicated, patient-friendly, and convenient one-stop care to safeguard
bone health every step of the way.
1. Why Do Cancer
Therapies Weaken Bones?
Healthy bone tissue continuously renews itself through bone remodeling (a
balance between breaking down old bone and building new bone). Several cancer
treatments disrupt this equilibrium, accelerating bone loss:
- Hormone
Therapy (Endocrine Therapy):
- Breast
Cancer (Aromatase Inhibitors, such as Anastrozole): These medications
dramatically lower estrogen levels (female sex hormones). Without
estrogen’s protective effect on bone tissue, bone loss can occur two to
four times faster than in postmenopausal women who are not on these
therapies.
- Prostate
Cancer (Androgen Deprivation Therapy / ADT): Suppresses androgens (male sex
hormones), likewise accelerating bone demineralization and raising
fracture risks.
- Chemotherapy
and Radiation Therapy:
These treatments can impair bone-forming cells directly or cause premature
ovarian or testicular failure.
- Steroids
(Corticosteroids):
Frequently prescribed to control chemotherapy-induced nausea or reduce
inflammation, prolonged or high-dose steroid use inhibits new bone
formation.
- Bone
Metastasis:
When cancer cells spread to bone tissue, they compromise skeletal
integrity, significantly raising the risk of pathological fractures
(fractures occurring under minimal stress due to underlying bone disease).
2. When Should You
Have a Bone Density Test?
Patients planning to start or currently undergoing hormone therapy, long-term steroid treatments, or those
with higher baseline fracture risks should undergo an initial bone density
assessment prior to or early in treatment.
- The
Gold Standard: Dual-Energy X-ray Absorptiometry (DXA), which
measures bone mineral density at the lumbar spine and hips.
- Understanding
Your T-Score:
- > -1.0: Normal bone density.
- -1.0 to -2.5: Osteopenia (low bone mass;
early bone thinning).
- < -2.5: Osteoporosis (significant bone
fragility requiring medical intervention).
- Follow-up
Frequency:
High-risk patients should generally repeat a DXA scan every 1 to 2 years
to track bone changes.
3. Bone Protection
Medications and Dental Precautions
When bone density falls below safe thresholds, clinicians may prescribe
medications to slow bone breakdown and reduce fracture risks:
- Common
Medication Classes:
- Bisphosphonates: Inhibit osteoclasts (cells
that break down bone), effectively preserving bone architecture.
- Monoclonal
Antibodies (Denosumab / subcutaneous injections): Administered once every
six months to halt bone loss. This is an effective choice for individuals
with impaired kidney function or difficulty taking oral pills.
- Important
Pre-treatment Step: Dental Clearance
- Both
medication classes carry a small risk of Osteonecrosis of the Jaw
(ONJ), a condition where the jawbone fails to heal properly.
- Essential
Action: Before starting these medications, undergo a
comprehensive dental evaluation. Complete any necessary invasive dental
procedures—such as extractions, dental implants, or deep scaling—in
advance. Maintain meticulous oral hygiene during therapy and avoid
invasive jaw procedures while on treatment.
- Nutritional
Support:
With your physician's approval, aim for 1,000–1,200 mg of calcium
and 800–1,000 IU of vitamin D3 daily to provide
essential building blocks for bone maintenance.
4. Exercise
Guidelines for Bone Health
Appropriate exercise provides mechanical stimulation to promote bone
preservation and counter muscle wasting:
- Weight-Bearing
Aerobic Activities:
- Recommended: Brisk walking, stair
climbing, low-impact hiking.
- Benefits: Ground reaction forces
stimulate bone-forming cells throughout the spine and lower limbs.
- Dose: 30 minutes per session, 3
to 5 days per week, at a moderate intensity (mild sweating while
remaining able to carry on a conversation).
- Progressive
Resistance Training (Strength Exercises):
- Recommended: Resistance bands,
bodyweight sit-to-stand repetitions, light dumbbells.
- Benefits: Muscle contractions pull
on bone attachments, strengthening the hip and spine. Aim for 2 to 3
sessions weekly.
- Balance
and Stability Training:
- Recommended: Tai Chi, single-leg
stands, straight-line walking.
- Benefits: Enhances neuromuscular
coordination to prevent falls caused by treatment-related fatigue or
neuropathy.
- If
diagnosed with osteoporosis or bone metastases, avoid deep forward spinal
flexion (bending from the waist), extreme spinal twisting (certain yoga
poses), and high-impact jumps to prevent vertebral compression or
pathological fractures.
5. FEMH
Osteoporosis Education Center: Accessible and Coordinated Care
Managing cancer care while protecting bone health does not have to be
complicated. The FEMH Osteoporosis Center
streamlines support through integrated services:
- Dedicated
Case Managers:
One-on-one assessments evaluating fracture risks (FRAX), individualized
nutrition guidance, and tailored exercise recommendations.
- Multidisciplinary
Coordination:
Smooth referrals linking Orthopedics, Oncology, and Dentistry, organizing
DXA scans and dental clearances without redundant hospital visits.
- Ongoing
Follow-up Care:
Proactive scheduling and treatment reminders to maintain continuous bone
protection throughout your cancer journey.
6. Practical Fall
Prevention Tips
- Improve
Home Safety:
Keep walkways well-lit and free of clutter. Install sturdy grab bars and
non-slip mats in the bathroom.
- Limit
Alcohol and Avoid Smoking: Tobacco and excessive alcohol intake accelerate bone
mineral loss and can reduce the efficacy of medications.
Maintaining healthy bones is integral to comprehensive cancer care. Speak
with your healthcare team about your bone health, and make full use of the
resources at the FEMH Osteoporosis Center to stay
active, mobile, and strong throughout treatment.
- Follow-up
Frequency:
High-risk patients should generally repeat a DXA scan every 1 to 2 years
to track bone changes.
3. Bone Protection
Medications and Dental Precautions
When bone density falls below safe thresholds, clinicians may prescribe
medications to slow bone breakdown and reduce fracture risks:
- Common
Medication Classes:
- Bisphosphonates: Inhibit osteoclasts (cells
that break down bone), effectively preserving bone architecture.
- Monoclonal
Antibodies (Denosumab / subcutaneous injections): Administered once every
six months to halt bone loss. This is an effective choice for individuals
with impaired kidney function or difficulty taking oral pills.
- Important
Pre-treatment Step: Dental Clearance
- Both
medication classes carry a small risk of Osteonecrosis of the Jaw
(ONJ), a condition where the jawbone fails to heal properly.
- Essential
Action: Before starting these medications, undergo a
comprehensive dental evaluation. Complete any necessary invasive dental
procedures—such as extractions, dental implants, or deep scaling—in
advance. Maintain meticulous oral hygiene during therapy and avoid
invasive jaw procedures while on treatment.
- Nutritional
Support:
With your physician's approval, aim for 1,000–1,200 mg of calcium
and 800–1,000 IU of vitamin D3 daily to provide
essential building blocks for bone maintenance.
4. Exercise
Guidelines for Bone Health
Appropriate exercise provides mechanical stimulation to promote bone
preservation and counter muscle wasting:
- Weight-Bearing
Aerobic Activities:
- Recommended: Brisk walking, stair
climbing, low-impact hiking.
- Benefits: Ground reaction forces
stimulate bone-forming cells throughout the spine and lower limbs.
- Dose: 30 minutes per session, 3
to 5 days per week, at a moderate intensity (mild sweating while
remaining able to carry on a conversation).
- Progressive
Resistance Training (Strength Exercises):
- Recommended: Resistance bands,
bodyweight sit-to-stand repetitions, light dumbbells.
- Benefits: Muscle contractions pull
on bone attachments, strengthening the hip and spine. Aim for 2 to 3
sessions weekly.
- Balance
and Stability Training:
- Recommended: Tai Chi, single-leg
stands, straight-line walking.
- Benefits: Enhances neuromuscular
coordination to prevent falls caused by treatment-related fatigue or
neuropathy.
- If
diagnosed with osteoporosis or bone metastases, avoid deep forward spinal
flexion (bending from the waist), extreme spinal twisting (certain yoga
poses), and high-impact jumps to prevent vertebral compression or
pathological fractures.
5. FEMH
Osteoporosis Education Center: Accessible and Coordinated Care
Managing cancer care while protecting bone health does not have to be
complicated. The FEMH Osteoporosis Center
streamlines support through integrated services:
- Dedicated
Case Managers:
One-on-one assessments evaluating fracture risks (FRAX), individualized
nutrition guidance, and tailored exercise recommendations.
- Multidisciplinary
Coordination:
Smooth referrals linking Orthopedics, Oncology, and Dentistry, organizing
DXA scans and dental clearances without redundant hospital visits.
- Ongoing
Follow-up Care:
Proactive scheduling and treatment reminders to maintain continuous bone
protection throughout your cancer journey.
6. Practical Fall
Prevention Tips
- Improve
Home Safety:
Keep walkways well-lit and free of clutter. Install sturdy grab bars and
non-slip mats in the bathroom.
- Limit
Alcohol and Avoid Smoking: Tobacco and excessive alcohol intake accelerate bone
mineral loss and can reduce the efficacy of medications.
Maintaining healthy bones is integral to comprehensive cancer care. Speak
with your healthcare team about your bone health, and make full use of the
resources at the FEMH Osteoporosis Center to stay
active, mobile, and strong throughout treatment.