Using Physical Therapy for Treating Osteoporosis in Cancer Patients

Treating osteoporosis in cancer patients is a particular concern since chemotherapy contributes to bone loss and lack of balance, which increases the risk of falling and breaking a bone. The article will explore the symptoms, causes and treatments for osteoporosis in cancer patients.

What is Osteoporosis?

Osteoporosis is a bone condition in which the skeleton begins to become too “porous”—full of tiny holes, like a hard sponge.  The bones do not change shape (initially), but become increasingly less dense, and consequently more fragile.

Bones, of course, are living tissue made of cells (called “osteoclasts”).  These cells are continually dying and being rebuilt.  But for multiple reasons, the rebuilding can sometimes not keep up with the breaking down.  That’s what causes osteoporosis.

Osteoporosis (source)

Symptoms of Osteoporosis

Early on there are no obvious symptoms.  Long-term, though, yes, there can be several very unpleasant symptoms of osteoporosis, including:

  • Back pain, caused by a fractured or collapsed vertebra
  • Loss of height over time
  • A stooped posture
  • A bone that breaks much more easily than expected

In those who are young and healthy, a broken bone is usually somewhere between a minor and a major inconvenience.  But in those who are elderly, or who are dealing with some other health condition already—like cancer—a break in the wrist, spine, or hip can be crippling.

If you read the previous blog post on neuropathy, you’ll know that cancer treatments can also cause muscle weakness and balance issues.  This is obviously not a good combination to have with weakened bones.

How Cancer Treatments Cause Osteoporosis

Both cancer and its treatments have pretty high odds of shutting down bone growth, either directly or else by shutting down or blocking the hormones that are required for bone growth.  In women the affected hormones are mostly estrogens; in men, androgens.

Many chemotherapies deliberately interfere with sex hormones as a means of treating ovarian, breast, or prostate cancers, in particular.  And corticosteroids—often used against nausea and other side effects of cancer therapies—are themselves detrimental to bone health.  For more details, see this article from the Bone Health and Osteoporosis Foundation.

Nutrition for Treating Osteoporosis

Any bone growth or repair needs calcium, and calcium management in the body also requires magnesium and Vitamin D.  But of course, the full truth is more complex.  “Drink your milk” is insufficient dietary advice for getting stronger bones!

In the first place, nutrition is more than diet.  You have to not only eat right, but in order to use the nutrients in your foods you also have to:

  • Digest fully
  • Absorb nutrients properly in the intestines
  • Transport the nutrients efficiently through the bloodstream
  • Get the nutrients into the cells where they’re needed through cell-wall transport
  • Have all the hormones, micronutrients, co-factors, and other “chemistry ingredients” in place, in the right ratios.

Then, and only then, do you have true “nutrition” happening.  If any of these steps break down, your lovely “nutrient” hangs out somewhere doing nothing until it degrades into a toxin and a liability that has to get excreted.

So, in terms of the bones, it's possible to be overdosing on calcium, and still losing bone mass.  Bone health is a whole-body issue that has to be addressed holistically.  (Which means diet, but not just diet.)

Treatments for Osteoporosis

There are medications that can help prevent bone loss, but most of these are associated with increased risk of serious adverse side effects.  Also, while these drugs can in fact increase bone mass density (BMD), they do not necessarily lower the risk of fracture, which is the main goal.

Here are some other treatment options to consider:

A Partial List of Osteoporosis Treatments

Dietary Changes

  • Plenty of everything that’s necessary for bone upkeep: chelated calcium & magnesium, vitamin D, vitamin K
  • Foods and supplements rich in red/orange pigments, i.e., the carotenoids, most notably lycopene (study)
  • 2-10 dried plums (prunes) daily helps with estrogen issues (study) and provides polyphenols and trace minerals.  Organic apples, unpeeled, are good for similar reasons.
  • Daily intake of green/yellow vegetables has shown ~5x less risk of bone density loss (study)
  • Some estrogen-rich foods like black cohosh and hops seem to have similar benefits to estrogen therapy, without side effects.
  • Sesame seeds and coriander
  • Pineapple
  • Mercury-free fish oils rich in omega-3 fatty acids

Whole-Body Treatments

  • Investigate acupuncture
  • Since bone density depends on various hormones, especially estrogen, various types of hormone therapy are sometimes used.  Ask your doctor if you are interested but be aware of potential side effects.

Lifestyle Changes

  • Be active outside!
  • Get sunshine, but also do your best to avoid exposure to air pollution (e.g., jog on forest trails, not sidewalks along highways)
  • Perform regular low-impact exercise and perhaps especially group exercise
  • Obtain targeted physical therapy (see below)

Almost all of these therapies have a multitude of other benefits, beyond just bone health.  At any time, you want the best “return on investment” from the effort you’re putting towards your health.  But in a time of health crisis, like a cancer battle, “high ROI” isn’t just desirable, it’s vital.

A holistic food, exercise, and physical therapy routine can treat (and prevent!) several issues simultaneously. And this typically requires expert input.  That’s where Oncology Rehab and Wellness comes in.

Physical Therapy (PT) for Treating Osteoporosis

Just like strenuous exercise builds muscle mass, the right kind of stress also builds bone mass.  Of course you can overdo it and create injury, but you can also under-do it: lying in bed and “convalescing” is appropriate for some conditions, but not for osteoporosis.  Bones atrophy with dis-use, just like muscles and brain cells.

Here’s another consideration: at the beginning of the article, I mentioned that osteoporosis has no immediate symptoms early on.  One way of looking at that truth is to say: “a little bit of osteoporosis isn’t that big a deal—so long as you don’t fall down!”  Or in other words: if the main risk of osteoporosis is (for example) breaking a hip, but you never fall such as to break the hip, then how much should you worry about the osteoporosis?

Here’s the point.  Severe fractures are chiefly associated with falling.  There are cases where a bone breaks first and a fall results, but that is not typical.  Falling is chiefly associated not with osteoporosis but with things like stepping wrongly, overbalancing, and having weakened muscles and/or nerves.

The good news is proper physical therapy not only restores bones, it also strengthens muscles, trains nerves, enhances balance, builds heart and lung capacity—a host of benefits that all work together to produce greater whole-body health and reduce numerous risks at once.

If you are recovering from cancer treatment, and are concerned about your bone health now or in the future, physical therapy is a great first place to start rebuilding.

Your PT can assist you with selecting the therapies that are best suited to help in your specific situation.  These will be tailored for the details of your current conditioning and any considerations stemming from cancer treatment, and could include things like:

  • Weight-bearing activities (including walking or jogging)
  • Resistance training (such as weight lifting or yoga)
  • Balance and posture exercises
  • “Bone-safe” education for everyday activities
  • Nutritional and lifestyle advice

This meta-study reviews current research and backs up many of the bullets above.

Our Osteoporosis Treatments

At Oncology Rehab and Wellness, we have an expert physical therapy and nutrition team who work together to help cancer patients prevent bone loss - or to increase bone density if already diagnosed with osteoporosis or osteopenia.

Our program for treating osteoporosis in cancer patients includes a full assessment of strength, posture, flexibility, balance and overall function followed by the development of a progressive exercise program based on your individual needs.

To learn more about how our cancer rehab services could help you, call us at (703) 789-0367 or schedule a 15-minute consultation.