Cancer, Exercise & Bone Health

Beyond the Break Web Module

Kate Smith, BKin. (Hons), R.Kin.

Program ManagerWellspring Cancer Support

Foundation (GTA)

Osteoporosis, Cancer and Exercise

• What is Osteoporosis and Osteopenia?• Cancer types that have a higher risk of affecting

bone health• Cancers types that have hormone involvement • Cancer treatments that affect bone health

• HOW EXERCISE CAN HELP!

Bone Density

Osteoporosis the ‘silent disease’

• brittle• porous• weak• easily damaged• subject to fracture

calcium mineralization bone densitystrengthT-score

= bone weakness and skeletal deformation

Osteopenia the ‘in between’

• Less than normal peak density• Not low enough to be

osteoporosis• Precursor to osteoporosis• T-score between -1.0 and -2.5

SD • Like osteoporosis, treatable not

curable

Osteopenia vs. Osteoporosis

Osteoporosis• Low bone mass• Deterioration of bone

tissue• Range in severity• Bone fragility • Risk of fracture

• Hips• Spine• Wrist• Shoulder

• Asymptomatic

Osteopenia• Lower peak bone density than

normal • Not as low as osteoporosis• Can develop into osteoporosis• Bone fragility • Risk of fracture

• Hips• Spine• Wrist• Shoulder

• Asymptomatic

Cancer Type and Risk of Osteoporosis

Bone Impacting Cancers

• Osteosarcoma• Chondrosarcoma• Ewing Sarcoma• Breast Cancer • Lung Cancer• Thyroid Cancer• Kidney Cancer• Prostate Cancer• Multiple Myeloma

Hormone Involved Cancers

• Breast Cancer• Endocrine receptor

positive• HER2 positive• Triple positive

• Prostate Cancer• Endometrial

Cancer• Uterine Cancer• Ovarian Cancer• Testicular Cancer

Bone Cancers

Metastasizes to bone

Cancer patients can experience side effects of diagnosis and treatment referred to as Secondary Osteoporosis or Secondary Osteopenia

Bone Cancers (Osteosarcoma, Chondrosarcoma, Ewing Sarcoma)

• Osteosarcoma• most common bone cancer

• develops in long bones

• young adults <30 years

• Chondrosarcoma• rare bone cancer• young adults

• Ewing Sarcoma• develops in long bones

• young adults and children

AFFECT BONE INTEGRITY AND CELL PRODUCTION

Bone Metastasis• Spread from

primary site, not ‘bone cancer’

• To any bone in the body

• Most common locations:• Spine• Pelvis• Ribs• Upper leg (femur)• Upper arm (humerus)

• Skull

Hormone Involved Cancers

Breast Cancer• Estrogen protective

effect on bone• Decrease estrogen

promotes bone loss• Treatment modalities

effect ovarian function = low estrogen levels

• Elicit early menopause in premenopausal women

Prostate Cancer• Testosterone protective

effect on bone• Hormone deprivation

therapy = increased risk

• Treatment modalities effect testosterone production

• Early and late stage to stop or decrease risk of spread

Cancer Treatment Effects on Osteoporosis

Surgery• Surgical resection of

cancer tumour or hormone producing organ Radiation Therapy

• The treatment of disease by the use of cytotoxic chemicals and other drugs.

Chemotherapy

Hormone Therapy

• Intense energy beams concentrated on location to kill cancer cells

• Hormone deprivation to impair cancer growth

Surgery

• Bone cancer • Limb salvaging or limb amputation

• Removal of hormone producing organs • Orchiectomy• Ovarectomy• Hysterectomy

Chemotherapy

• Calcium levels drop• Impair gonadal

function• Lead to loss of

serum estrogen• Effect bone

turnover• Suppress bone

marrow• Steroids • Anti-nauseants

Radiation Therapy

• Destroys bone tissue • Especially pelvic region

• Damage to osteoblasts

• Irradiation = increased osteoblasts

• Deterioration bone quality and quantity

Hormone Therapy

• Suppression of hormones

• Tamoxifen (breast)• Arimidex (breast)• Aromatase inhibitor

(breast)• LHRH (prostate)

Medications

• Anti-nauseates• Steroids• Bisphosphonates

How Exercise Helps

• Increases muscle strength

• Increase core strength

• Fall prevention training

• Balance training• Weight-bearing

exercise• Safe and

Progressive stress on muscle to pull on bone to induce bone rebuild

Physical Concerns & Oncological Emergencies

HOW IS CANCER DIFFERENT?• Fatigue• Falls & Fractures• Oxygen Saturation• Blood pressure/Heart

Rate • Spinal Compression

Fractures• Malignant Spinal Cord

Compression• Hypercalcamia• Dowanger’s hump +

breast cancer posture

Wellspring Cancer Exercise Program

• 30 week exercise program• Individual assessment• Specially trained health

professional• Experience in oncology• Group environment• Individualized program• Program for cancer patients • No cost to patient

Wellspring Cancer Exercise Program

https://www.youtube.com/watch?v=f-d8Y6fbrQA

Questions?

Referenceshttp://www.niams.nih.gov/Health_Info/Bone/Bone_Health/bone_mass_measure.asphttp://www.naturalhealthadvisory.com/daily/osteoporosis-prevention-and-treatment/bone-density-chart-understand-your-bone-density-scores/ http://www.webmd.com/osteoporosis/tc/osteopenia-overviewhttps://dianecasey56.wordpress.com/2013/10/28/what-exactly-is-osteoporosis-what-is-osteopenia/http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&ContentID=26578-1http://www.womens-health-advice.com/osteoporosis/osteopenia.htmlhttp://www-rohan.sdsu.edu/~pcipart6/Bone/osteosarcoma.htmlhttp://www.emedicinehealth.com/bone_cancer/article_em.htm http://www.aboutcancer.com/hosp6.htmhttp://www.aboutcancer.com/hosp6.htmhttp://www.cancer.org/treatment/understandingyourdiagnosis/bonemetastasis/bone-metastasis-detailed-guide-tochttp://www.webmd.com/breast-cancer/breast-cancer-and-osteoporosis?page=3 http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/osteoporosis_prostate_cancer.asp#b http://www2.mdanderson.org/depts/oncolog/articles/10/3-mar/3-10-2.html http://yaletownnaturopathic.com/fasting-before-chemotherapy/http://www.telegraph.co.uk/news/health/news/7985399/Thousands-of-cancer-patients-missing-out-on-radiotherapy.htmlhttp://onlinelibrary.wiley.com/doi/10.1002/9781118453926.ch88/summaryhttp://www.diseasesanddrugs.com/2014/07/hormonal-treatment-for-prostate-cancer.htmlhttp://www.medscape.org/viewarticle/444817_3 http://umm.edu/health/medical/reports/articles/osteoporosishttps://nigelwayne.wordpress.com/ https://rickolddoc.wordpress.com/2013/12/13/treatment-of-osteoporosis-and-fragility-fractures/http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-physically/spinal/what-spinal-cord-compression-is http://www.massagetherapy.com/articles/index.php/article_id/1260/Osteoporosis-and-Hyperkyphosis%3A-What-Does-Calcium-Have-to-Do-With-ItSteele, J. CancerSmart Rehab Techniques in Oncology Course NotesSteele, J. CancerSmart Rehab Advanced Techniques in Oncology Course NotesNewcastle University ONC8002: Cancer Pathology Course Notes