Some treatments for breast cancer can contribute to bone loss. But you may be able to reduce the risk with a nutritious diet, weight-bearing exercise, certain medications, and other practices.

While some bone loss during breast cancer treatment may be inevitable, you can take steps to help slow down the process.

Here are seven ways to keep your bones strong and healthy during breast cancer treatment.

Some breast cancer treatments may increase your risk for bone loss, osteoporosis, and fractures. Metastatic breast cancer that has spread to the bones can also increase the risk of fractures.

For instance:

  • Some chemotherapy medicines can affect bone health by causing early menopause.
  • Aromatase inhibitors, a type of hormonal therapy that prevents estrogen formation, can lead to bone loss.
  • Using medications or surgery to shut down the ovaries can also cause a sudden drop in bone density.

A doctor may talk with you about targeted medications that help with bone strength during breast cancer treatment.

Bisphosphonates are one class of drugs that can help reduce bone loss and the risk of fracture in postmenopausal women with estrogen-receptor-positive disease who receive aromatase inhibitors.

Bisphosphonates include:

  • risedronate
  • zoledronic acid
  • alendronate
  • ibandronate

Raloxifene is a selective estrogen receptor modulator used to treat and prevent osteoporosis in postmenopausal people.

The targeted therapy drug denosumab can reduce the risk of bone complications caused by advanced-stage breast cancer.

Weight-bearing exercise is any activity that requires you to be on your feet, with your bones supporting your weight. This type of exercise forces you to work against gravity, which helps strengthen the bones.

Examples of weight-bearing aerobic activities include:

  • walking
  • jogging
  • dancing
  • hiking
  • stair climbing
  • racquet sports

The other type of activity that is critical to bone health is resistance exercises, such as lifting weights, according to the National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS).

A 2017 systematic review found evidence to suggest that exercise may contribute to “a clinically important preservation of bone health” for premenopausal women diagnosed with breast cancer.

An additional study published in 2021 found that a 12-month exercise program for premenopausal women with early breast cancer helped prevent bone loss for 3 years.

For maximum bone health, you can participate in a combined weight-bearing aerobic and resistance training program at least 3 to 4 days per week for 30 to 60 minutes.

This will also help you meet the minimum recommended exercise guidelines of 150 to 300 minutes of moderate intensity aerobic activity each week or 75 minutes of vigorous intensity physical activity set by the Department of Health and Human Services.

Vitamin D and calcium intake are critical during breast cancer treatment. You can get vitamin D from supplements and your diet, as well as through the skin from sunlight.

In general, experts recommend an intake of 600 IU per day for people up to age 70 and 800 IU per day after age 70.

In addition, anyone 19 to 30 years old should get 1,000 milligrams (mg) of calcium per day, and women ages 51 to 70 should get a minimum of 1,200 mg of calcium per day, according to NIAMS.

Dietary sources of vitamin D include:

  • sardines
  • cod liver oil
  • salmon
  • swordfish
  • orange juice fortified with vitamin D
  • egg yolks
  • vitamin D-fortified cereals
  • beef liver
  • vitamin-fortified dairy products

Dietary sources of calcium include:

  • milk and dairy products
  • calcium-fortified breakfast cereals
  • green leafy vegetables
  • fish, including larger fish like salmon and tuna and small fish like sardines
  • calcium-fortified orange juice
  • edamame
  • almonds

Eating a varied and balanced diet full of nutrient-dense food can help support bone health while undergoing breast cancer treatment.

According to the Dietary Guidelines for Americans, a nutrient-rich diet includes:

  • vegetables of all types
  • fruits
  • grains (focus on whole grains)
  • dairy (fat-free or low fat milk, yogurt, and cheese)
  • lean protein (poultry, seafood, lean meats, eggs, beans, peas, and lentils)
  • omega-3 fatty acids
  • foods rich in vitamin D
  • calcium-rich foods

There’s a direct relationship between decreased bone density and tobacco use, which makes cigarette smoking a risk factor for osteoporosis and fractures, according to the NIAMS.

Smoking also causes fractures to heal slower because of the harmful effect of nicotine on bone-forming cells, according to the American Academy of Orthopaedic Surgeons.

If you smoke, you can talk with a doctor about a smoking cessation program. Quitting smoking is critical, especially when going through breast cancer treatment.

Consuming too much alcohol could have a detrimental impact on your bones and overall health.

A 2019 review found alcohol can affect bone thickness and strength. Researchers found that people who consume 1 to 2 drinks per day had a 1.34 times the risk of developing osteoporosis compared to nondrinkers.

So, if you consume more than one alcoholic drink per day, consider reducing the number of days you drink or cut back on daily consumption.

It’s also a good idea to talk with a doctor about ways to cut back, specifically as it relates to your treatment plan.

Getting an accurate assessment of your bone health before starting breast cancer treatment can allow a doctor to measure any loss you may experience.

American Bone Health recommends getting a bone density test before treatment and then every 1 to 2 years during treatment.

One example of a bone density test is a dual-energy X-ray absorptiometry, commonly known as a DEXA scan. In addition to measuring the bone mineral density of your whole skeleton, a DEXA scan also measures specific points that are more likely to break, such as the:

  • hips
  • spine
  • wrists

Is there a link between osteoporosis and breast cancer?

Some breast cancer treatments may increase your risk of osteoporosis by causing early menopause, which can affect your bone density.

What cancer is associated with osteoporosis?

Cancer can develop in the bones or spread from other organs to the bones, causing bone loss. Certain breast cancer treatments can also cause osteoporosis.

Can osteoporosis turn into cancer?

No, osteoporosis cannot turn into cancer but cancer can cause bone loss and weakness. This can include cancers that start in the bones or cancer that spread to the bones.

Is osteoporosis a long-term and late effect of breast cancer treatments?

People who undergo certain breast cancer treatments, including some chemotherapy medications, aromatase inhibitors, and using medications or surgery to shut down the ovaries, may have an increased risk of osteoporosis.

People may also develop bone loss or weakness if breast cancer spreads to the bones.

Certain breast cancer treatments can contribute to bone loss. Yet there are things you can do to boost bone health and reduce the risk of loss and fracture.

Eating a diet high in vitamin D and calcium, participating in weight-bearing exercise, avoiding smoking, and taking any medications prescribed by a doctor are just a few ways to increase your bone health during breast cancer treatment.

Talk with a doctor if you have any questions about bone loss and ways to keep your bones strong during treatment.

It might also be helpful to connect with a registered dietician and physical therapist to help you design a specialized diet and exercise plan for preventing bone loss.