Side Effect: Bone Fracture (Broken Bone)

• A bone fraction is a condition where there is a partial or complete break in a bone.
• Fractures can occur for various reasons such as accidents, falls, or bone loss also known as osteoporosis.
• Patients with cancer can experience bone loss at a faster rate due to certain cancer treatments, low muscle mass, or radiation therapy.

Symptoms of a bone fracture can include:

• severe pain
• swelling
• a snapping sound heard when the bone breaks
• skin bruising or bleeding
• a change in the appearance of the limb
• loss of function of the affected limb where the bone is broken

Symptoms of bone loss are often invisible to the naked eye, so your healthcare team will need to order a test to check your bone density. The test most commonly used is called a DXA or “DEXA” scan which stands for Dual Energy X-ray Absorptiometry scan, which is a painless and easy-to-conduct study.

• Women tend to be at the highest risk of bone fracture.
• The risk of a fracture and bone loss also increases for patients over 50 years of age.
• If you’ve had a hematopoietic stem cell transplant, you may also be at higher risk of bone loss.
• Cancer treatments that affect hormone levels also increase the risk of bone loss and possible fracture. This includes chemotherapy that affects the ovaries or testicles as well as treatments that target hormone production. Examples of hormonal therapy include:
  • anastrozole (Arimidex®)
  • exemestane (Aromasin®)
  • letrozole (Femara®)
  • goserelin (Zoladex®)
  • leuprorlide (Lupron®)
  • triptorelin (Trelstar®)

Studies have also shown that targeted therapies such as imatinib, nilotinib, and dasatinib, as well as ibrutinib can increase bone loss that may increase the risk of bone fracture.

In some cases, steroids are part of cancer treatment. Taking steroids for an extended period of time (greater than 3 months) can increase the risk of bone fractures.

Certain cancers, such as multiple myeloma, may invade bones causing them to weaken under normal pressure. Over time, the bone may weaken to a point where a person may break a leg simply by standing from a seated position. This type of bone break is known as a “pathologic fracture.”

Preventing bone fracture in patients with cancer involves a combination of lifestyle changes, such as maintaining a healthy diet rich in calcium and vitamin D and engaging in regular exercise.

Calcium rich foods include:

• milk
• yogurt
• cheese
• broccoli

Foods rich in vitamin D include:

• milk fortified with vitamin D

Your physician may also recommend targeted treatments to prevent bone loss and improve bone density such as bisphosphonates or denosumab (Prolia®, Xgeva®). Common bisphosphonates include:

Intravenous infusions:

• Zoledronic acid (Reclast®, Zometa®)
• Pamidronate (Aredia®)

Oral pills:

• Ibandronate (Boniva®)
• Alendronate (Fosamax®)