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Womens Healthcare 2020

Looking after bone health in metastatic breast cancer

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Professor Cathy Kelly

Consultant Oncologist

A person has metastatic breast cancer when breast cancer spreads to other parts of the body for example bones, liver, lung or brain.

The most common part of the body for breast cancer to travel to is bone. When breast cancer is in the bones we say the person has bone metastases .The diagnosis is usually made when the person complains of bone pain and tenderness.

In most cases the diagnosis is straightforward, however sometimes it can be difficult if the person has other bone and joint problems such as a degenerative disease, inflammatory joint conditions or previous bone injuries that cause them ongoing pain. There are many different radiological tests that are used to detect and determine the extent of bone metastases. These include plain X-rays, CT, MRI and bone scans.

Treatment options for bone metastases

Bone metastases can cause a number of problems such as fractures, bone pain, pressure on nerves and in some cases levels of calcium in the person’s blood can increase and make them feel unwell.  Thankfully there are many excellent treatment options. Medical oncologists can prescribe bone modifying agents. These are drugs typically used to treat osteoporosis and they have resulted in a dramatic reduction in the number of skeletal complications seen in people with bone metastases. 

They are also associated with improvements in bone pain and quality of life. Treatment with these drugs can cause blood levels of calcium to fall so patients need to take regular calcium and vitamin D supplements to prevent this. 

Another important side effect associated with these drugs is a condition called osteonecrosis of the jaw.  In order to minimise the risk of ONJ a dental review before starting bone modifying drugs is advised.

Maintaining quality of life and mobility

For painful bone metastases a single dose of radiation is often very effective and in some cases orthopaedic surgeons can stabilise or insert pins into bones that have become unstable as a result of the bone metastases. Palliative care specialists are also crucial in making sure pain is not a problem and this is essential to maintain quality of life, and mobility.   

For postmenopausal women with a history of breast cancer that has been fully removed, bone modifying drugs i.e. osteoporosis drugs can be prescribed to reduce the risk of their cancer coming back in their bones. Often these women are taking hormonal treatments that can cause a reduction in their bone density so giving them an osteoporosis drug can have two benefits. Firstly, it can improve their bone density, and secondly it can reduce their risk of breast cancer reoccurring in their bones.

Amgen had no editorial input

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