1. Cancer, Exercise & Bone Health
Beyond the Break Web Module
Kate Smith, BKin. (Hons), R.Kin.
Program Manager
Wellspring Cancer Support Foundation (GTA)

2. 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!

3. Bone Density

4. Osteoporosis the ‘silent disease’
brittle
porous
weak
easily damaged
subject to fracture
calcium
mineralization
bone density
strength
T-score
= bone weakness and skeletal deformation

5. 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

6. Osteopenia vs. Osteoporosis
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
Low bone mass
Deterioration of bone tissue
Range in severity
Bone fragility
Risk of fracture
Hips
Spine
Wrist
Shoulder
Asymptomatic

7. Cancer Type and Risk of Osteoporosis
Cancer patients can experience side effects of diagnosis and treatment referred to as Secondary Osteoporosis or Secondary Osteopenia
Hormone Involved Cancers
Bone Impacting Cancers
Osteosarcoma
Chondrosarcoma
Ewing Sarcoma
Breast Cancer
Lung Cancer
Thyroid Cancer
Kidney Cancer
Prostate Cancer
Multiple Myeloma
Breast Cancer
Endocrine receptor positive
HER2 positive
Triple positive
Prostate Cancer
Endometrial Cancer
Uterine Cancer
Ovarian Cancer
Testicular Cancer
Bone Cancers
Metastasizes to bone

8. Bone Cancers (Osteosarcoma, Chondrosarcoma, Ewing Sarcoma)
most common bone cancer
develops in long bones
young adults <30 years
Chondrosarcoma
rare bone cancer
young adults
Ewing Sarcoma
young adults and children
AFFECT BONE INTEGRITY AND CELL PRODUCTION

9. 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

10. Hormone Involved Cancers
Breast Cancer
Prostate 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
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

11. Cancer Treatment Effects on Osteoporosis
Surgery
Chemotherapy
Surgical resection of cancer tumour or hormone producing organ
The treatment of disease by the use of cytotoxic chemicals and other drugs.
Radiation Therapy
Hormone Therapy
Intense energy beams concentrated on location to kill cancer cells
Hormone deprivation to impair cancer growth

12. Surgery Bone cancer Removal of hormone producing organs
Limb salvaging or limb amputation
Removal of hormone producing organs
Orchiectomy
Ovarectomy
Hysterectomy

13. Chemotherapy Calcium levels drop Impair gonadal function
Lead to loss of serum estrogen
Effect bone turnover
Suppress bone marrow
Steroids
Anti-nauseants

14. Radiation Therapy Destroys bone tissue Damage to osteoblasts
Especially pelvic region
Damage to osteoblasts
Irradiation = increased osteoblasts
Deterioration bone quality and quantity

15. Hormone Therapy Suppression of hormones Tamoxifen (breast)
Arimidex (breast)
Aromatase inhibitor (breast)
LHRH (prostate)

16. Medications
Anti-nauseates
Steroids
Bisphosphonates

17. 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

18. 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

19. 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

20. Wellspring Cancer Exercise Program

21. Questions?

22. References
Steele, J. CancerSmart Rehab Techniques in Oncology Course Notes
Steele, J. CancerSmart Rehab Advanced Techniques in Oncology Course Notes
Newcastle University ONC8002: Cancer Pathology Course Notes