Osteoporosis
People with cancer may be at risk for osteoporosis, especially if they’re receiving certain cancer treatments. Osteoporosis can lead to broken bones, pain, and trouble moving around. Taking care of your bones is an important part of staying healthy and maintaining quality of life during cancer care.
What is osteoporosis?
Osteoporosis happens when the body breaks down more bone tissue than it can replace. This leads to a decrease in the amount and thickness of bone (bone mass). As a result, bones become weak and fragile – making them more likely to fracture or break.
What causes osteoporosis?
Your bones are always changing. Over your lifetime, your body breaks down old bone and builds new bone to replace it. Until your mid-20s, new bone is built faster than old bone is broken down. Bone mass usually reaches its peak around age 30. After that, bone is replaced more slowly, which can lead to thinner, weaker bones, also known as bone thinning or bone loss.
Risk factors for osteoporosis not related to cancer include:
- Sex: Women, especially after menopause, are at higher risk due to lower estrogen levels.
- Age: The risk of osteoporosis increases as you get older.
- Smoking and chronic heavy alcohol use: Both can weaken bones and increase risk.
- Family history: Having close relatives with osteoporosis raises your risk.
- Hormone levels: Low estrogen or testosterone, or high thyroid hormone, can lead to bone loss.
- Nutrition problems: Not getting enough calcium or vitamin D increases risk.
- Medical problems: Certain GI disorders like celiac disease or inflammatory bowel disease, autoimmune diseases like rheumatoid arthritis or lupus, kidney or liver disease, some cancers, or GI surgeries can raise risk.
- Physical inactivity: People who are inactive or on long-term bed rest are more likely to get osteoporosis.
- Body size: People who are thin or have a small frame are at higher risk.
- Medications: Hormone therapy used for cancer treatment, as well as long-term use of steroids, thyroid meds, or some heartburn drugs, can weaken bones.
Cancer, cancer treatment, and osteoporosis
Certain kinds of cancer, cancer that has spread to the bone, and some cancer treatments can increase your risk of fracture, cause osteoporosis, or make it worse. These include:
- Cancer that starts in the bone
- Cancer that has spread to the bone, including breast cancer, prostate cancer, multiple myeloma, and lung cancer
- Certain types of chemotherapy
- Hormone therapy for breast or prostate cancer, which can lower hormone levels that contribute to bone mass and density
- Treatments that cause early menopause, like surgery for ovarian cancer
Is osteoporosis a sign of cancer?
Osteoporosis isn’t usually a sign of cancer. Most often, it happens as a result of getting older or because of hormone changes after menopause. Some cancers or cancer treatments (like the ones above) can cause bone loss, but having osteoporosis doesn’t automatically mean you have cancer.
What are symptoms of osteoporosis?
Osteoporosis doesn’t happen suddenly. But many people don’t know they have it until they break a bone, have pain, lose height or start to hunch over, or have trouble getting around. Sometimes the signs of osteoporosis are mistaken for arthritis, another bone disease that affects the joints.
Symptoms of osteoporosis include:
- Back pain
- Unusual loss of height over time
- Stooped posture or curved upper back
- Painful joints or stiffness
- Breaking a bone more easily than expected, such as after a minor injury
Diagnosing osteoporosis
Osteoporosis is diagnosed by measuring bone density. The most common test for this is a DEXA (dual energy X-ray absorptiometry) scan, also called a bone density scan. You may have this test before, during, and after cancer treatment.
A bone density scan checks how strong your bones are by measuring how much calcium and other minerals they contain. The scan usually focuses on your hip or lower spine. Higher bone mineral levels mean stronger, denser bones. The results are given as a score that falls into one of three categories:
- Normal bone density
- Low bone density (osteopenia)
- Very low bone density (osteoporosis)
Treating and managing osteoporosis
Treatment for bone loss often involves the use of bone-strengthening medicines, dietary supplements, and lifestyle changes.
Bone- strengthening medications
Bone-strengthening medications help slow down bone loss. They may also help prevent further damage and support bone healing. These medications include:
- Bisphosphonates, which block the cells that destroy bone (osteoclasts). Examples include pamidronate (Aredia), alendronate (Fosamax), and zoledronic acid (Zometa).
- RANK ligand inhibitors, which block proteins that help break down bone. An example is denosumab (Prolia, Xgeva).
Common side effects of bone-strengthening medications include flu-like symptoms, bone pain, and kidney problems (bisphosphonates) or low blood levels of calcium and phosphate (RANK ligand inhibitors).
Your doctor may recommend seeing a dentist before starting treatment with these medications. This is because of a rare but serious side effect called osteonecrosis of the jaw (ONJ). ONJ happens when part of the jawbone is severely damaged and dies. Symptoms may include jaw pain, swelling, infection, loose teeth, or visible bone. If you’re taking these medicines, make sure to tell your dentist. This is especially important if you need any dental work.
Dietary supplements
Your doctor may recommend taking calcium or vitamin D to maintain healthy bones, especially if you don’t get enough from food. Talk with your cancer care team before starting any vitamin or mineral supplement.
The United States National Institutes of Health (NIH) recommendations for calcium and vitamin D for adults are:
- Vitamin D: 600 to 800 international units (IU) per day
- Calcium supplements: 1,000 to 1,200 milligrams (mg) per day
- For women before age 50: 1,000 mg per day
- For women age 50 and older: 1,200 mg per day
Exercise and nutrition
Physical activity can also prevent bone loss. Walking, dancing, stair climbing, and tai chi are low impact, weight-bearing exercises that put stress on your bones. This triggers the body to make cells that form bone. Regular weight-bearing exercise also builds strong muscles, which can help your balance. Your doctor can recommend an exercise plan based on your needs, physical abilities, and fitness level.
Eating a well-balanced diet is also important for bone health. Being underweight can contribute to bone loss and fractures.
Fall prevention
Falling is the main cause of fractures for people with osteoporosis. Many factors can increase the risk of falling, including:
- Shoes that do not fit well
- Poor vision
- A cluttered living space
- Mental health difficulties
- Drowsiness related to pain medicine
- Poor concentration or focus
Learn about how to reduce your risk for falls in Balance Problems, Weakness, and Falls.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Society of Clinical Oncology (ASCO). Osteoporosis. Accessed at cancer.net. Content is no longer available.
International Osteoporosis Foundation. Falls prevention. Accessed at https://www.osteoporosis.foundation/patients/prevention/falls-prevention on July 28, 2025.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Breast cancer. v4.2025. Accessed at www.nccn.org on July 28, 2025.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate cancer. v2.2025. Accessed at www.nccn.org on July 28, 2025.
Porter JL, Caracallo MA. Osteoporosis. [Updated 2023 August 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan -. Available from https://www.ncbi.nlm.nih.gov/books/NBK441901/
Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021.
US Department of Health and Human Services. Calcium: Fact sheet for health professionals. Updated July 11, 2025. Accessed at https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/on July 28, 2025.
US Department of Health and Human Services. Vitamin D: Fact sheet for health professionals. Updated June 27, 2025. Accessed at https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ on July 28, 2025.
Last Revised: August 20, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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