Preserving Bone Density

Pharmacologic management of bone density loss often causes other problems for breast cancer survivors who may already be unhappy with the polypharmacy approach. Bisphosphonates, for example, can cause osteonecrosis of the jaw, joint pain, back pain, abdominal pain, nausea, diarrhea, and renal toxicity. Patient adherence is low; fewer than 50% of patients adhere to their medication routine. Patients do not want more side effects, thus they hesitate to seek pharmacologic options.1

A low impact exercise such as walking is popular; easy to do; requires no special clothing, gym membership, or equipment; but it does not improve bone density. In fact, studies have shown that although a walking program might help maintain bone density, patients participating in a walking program actually may experience a loss of bone at specific sites.1 Resistance training, however, demonstrates positive results on bone density in healthy women. 

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Few studies have evaluated the effect of resistance training in women with breast cancer; therefore, the researchers conducted a review of the literature to determine whether this form of exercise could help breast cancer survivors maintain bone density. The focus was kept on maintenance in breast cancer survivors because the loss of bone density is so accelerated that just reducing the diminution is significant.

Study findings demonstrate that resistance training can reduce or overcome some of the adverse effects of breast cancer treatment as well as maintain bone density. However, although resistance training has none of the side effects of medication, some precautions are warranted before initiating a resistance training program. 

The program should begin during treatment, when bone density losses start to occur, and continue through completion of treatment. Additional higher impact exercise might be necessary to further maintain or even build bone density. Such a program could reduce the risk of fractures and a lifetime of complications, or worse.

A recent meta-analysis of the effects of resistance training in women with or at risk for breast cancer-related lymphedema determined that at least 1 in 5 breast cancer survivors develop arm lymphedema.2 These patients have often been told to avoid strenuous, repetitive exercise to minimize their risk of developing lymphedema or worsening an existing case of the adverse effect. Some patients misunderstand the recommendation and adopt a sedentary lifestyle, which can be a significant contributing factor to the development of lymphedema.2

A study involving 27 breast cancer survivors, average age 64 years, assessed the effects of an upper body resistance training intervention on lymphedema. The results showed that breast cancer patients who had or who were at risk for lymphedema can safely perform moderate-intensity upper body resistance exercises during and after treatment.2