Steroids have helped patients with brain cancer for decades. The powerful medications aid in reducing tumor-associated edema and brain swelling sometimes caused by the cancer itself or related treatments. While steroids are helpful to brain cancer patients, they can be linked to a large number of potentially serious side effects including: osteoporosis, diabetes, hypertension, hormonal problems, muscle weakness and reduce the effectiveness of new immunotherapies.

How do steroids induce osteoporosis?

High dose steroid treatment reduces the formation of bone and thereby produces weakened bones. Weak bones can break easily, even without an obvious injury. Unfortunately, this can be a major challenge for brain cancer patients in particular, who require long-term use of steroids.

Prevention of Steroid-induced Osteoporosis

If you or a loved one is being treated for brain cancer, there are a number of steps you and your doctor can take to prevent steroid-induced osteoporosis.

Below are five prevention recommendations.

1. Explore the risks of bone fractures

In general patients with cancer, including women with chemotherapy-induced ovarian failure, those treated with aromatase inhibitors for breast cancer, men receiving androgen-deprivation therapy for prostate cancer, and patients undergoing glucocorticoid therapy, face an increased risk for bone loss and osteoporosis because of the side effects of certain treatment options.

In addition to potential side effects, lifestyle factors such as smoking and drinking too much alcohol, inadequate exercise, low calcium intake, and vitamin D deficiency can greatly increase the risk of bone fractures. The more risk factors present, the more likely your bone health can be impacted.

2. Adopt healthy lifestyle modifications

One way to protect your bone health is by adopting healthy habits. Physical activity can improve muscle mass, strength, balance, and reduce the risk of falls leading to hip and wrist fractures. You should also work with your doctor to review medications that may impact your bone health. Limiting smoking and excessive alcohol consumption can also have a positive impact on your bone strength.

3. Take Supplementation such as calcium and vitamin D

Adequate intake of calcium and vitamin D is critical to bone health. Studies have shown that calcium and vitamin D supplementation can decrease the risk of bone fractures. The National Institutes of Health Office of Dietary Supplements and the Surgeon General recommend a total daily calcium intake of at least 1000 mg per day for individuals under 50 years of age without major osteoporosis risk factors, and at least 1200 mg per day for those older than 50 years. Talk to your doctor about the appropriate supplemental amount for you.

4. Get Screened for osteoporosis

Early detection of osteoporosis can prevent serious fractures and injuries. Work with your doctor to get screened early if you are concerned about your bone health or have a number of risk factors for osteoporosis. The screening is simple and easy. Most commonly, doctors use a bone density test, or DEXA. If you are undergoing cancer treatment and have a risk of osteoporosis, there are medications to take to strengthen bones.

5. Starting drug therapy as clinically indicated

A bone density test is recommended prior to or at the time of starting steroid therapy. A multidisciplinary approach can aide in the prevention of steroid-induced osteoporosis. Talk to you doctor about protective drug therapies, such as bisphosphonates (etidronate, alendronate, risedronate, ibandronate and zoledonate), and denosumab.

The goals of osteoporosis treatment are to:

  • Stop bone loss
  • Prevent bone fractures with medicines that strengthen bone
  • Minimize the risk of falls that might cause fractures

It’s never too early or too late to take steps to protect your bones from osteoporosis fracture risks, especially if you are taking steroids for cancer therapy. Talk to your doctor about ordering a bone density test.

Our Endocrine/Bone Disease Program, offers highly experienced physicians in dealing with osteoporosis in cancer patients. If you wish, you can schedule an appointment to learn how to reduce your chance of bone fractures and loss as you start your cancer treatment journey.

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Our Neurosciences and Neurotherapeutics department is committed to accelerate the development of novel therapies for brain cancers and neurological disorders through drug innovations and precision medicine. Learn more about our brain cancer research topics by visiting our website.

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About the Author

Dr. Frederick R Singer

Dr. Frederick R Singer

Dr. Singer is the Professor of Endocrinology and the Director of the Endocrine & Bone Disease Program at the John Wayne Cancer Institute. He specializes in metabolic bone disease and has long-term experience in osteoporosis which develops in cancer patients and individuals with bone metastases. Learn More About Dr. Fredrick Singer.

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