The Link Between Breast Cancer and Bone Health

EP 131 – Dr. Fred Singer

[00:00:00] Adam Walker: This program is supported by Amgen. Amgen strives to serve patients by transforming the promise of science and biotechnology into therapies for patients with serious illnesses, learn

[00:00:20] Adam Walker: From Susan G Komen. This is real pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room. On today’s podcast. We talked to Dr. Fred singer from American bone health to discuss the link between breast cancer and bone health.

[00:00:39] Adam Walker: You will learn about how to assess your risk of bone fractures, how to improve your overall bone health and the different screenings available to integrate. Obtaining a baseline bone scan coupled with knowing your bone health risks can offer you a plan for maintaining strong, healthy bones, which is important to your overall health Dr.

[00:00:59] Adam Walker: Singer. Welcome to the. Thank you. Well, I’m excited to talk to you about this. This is a kind of unusual topic for us. Um, and, but I think it’s important. And so talk to us, tell us what’s the link between bone health and breast cancer and for metastatic patients, what can they do to improve their overall.

[00:01:20] Dr. Fred Singer: Well, I think breast cancer patients in my extensive experience are, uh, at considerable risk for developing bone loss and. Perhaps osteoporosis and fractures. Uh, the good news is it’s completely preventable in the vast majority of people, but one has to be aware of the subject and to deal with it. Uh, so the, the risk in breast cancer patients.

[00:01:54] Dr. Fred Singer: There’s several one, uh, most women with breast cancer post-menopausal so once they have a diagnosis, they’re not going to be on estrogen, which does protect the bones very nicely. Number two, depending on the type of tumor, the oncologist may give chemotherapy, which. More or less kills tumors, but it also damages bone and number three, commonly in many patients, uh, And anti estrogen drugs are used.

[00:02:35] Dr. Fred Singer: So even when someone is post-menopausal, they’re still producing a little estrogen anti-estrogen drugs, knock it down. So bone loss is somewhat greater. So, uh, therefore if one has breast cancer and undergoes those kinds of therapies, Uh, or even if they don’t undergo those therapies there they’re estrogen deficient.

[00:02:59] Dr. Fred Singer: So bone loss is common if not in almost every patient and that can lead over years, at least to. Osteoporosis and fractures now, metastases from breast cancer. That’s a little different story. That’s a bit more threatening. It suggests the tumor, the tumor has not been, uh, completely resolved. Uh, and, uh, there are other drugs that are given to try and.

[00:03:31] Dr. Fred Singer: Uh, kill the tumor cells, but one can help protect the bone with, uh, drugs, uh, which, uh, help prevent bone loss, but still the main problem is you have a cancer that’s escaped from the breast, uh, and then maybe in other parts of the body. So the main treatment is, um, therapy to, uh, try and, uh, wipe out the cancer.

[00:04:01] Dr. Fred Singer: Hmm. So, uh, that’s this patient with breast cancer, more commonly, uh, the concern is bone loss, but as a smaller percentage to have a test to see is to bone, which is, uh, a more difficult problem to deal with

[00:04:22] Adam Walker: for those metastatic patients. Is there anything they can do to improve their overall bone health?

[00:04:27] Dr. Fred Singer: Well, they can do the same thing. Uh, patient will do without the metastasis that’s nutrition, adequate calcium and vitamin D and you know, medications which protect against bone loss. So there is not a big difference in trying to keep bone health, whether it’s someone with metastasis or not. Uh, so the problem is.

[00:04:55] Dr. Fred Singer: How do you deal with a metastasis, which is a different story.

[00:05:00] Adam Walker: Um, okay. Okay. So, uh, so you’re, you’re with American bone health. ABH has an online fracture risk calculator for individuals to use, to understand the risk of fracture. So tell me, what is this tool assess? Who is it for? And if someone is found to be at a high risk of fracture, what should they do next?

[00:05:22] Dr. Fred Singer: Well, the American bone health has developed a scientifically, a fracture risk calculator, which gives a number, which is what is your 10 year risk of having a significant fracture. Uh, so the age at which you might have that done is 45 or more. It could actually be younger if you have, uh, other factors in new history, which we could mention.

[00:05:53] Dr. Fred Singer: So the risk calculator takes into assessment. The family history does mother or father have osteoporosis. The body weight is somebody extremely skinny from not eating very much. Has the person had a fracture previously? Does the first person have other disorder, you know, um, you know, like rheumatoid arthritis and taking prednisone or steroids and, uh, so that, uh, other disorders, plus certain medications like steroids in particular can cause bone loss and therefore make the 10 year risk of fractures higher.

[00:06:41] Dr. Fred Singer: Uh, Calculator can be done without a bone density test, but it probably improves the reliability of the estimate. If someone has a bone density test and by the way, bone scan is probably not the right term for bone density, because a bone scan is generally a nuclear test, which is different.

[00:07:08] Adam Walker: Great. Uh, well, and I think I might be, I think that might be one of my, one of my next questions too.

[00:07:13] Adam Walker: So that’s, that’s, that’s a good segue, uh, in just a moment, but let’s talk about kind of health screenings for bone health. Uh, so at what age should a person consider getting a bone density test, which I think is called a DEXA scan. And how does family health history affect those recommendations?

[00:07:33] Dr. Fred Singer: Well, the, um, you know, general recommendations are that women and men 65 years, uh, or older should have a bone density test.

[00:07:46] Dr. Fred Singer: If they haven’t had one. I honestly believe that’s a little, uh, limiting. Uh, if someone has a family history, for instance of osteoporosis, Uh, or other factors, significant factors, a younger age in 65 is appropriate. In fact, when a woman goes into menopause or roughly around 50 years of age, if there’s other factors in their life or in their history, I think that’s a good time to have a bone density test, but in general it said age 65.

[00:08:25] Dr. Fred Singer: To me, that’s a bit late, particularly if you’re a woman not taking estrogen, you’re losing bone for 15 years and you don’t know where you started. Uh, so, uh, and, and, uh, the family history is very important. It’s been estimated that about 60% of your bone density is based on your genes. So that’s quite a bit, uh, that, of course there’s other factors.

[00:08:52] Dr. Fred Singer: Hmm.

[00:08:52] Adam Walker: Okay. Oh, wow. That’s that’s really good to know. Um, so, so I mentioned this and it sounds like I pronounced it right, but what, what is a DEXA scan? Uh, where can people get one and what’s that experience like for a person?

[00:09:06] Dr. Fred Singer: Well, a DEXA scan, uh, that’s an abbreviation. For dual absorption, uh, dual absorption and absorbtiometry, but DEXA that are DXA for short.

[00:09:21] Dr. Fred Singer: So it’s a simple test, takes 10 minutes or so, uh, very little radiation. You lie on a table and a machine passes over from your, uh, back to your hips. The risk can also be done so that years, some years ago was developed as one of the best, if not the best screening tool for seeing how much bone density someone has and bone density is critical and in the prevention of fractures.

[00:09:57] Dr. Fred Singer: So those are done. Some doctor’s offices have. These machines, uh, but in general, they’re in radiology departments, whether it’s in a hospital or in a, uh, outside of a hospital and a radiology, uh, uh, you know, set up, uh, so it’s safe. It’s effective. Uh, and, uh, it should be done in appropriate people. And as people age, a higher percentage of people should have this test if they’ve never had it.

[00:10:37] Adam Walker: And you mentioned a minute ago, there’s a difference between a DEXA scan and a bone scan. Would you mind just walking me through what that.

[00:10:43] Dr. Fred Singer: DEXA measures the bone, but bone scan specifically refers to a nuclear test, which is done to look for metastases, such as from breast cancer or for some other rare bone diseases.

[00:11:00] Dr. Fred Singer: So the term bone scan is misleading. It should be DEXA for short.

[00:11:09] Adam Walker: Okay. Gotcha. And so, so let’s talk for a second. Let’s shift gears and talk about insurance coverage for these scans. Is there a difference in how some of these scans are covered? And is there an age when that coverage begins to kick in for some of these tests?

[00:11:26] Dr. Fred Singer: The insurance industry. It’s impossible to say. Uh, there’s one way things are done. We’re talking about private insurance. Uh, I have not had a lot of trouble getting bone density tests paid for by insurance. If there’s appropriate reasons to have them done. And that can be anywhere from, uh, Childhood almost, or adolescents to a very elderly people.

[00:12:01] Dr. Fred Singer: It depends on the history. Uh, but uh, Medicare pays. For one test every two years, uh, for people, uh, over 65, I believe that’s the, uh, age, but if someone has a history which could produce osteoporosis, the test, uh, from private insurance should be paid for. Much earlier than 65. Uh, but I, you know, insurance is a strange business.

[00:12:40] Dr. Fred Singer: Uh, so I rarely have ever had a patient not been approved for a test given the right information.

[00:12:53] Adam Walker: Okay. Okay. Yeah. And that makes sense. Um, so, so I guess my last question, then, what information does a DEXA scan provide? That’s useful for someone without a history of cancer. Um, and how does that information differ for someone who has undergone treatment for early or late stage breast cancer?

[00:13:13] Dr. Fred Singer: Honestly, there’s not a big difference. If someone has a significantly low. Um, density, whether they’ve had the cancer or not. The goal is first to at least prevent further loss of bone or to make the bone, uh, improve. Uh, now the, the tricky part is in breast cancer. Uh, we have a few drugs that stimulate.

[00:13:46] Dr. Fred Singer: Bone, but they might be, uh, dangerous if someone had a little bone metastases. So in breast cancer patients, generally we give medications which protect against bone loss and they can strengthen the bone, but they don’t actually build new bone, but, but they do reduce the fracture risk, you know, on the order of 50%.

[00:14:15] Dr. Fred Singer: Compared to those untreated. Uh, so whether you have breast cancer or not, the bone density tells you do something or don’t worry. Uh, but in the elderly woman with a breast cancer, often something needs to be done. Uh, and the younger person, if they have a normal bone density, Wonderful. Uh, you don’t have to do anything except maintain good nutrition, calcium vitamin D exercise, et cetera.

[00:14:54] Adam Walker: Ah, it’s all, that’s so important, um, for, for every aspect of our health. So, uh, so Dr. Singer, this has been great. Do you have any final thoughts that you’d like to share with our listeners?

[00:15:04] Dr. Fred Singer: No. I think one of the problems we have. Yeah in our country is after a hip fracture. Usually in someone quite elderly, roughly 10 to 20% of people actually get treated.

[00:15:24] Dr. Fred Singer: And that means they didn’t even have a bone density test. So. Uh, it’s hard to understand considering how widely available bone density tests are, uh, how safe it is to have a test, uh, and the benefits of knowing, you know, what your bone density is, is very great. And the ignorance of not knowing is very dangerous because if someone has one fracture, Uh, particularly a hip fracture, the odds of another fracture are considerably increased even in the next year.

[00:16:04] Dr. Fred Singer: So, uh, I think the main thing is if your doctor is, uh, not terribly interested in bone density tests, you’d have to bring up the subject. Uh, I’ve never had a bone density test. Uh, can I get one.

[00:16:24] Adam Walker: Hmm, that’s important. I mean, being your own advocate is something we’ve talked about many times on this show and in this case, I mean, to your point as well, it’s important to advocate for yourself to get the right test, to know where you are and to know what you need to do to continue to improve and maintain your health.

[00:16:39] Adam Walker: So, uh, Dr. Singer, this was a really informative, uh, I really appreciate you joining us on the show today. Thank you. Thanks to Amgen for supporting this podcast to learn more about Amgen’s mission to serve patients with a cutting edge science-based approach, follow Amgen biotech on Instagram and Facebook.

[00:17:09] Adam Walker: Thanks for listening to real pink, a weekly podcast by Susan G Komen for more episodes, visit real for more on breast cancer. Visit Make sure to check out at Susan G Komen on social media. I’m your host, Adam, you can find me on Twitter at AIG Walker or my blog, Adam J