How to prevent bone loss during hormone therapy?

Question

Hello doctor,

My cousin’s wife, aged 38, was told she has hormone-receptive breast cancer. The doctors suggested she might need years of hormone-blocking treatment. She is worried about the side effects, especially osteoporosis or heart issues that she read online. Is there a way to manage these risks proactively? Also, she keeps asking if switching to a fully vegan diet can reduce these side effects or help the medication work better. What do you think?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Hormone-blocking therapy can impact bone density, cardiovascular health, and more, but she can follow some tips to reduce the risk. She should have calcium supplements (Caltrate) 500 mg twice daily after meals and vitamin D supplements 40,000 IU one tablet weekly before breakfast.

She should also eat calcium-rich foods like milk and milk-based products. Regular DEXA (dual-energy X-ray absorptiometry) scans can help monitor her bone density.

Weight-bearing exercises can strengthen bones. Bisphosphonates or Denosumab in case of significant bone density loss. Food that is low in saturated fats and high in fiber is recommended. Regular exercise and maintaining a healthy weight may be beneficial. No smoking (totally zero).

If a cardiac problem occurs, it can be managed with cholesterol-lowering or blood pressure medications. A well-planned vegan diet can be beneficial, and it may reduce cholesterol, improve heart health, and provide antioxidants, but it will not directly enhance the medication's effectiveness.

If she wants to be a vegan, then her diet must contain protein, vitamin B12, iron, and omega-3 fatty acids from sources like flaxseeds, chia seeds, walnuts, or algae-based supplements.

Flaxseeds and soy might provide mild estrogen-like benefits without interfering with her treatment. You can work with a dietitian. Vegan food may give her some benefits, but she does not need to become a vegan. She can have all types of healthy food.

I hope this helps.

Let me know if you have any other concerns.

Thank you.