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Anti-Cancer Drugs and Bone Health

If you've had breast cancer and are taking certain drugs that affect your bones, your doctor should monitor your bone density and may prescribe a bone-maintenance drug.

Some breast cancer patients take a type of drug called an aromatase inhibitor. These drugs include:

  • anastrozole (Arimidex)
  • exemestane (Aromasin)
  • letrozole (Femara)

These drugs target a substance your body makes called aromatase. That leads to lower estrogen levels, which can dim estrogen-fueled cancers.

That's good news for your cancer, but lowering your estrogen levels can be bad for your bones, since estrogen stops bone resorption. That's why doctors often prescribe improved lifestyle changes such as exercise, a diet rich in calcium and vitamin D, and bone-maintenance drugs to women who are taking the aromatase inhibitors. 

Men who have been treated for prostate cancer are sometimes prescribed anti-androgen therapy. Examples of these drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron).

These drugs block the action of the hormone testosterone, usually slowing prostate cancer growth. However, these medications can decrease bones' density and increase fracture risk, so doctors may prescribe changes in lifestyle such as exercise, smoking cessation, reduced caffeine intake, and a bone-maintenance drug.

Antidepressant Drugs and Bone Health

Some drugs used to treat depression, known as SSRIs, may affect your bones. Examples of SSRIs include:

  • citalopram (Celexa)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

That's not to say you shouldn't take them. When weighing risks and benefits, Kearns says to remember that depression itself has been linked with poor bone health.

However, most studies looking at the effects of SSRIs on bone health have found a greater chance of fractures in people taking drugs, Kearns says.

One study, for instance, found those currently taking the SSRI antidepressants were more than twice as likely to have a fracture not in their spine than those not taking an SSRI. Another study of women with a history of depression showed lower bone density in those who had taken  SSRIs  than those who didn't take the drugs.

Kearns' advice: Ask your doctor each time they refill the antidepressant prescription: "Is this still the right drug?" "Is this the right dose?" Make sure the doctor prescribing your antidepressant knows about your bone health concerns, and consider asking about how much calcium and vitamin D you need.

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