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Breast Cancer Therapies: How to Protect Your Bones at the Table

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Breast Cancer Therapies: How to Protect Your Bones at the Table

Bones need calcium and vitamin D, and we know this. Less well known, however, is that salt also plays an important role in preventing bone fragility: the less there is, the better. The reason? Its excessive consumption contributes to descaling.

He explained it Lucilla Looknutritionist and coordinator of the SmartFood project (research program in Nutrition Sciences of the European Institute of Oncology in Milan), during the presentation of the fourth edition of the Ora POSSO campaign, an initiative dedicated to the all-round protection of the bones of those being treated for breast cancer , promoted by Europa Donna Italia together with the Italian Foundation for Research on Bone Diseases (Firmo) and by Amgen.

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Salt, we eat less but it is always too much

by Giulia Masoero Regis


Bone fragility, because those with breast cancer are more at risk

Already after the age of 25, the female skeleton undergoes a progressive reduction in bone mineral density: knowing how to protect one’s bones is therefore important for all women. In particular, however, it is for those who have breast cancer and are following hormonal therapy, that is, about 70% of patients. In fact, some of the drugs essential to reduce the risk of relapse, such as aromatase inhibitors, increase the risk of bone fragility and consequently of fractures, even after minimal trauma.

This happens due to the sudden reduction of estrogen which exposes patients to an alteration in the quality of the bones and bone resorption. The data show that as many as one in 4 of women with breast cancer suffers the consequences of bone fragility induced by hormonal therapies.

How to ensure the right amount of calcium and vitamin D

For bone health, nutrition plays a major role. “Breast cancer patients have a daily calcium requirement of 1,200 milligrams,” says Titta. Equal, therefore, to that of women who are breastfeeding or pregnant (for comparison, the requirement of adults is 800 milligrams per day).

How to guarantee it? “When you think of calcium – answers Titta – the first thing that comes to mind are dairy products: that’s correct, because they are rich in this mineral, but they must be included in the diet without excess. The recommended doses include 2-3 servings a day. 250 ml milk and / or 125 ml yogurt. Cheese, on the other hand, should be consumed 2-3 times a week in portions of 100-120 grams, preferring fresh to seasoned “. But milk and derivatives are not the only source of calcium, which is instead contained in abundance even in many plant foods. “A plate of black cabbage – continues the nutritionist – is able to ensure 1,000 mg. Sesame seeds are also rich – 3 tablespoons reach almost 300 mg -, soy beans – a 50 gram portion ensures 130 mg – almonds and dried figs “.

As far as vitamin D is concerned, it is known that the UV B rays of the sun are the main source (always “taken” with due precautions, of course). Even the diet, however, can make a significant contribution: “The winning move is to consume fish 3 to 5 times a week, in particular sea bass, mackerel, mullet and anchovies: a portion of 10 anchovies also ensures 200 mg of football, “says Titta. “Eggs are also very rich in it: a single egg contains 1/15 of the daily requirement of vitamin D, the same amount that, curiosity, is ensured by a handful of Japanese Shiitake mushrooms. The secret to a healthy and balanced diet is then in regularly rotating food.

How to reduce salt

As we have anticipated, then, salt affects bone decalcification. But not only: its excessive consumption increases the cardiovascular risk, also increased by therapies for breast cancer. The World Health Organization recommends not to exceed 5 grams of salt per day. Easy to say but not to do, because salt is present in high quantities in many foods.

What rules to follow? “For example, it is good to prefer fresh foods to preserved ones, limit the consumption of pizza and baked goods as much as possible, avoid salting salads or other side dishes, especially if they accompany a food such as fish, which is already salty his, and prefer fresh cheeses to mature ones “, explains Titta.

On alcohol, supplements and physical activity

Finally, one cannot fail to mention the risks associated with alcohol consumption. It is well known that it has a negative impact on oncological disease, but perhaps less so is the fact that it also negatively affects bone health. “In addition to a balanced diet – Titta continues – the use of supplements should also be considered, when necessary and according to a supplementation plan established by a specialist. Finally, we must not forget moderate but regular physical activity – such as walking at a brisk pace – because it makes bones more elastic and therefore more capable of absorbing shocks, and muscles stronger and more resistant to fatigue.

Vitamin D, when it is necessary to supplement it

by Simone Valesini



Nutrition and cancer: the indications are too vague for the patients

For breast cancer patients all this is important information, yet it is not always given by doctors (and a nutritionist is not always present in a breast cancer center). This is highlighted by a survey by Europa Donna Italia, which shows a picture with different gray areas.

Over 300 women with breast cancer on adjuvant hormone therapy between the ages of 18 and over 60 were interviewed. Almost all of them claimed to be aware of the impact of these drugs on bone health: 54% received information from the oncologist, 14% from information campaigns, 10% from independently searched sources, 7% from endocrinologist, 6% from patient associations and 4% from the general practitioner. Furthermore, 87% said they were aware of the importance of nutrition for bone health.

Well, but did eating habits change after the diagnosis? Ni: just over half of the respondents (58%) changed their diet. The reason is to be found precisely in the lack of adequate information on what to bring to the table: only 33% of patients received practical indications from their referring doctor, 36% relied exclusively on the web to find out which foods to prefer and 25 % contacted a nutritionist on their own. Not surprisingly, 77% of the patients interviewed indicate nutrition as one of the issues on which they would like to have more light. This is why this year the Ora pOSSO campaign has decided to draw attention to the topic.

An image of the campaign

An image of the campaign

“These are data that deserve reflection”, he commented Rosanna D’Antonapresident of Europa Donna Italia: “All women must know of the existence of strategies that help defend bone health during adjuvant hormonal therapy. In this, the role of the doctor in prescribing not only drugs is fundamental. also of interventions in defense of bone quality “.

What else you need to know

Prevention, of course, does not stop at the table and lifestyles. “Patients treated with aromatase inhibitors should be subjected to a very careful analysis of bone metabolism, to verify the bone remodeling parameters, which are usually very high in these cases”, explains Maria Luisa Brandi, President of the Observatory. Fragility Fractures (OFF): “In any case, when a woman begins to follow an adjuvant hormone therapy that will last for a long period – that is, for at least 5 years and in some cases even for 10 – it is essential that a anti-resorptive therapy able to prevent fractures. Today, however, these treatments are often not prescribed “. A figure also highlighted by the Europa Donna survey: only 55% received specific treatments to prevent the risk of fragility fractures.

Menopause, how to prevent (and treat) osteoporotic fractures

by Angela Nanni



The Ora pOSSO campaign

To learn more about all these issues, the Facebook page @EuropaDonnaItalia hosts live shows with specialists. Specific physical activity programs dedicated to patients can also be consulted on the ossefragili.it/oraposso website, to help them move and keep their bones healthy. And also to ‘knowing how to ask’, to build an effective dialogue with the specialist. Finally, in September, a booklet will be available with practical information (why exactly this is needed) on the diet.

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