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After treatment and remission

Bones and osteoporosis

Steroids, inactivity, hormone changes and transplant can weaken bones. This topic explains loss of bone density, avascular necrosis and how to protect your bones.

Last updated: ~3 min read
Two clear bone cross-sections, one dense and one sparse.
Figure 1.Healthy bone is dense; osteoporotic bone is sparse.

01Short answer

After leukaemia treatment there can be two main bone problems. The first is loss of bone density (osteopenia, osteoporosis): steroids (prednisolone, dexamethasone), long inactivity, hormone deficiency, low vitamin D, some medicines and transplant thin the bone and raise the risk of fractures. The second is avascular necrosis (osteonecrosis): the blood supply to bone is disrupted and bone tissue is damaged — most often in the hip and knee joints, especially in teenagers and young adults after dexamethasone. The COG recommends measuring bone density with DXA for people at risk. To protect bones: weight-bearing and strength exercise, enough calcium and vitamin D (your doctor checks levels), and not smoking or drinking too much alcohol. When needed, your doctor prescribes medicine.

02Simple explanation

Two main problems: osteoporosis and avascular necrosis.

The main cause is steroids.

Density is measured by DXA.

For joint pain — MRI.

What helps: movement, vitamin D, not smoking.

03Scientific explanation

Steroids: corticosteroids reduce bone formation and increase bone breakdown; the effect depends on dose and duration (MedlinePlus).

Avascular necrosis: in ALL treatment it is more common in children over 10 and teenagers after dexamethasone; according to NIAMS, MRI is the most sensitive method at an early stage.

DXA: the COG recommends a baseline DXA after treatment for people who received corticosteroids, head radiation or a transplant.

Vitamin D: the NIH notes that vitamin D is needed to absorb calcium; deficiency is found with a blood test, and any supplement dose is set by your doctor.

04What happens in the body?

Bone is living tissue

Bone is constantly renewed: old tissue is broken down and new bone is built. Steroids and inactivity upset this balance and the bone thins.

What does osteoporosis mean?

Bone density and strength fall, and the risk of fracture rises even with a small fall. Often there are no symptoms until a fracture.

Avascular necrosis

The blood supply to part of a bone is disrupted. The first sign is joint pain, especially when walking. Finding it early on MRI improves treatment options.

A clear hip joint with one slightly dimmer area.
Figure 2.Avascular necrosis most often affects the hip.

How is it checked?

DXA — a low-dose bone density test. For joint pain, MRI. Blood tests for vitamin D, calcium and sometimes hormones.

How to protect your bones

Walking, stairs and strength exercises build bone. Enough calcium and vitamin D (on your doctor’s advice), not smoking and preventing falls.

Glowing footprints along a calm path in daylight.
Figure 3.Weight-bearing movement strengthens bones.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Strong bones

Steps to protect your bones.

Risk — Steroids, transplant, hormones.1RiskSteroids, transplant, hormones.
DXA — Bone density is measured.2DXABone density is measured.
Vitamin D — Your doctor checks levels.3Vitamin DYour doctor checks levels.
Strengthening — With movement and treatment.4StrengtheningWith movement and treatment.
DensityBone gets stronger.
ProtectionLower fracture risk.
MovementJoints keep working.

06Bone risk and checks (simplified)

FactorPossible effectCheck
SteroidsOsteoporosis, avascular necrosisDXA, MRI if painful
TransplantBone lossDXA
Hormone deficiencyBone lossHormone tests, DXA
Low vitamin DWeak bonesBlood test
InactivityBone and muscle loss—

* Your doctor sets the testing schedule.

07Key terms

Osteoporosis
Loss of bone density and strength.
Osteopenia
Mildly reduced bone density.
Avascular necrosis
Bone damage due to disrupted blood supply.
DXA
A low-dose test that measures bone density.
Weight-bearing exercise
Movement in which your legs carry your body weight.
Vitamin D
A vitamin that helps absorb calcium.

08Key points

  • Steroids affect bone.
  • DXA shows density.
  • Report joint pain in time.
  • Movement strengthens bones.
  • Your doctor checks vitamin D.
  • Do not smoke.

09Frequently asked questions

Should I take calcium and vitamin D?

Your doctor checks your levels and prescribes a dose if needed.

Can osteoporosis be painless?

Yes, often there are no symptoms until a fracture — which is why DXA matters.

Can avascular necrosis be treated?

Yes; early on, reducing load and physiotherapy, and sometimes surgery.

Do children’s bones recover?

In children bone density often improves after treatment, but follow-up is needed.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Should I take calcium and vitamin D?

  2. Can osteoporosis be painless?

  3. Can avascular necrosis be treated?

  4. Do children’s bones recover?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. MedlinePlus (U.S. National Library of Medicine). Bone mineral density test
  3. MedlinePlus (U.S. National Library of Medicine). Osteoporosis
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Osteonecrosis
  5. Bone Health & Osteoporosis Foundation. What is osteoporosis?
  6. NIH Office of Dietary Supplements. Vitamin D — Fact Sheet for Consumers
  7. MedlinePlus (U.S. National Library of Medicine). MRI
  8. National Cancer Institute (NCI). Follow-Up Medical Care
  9. National Cancer Institute (NCI). Cancer Survivorship
  10. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  11. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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