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bone fractures

kidclutch
Posts: 41
Joined: Oct 2017

Hello, all! My dad was diagnosed in October after a spine fracture sent him to the ER, caused by bone metastasis. Surgery and radiation on the spine eliminated the pain. Last week, discovered a stress fracture in the hip. No surgery recommended, 15 rounds of radiation ordered. He is on quarterly Lupron and daily Casodex. Hot flashes and bone pain are primary complaints. I guess my question is, when would be appropriate for administering a new Rx for bone strength and what has been your experience with any of those? Oncologist recommended calcium + vitamin D supplements. Hormone therapy is working (PSA falling- 60 at Dx to 6 at last check) but don’t want to waste a chance to intervene on osteoporosis early if possible. He is now at a research hospital with a new oncologist and we feel great about them! He recently turned 60 and is in good overall health aside from PCa. 

Old Salt
Posts: 720
Joined: Aug 2014

Several on this Forum have mentioned Prolia (denosumab) to counteract osteoporosis.

Personally (diagnosed with osteoporosis of the spine and osteopenia in my hips), I had an infusion of zoledronic acid (a bisphosphonate) and continued with daily vit D and Ca supplements.

I also joined an exercise group (2x a week; Bone Builders). One or the other did improve my DEXA scan results. 

Clearly, my situation (no metastasis and no fractures) wasn't as dire as that of your Dad, but I do recommend a multiple approach to strengthen his bones. In that context, XGEVA (also denosumab) is closely related to Prolia. Not sure which one would be better for him; his oncologist should know though.

Xofigo is another drug that is used. It's a radiopharmaceutical that hones in on metastatic lesions. 

All the drugs mentioned have side effects! I repeat the recommendation for weight-bearing exercises.

kidclutch
Posts: 41
Joined: Oct 2017

Did you have any trouble with the Zometa? I don’t think we are there yet, just wanted to make sure we are armed with the right questions once we do get there! (A Prolia commercial came on my TV while I was typing this. Maybe it was a sign! Haha.)

Old Salt
Posts: 720
Joined: Aug 2014

But they do happen to a minority of patients. THe best known one is ONJ (osteonecrosis of the jaw). I discussed this issue with my dentist. He pulled up the latest recommendations of the ADA (American Dental Associaion) about this and we both felt that the chance of a bad side effect was reasonably low for me.

https://www.ada.org/en/member-center/oral-health-topics/osteoporosis-medications

However, if a patient anticipates a major dental procedure, it should be done well prior to administration of zoledronic acid or Prolia.

PS: I choose zoledronic acid over Prolia because it is available as a generic and Prolia is expensive. It seems though that Prolia is preferred by others. 

mtop
Posts: 18
Joined: Jan 2017

Hello, new to forum. I had a bone scan done in May 2018 found Osteopenia in left thigh. Doctor wants to put me on Prolia. Trying to decide. Have read about people having terrible side effects. Already on Lupron and doctor wants to add Apalutamide. (More side effects.

kidclutch
Posts: 41
Joined: Oct 2017

Oncology hasn’t recommended it yet for my dad, just calcium + vit D and I’m going to make him some homemade berry gummies with gelatin. I suppose you won’t know if you’ll have side effects until you try it. I hope you aren’t in much pain!

mtop
Posts: 18
Joined: Jan 2017

Thanks, no real pain yet, also on calcium and vit D. I think that bone loss and other side effects are from the Lupron hormone shots. All of the listed side effects just worry the heck out of me. Have enough just from the Lupron.

kidclutch
Posts: 41
Joined: Oct 2017

Yep my dad’s bone health was fine prior to Lupron / Casodex, and side effects aren’t fun— that’s why I came here to talk about Prolia/Xgeva/etc. I’m hoping supplements help so we don’t have to introduce potential new side effects. It’s been a long 9+ months with this. 

mtop
Posts: 18
Joined: Jan 2017

Ya bone problems just found this year. Had RP 1/2016, been on Lupron since 9/2016. Side effects ie.. mem loss, weakness, tired. Now doc wants Prolia which has similar and new side effects. Hard to decide, other meds for bone loss not much better in reguards to side effects. Maybe I'm just worring to much? Read on other web sites about people having horrific side effects. Havent found much here.

Sidtippy2
Posts: 23
Joined: Aug 2018

My husband is on Xgeva and has been since he was diagnosed in Dec 17, he is stage IV w mets to bone, lymph nodes and lungs, PSA was 1550.  Is responding well to hormone therapy and the Xgeva has not caused any issues so far.

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