Treatments to manage your osteoporosis

Some prostate cancer treatments lead to worse bone health. For example hormonal therapy or pelvic radiation therapy both have negative impact on your bone health. They increase your risk of developing vertebral, hip, and pelvic fractures. Although osteoporosis occurs less frequently in men than in women, men have higher post-fracture mortality rate. If you received hormonal therapy for your prostate cancer, you should have a baseline DXA to measure bone mineral density. You should also receive retesting on the basis of your doctor’s clinical judgment.

Goals of treatment for osteoporosis among cancer survivors are to prevent further bone loss and potential fractures in the spine and hips. Once you are diagnosed with osteoporosis, exercises, nutrition and supplements may not be enough to prevent fractures. Medications such as bisphosphonates and denosumab may be needed to stop further bone loss and increase bone density. Medications can only control but not cure osteoporosis.

Drug treatments

(For steps to be taken other than receiving medications, refer to the healthy habits section.)

Bisphosphonates and denosumab are two classes of drugs approved for the treatment of osteoporosis and for management of bone metastasis and skeletal events associated with solid tumors; however, denosumab is not approved for use in patients with bone metastasis from multiple myeloma.

Narrator: No treatment can cure osteoporosis but the drugs discussed in this program can slow down the disease and help prevent you from getting a fracture or broken bone. Osteoporosis is a serious condition. It requires treatment and monitoring by a doctor to prevent additional problems.

Jane: Well we made it! So how was your first session?

Charlotte: Oh, it was fine…and I’m so glad we decided to do this together…it makes it a lot more fun.

Jane: That’s for sure… we can gossip (grins)…but first you can educate me about this bone thing… did you read all that info your doc gave you?

Charlotte: You know …a lot of it’s about the different drugs they use to treat this…and there’s a lot to digest…but it looks like at this point, just taking calcium won’t be enough…

Narrator: There are several types of medicines for treating osteoporosis: one class of drugs is called bisphosphonates. Denosumab is another class of osteoporosis medicine. Bisphosphanates are drugs you may have heard of by their various brand names…names like Boniva, Fosamax, Actonel and Reclast. These drugs all act by slowing down the loss of bone cells

None of these drugs cures osteoporosis, but all 3 of these drug classes have been shown to help prevent fractures in the spine. Most of them have also been shown to reduce fractures in the hip and other bones as well, but research on some individual drugs is not yet complete. 

Each of the drug categories has a different way of acting, and therefore they have different side effects and risks…and you will want to know more about those in order to work with your doctor to find the best one for you.

Remember, there are several types of medications for osteoporosis. They differ in the way they are taken, how often they need to be taken, in the way they act, the kinds of side-effects they have and how much they cost

[This video is from the Bone Disease Program of Texas and it's available at the program website at:] 

Once a diagnosis of osteoporosis is made, the treatment focuses on slowing down bone loss or building new bone, increasing bone strength and minimizing the risk of fractures. Patients should be aware that there are simple and effective treatments for osteoporosis.

And not every patient must be on treatment. I believe that nowadays instead of automatic response by giving a medication, we do look at each patient as an individual and analyze their risk factors on an individual basis.

 For menopausal women, estrogen therapy can prevent bone loss and increase bone strength. However, in light of recent concerns about the safety of long-term use of estrogen, it now has a more limited role in the treatment of osteoporosis and of course women with breast cancer must avoid estrogen therapy. Certain oral medications called bisphosphonates sold under such names as Fosamax, Actonel, Boniva or Reclast are used to prevent bone loss. However, these medications are not without side effects including stomach upset.

Raloxifene sold under the name Evista is approved for the prevention and treatment of postmenopausal osteoporosis in women. In addition, it is also approved for the prevention of breast cancer. Denosumab, sold under the name Prolia is a monoclonal antibody given as an injection under the skin twice yearly. It is approved for the treatment of osteoporosis.

The medication can slow down or stabilize or even slightly improve your bone density but it doesn’t necessarily cure osteoporosis and so we hope our patients understand that they may still develop a fracture but at least the medical therapy did reduce their risk.

A fragment of parathyroid hormone sold under the name Forteo is given as an injection under the skin once a day for two years. It’s been shown to lead to new bone formation and increased bone strength but it’s not for patients with active cancer or with a history of radiation therapy. Patients with low bone mass can help themselves by continuing to take supplements such as calcium and vitamin D and performing weight-bearing exercises. These exercises cause your bones and muscles to work against gravity. Good weight-bearing exercises include walking, dancing, tennis and stair-climbing.

Weight-bearing exercise is very important for healthy bone. This is because the main function of bone is to support our body to carry our weight.

There is a lot a cancer patient can do to protect bone health. It all begins with good communication with the physician.

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