Weekly Blog: Bone health

14 June 2022

By Tim Baker

As you navigate a prostate cancer diagnosis, coming to terms with treatments, side effects, lifestyle changes, the existential dread and angst, it’s easy to overlook one very important element of your cancer care. Bone health.

We don’t think about our bones much, until we have to and that’s usually because we’ve experienced some sort of adverse event – a fracture or bone pain or osteoporosis. So, it pays to be pro-active from the beginning.

When I was first diagnosed with metastatic prostate cancer seven years ago, with a lesion in my right femur (or thigh bone), I was referred to an orthopaedic surgeon to see if the leg needed to be pinned to prevent what my oncologist called “a pathological fracture”.

This was just one more alarming bit of news on top of my diagnosis as I traversed this treacherous new terrain and its confronting language. Not only might the bone be compromised by the cancer cells now colonising my femur, I was told, but the recommended treatment of hormone therapy (or androgen-deprivation therapy) might also reduce bone density over time, and could lead to osteoporosis.

Mercifully, the orthopaedic surgeon reported my thigh bone was holding up fine. The combination of hormone therapy and early chemotherapy eliminated the lesion from my femur, and it has remained clear since. And happily, there is much we can do to maintain bone health and offset any loss of bone density.

Most men on hormone therapy will be prescribed a bone protecting agent, usually one of two types, either bisphosphonate or a monoclonal antibody, such as Denosumab. As is often the case, though, this treatment comes with its own set of potential side effects, so its use needs to be monitored closely. Denosumab is given as an injection, usually in the abdomen, and your oncologist and/or oncology nurse will want to know if you are experiencing any side effects such as jaw pain.

It's important to report any serious side effects to your doctor, such as:

• Signs of allergy such as a rash, itching or hives on the skin; swelling of the face, lips, tongue or other part of the body
• Shortness of breath
• Signs that the level of calcium in your blood may have fallen too far, such as muscle spasms
• Numbness or tingling sensation, especially around the mouth
• Shortness of breath
• Signs that your kidneys may not be working properly, such as decreased urine output.

I was also given a card to carry in case of accident, to alert any treating health professional that I was taking Denosumab. It is also important to let your dentist know you are using Denosumab as it needs to be discontinued for a time before any tooth extractions can be performed. Otherwise, you risk a condition known as osteonecrosis of the jaw, a serious condition that usually manifests as jaw pain and requires urgent treatment.

Alongside medication, there are plenty of ways to be proactive about your bone health and chief among them is one miracle treatment I’ve written about before, which neatly addresses many of the side effects of prostate cancer treatment. And that miracle treatment is called exercise.

If you have a chronic health condition, such as advanced prostate cancer, you may qualify for a care plan under Medicare, which you can obtain from your GP. This allows you five subsidised referrals to allied health services each year – like exercise physiology or physiotherapy, as well as a range of other supportive therapies. I usually take all five of my referrals for physiotherapy, as supervised exercise training is one of the best ways to maintain bone health. A mix of resistance, weight bearing and balance exercises will help maintain bone strength, among a multitude of benefits (including improved cardio-vascular health, mood, and muscle mass, which can all be impacted by hormone therapy).

You may also be recommended calcium and/or Vitamin D supplements. Given that adverse bone events, such as fractures, bone pain, and osteoporosis can impact quality of life so acutely, it’s important to be mindful of bone health throughout prostate cancer treatment and beyond.

Even so, it’s perplexing how bone health can remain such a blind spot for many men with prostate cancer and their physicians. I think I’ve had one bone density test in seven years and I’ve no idea how my bone density might currently be tracking. The importance of calcium and vitamin D supplements had never been properly explained to me before I started researching this blog. I’ve had conflicting advice about how often I should be having Denosumab injections, and no one has been able to quantify the risk of osteonecrosis of the jaw. Perhaps it is because bone health is not the core businesses or either oncologists or urologists, who are the main medical specialists we encounter throughout prostate cancer treatment. But it’s something I intend being far more mindful of going forward and will be getting another bone density test as soon as possible.

But seven years on, I’m still surfing, exercising daily, doing yoga and pilates and a regular weights session, swimming laps in the warmer months. And I’m participating in the GAP4 Interval study to see if supervised training helps men with prostate cancer. Sadly, I’m in the control group so I miss out on the supervised training bit, but I still get a six-monthly fitness assessment which shows I’m maintaining overall fitness levels through my own efforts.

So, despite the many and varied challenges of prostate cancer and its treatment, I’m here to tell you it is entirely possible, and indeed desirable, to maintain a fit, active and healthy lifestyle while managing your condition. Your bones will thank you for it.

References

^{Healthy Bones Australia https://healthybonesaustralia.org.au/}

^{Prostate Cancer Foundation of Australia https://www.prostate.org.au/awareness/further-detailed-information/commonly-used-drugs-in-treatment-of-prostate-cancer/bisphosphonates/}

^{Bisphosphonate Fact Sheet, PCFA https://www.prostate.org.au/media/333739/Drug-Sheet-04-Bisphosphonates.pdf} 

This August, Tim will launch his latest book, Patting the Shark. This candid story documents his journey learning to live well with prostate cancer. To launch Patting the Shark, Tim will join Professor Suzanne Chambers at Brisbane Library on August 21, 2022 from 11am to 12pm to talk about his journey. To attend, click here.

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