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Advanced Prostate Cancer
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Lupron and osteoporosis

My Dexa Scan shows I am osteopenia. My MO suggest I take Fosamax or Prolia. I have been on Lupron since 12/18. Can anyone who has taken either of the two drugs share their experience.

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Prolia (denosumab) is very effective and requires an injection every 6 months. Fosamax has to be taken orally once a week, and at least one-half hour before the first food, beverage, or medication of the day. Alendronate is incorporated into the bone and it could be associated with low impact or atypical femoral fractures (brittle bones despite increased bone density). Both are associated with osteonecrosis of the jaw (about 2-3% incidence mostly in people having teeth extractions or other forms of dental surgery.. If there are bone metastases the patients are usually treated with Xgeva which is the same than prolia but in a higher dose. There are data indicating that denosumab could delay the development of bone metastases. in patients with castration resistant PC.

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I am in the same boat. I've had two injections of Prolia, six months apart. No obvious side effects.

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I had a similar case and went to zometa (similar drug). No real side affects except a little tired right after the shot. I added Celebrex because a clinical study (see link) showed the two in combination to reduce deaths over 20%.

Schwah

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My dad has been on fosamax for about a year with no issues whatsoever! I actually had osteopenia when I was younger from a health condition. My case is different because I wasn’t taking a medication that continued to deplete my bones, however I was able to reverse it with diet and weight bearing exercise alone. I’m not suggesting this for you at all but I do want to emphasize that a diet high in calcium and weight bearing exercise is very important!

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"calcium"

Does that include chocolate chip ice cream (two scoops) three if wife is not paying attention?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/09/2019 6:44 PM EDT

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I was on prolia as a precaution for osteoporosis while on ADT before getting bone mets. No side effects. When I got bone mets I switched to monthly xgeva shots (expensive) a stronger version of prolia. After clean bone mass scan I reduced it to quarterly. I believe it causes fatigue.

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I used Xgeva which is Denosumab, and Prolia is also Denosumab. For some reason the literature says that Xgeva is preferred over Prolia for metastatic bone cancer. Fosamax effects your osteoclasts that build up bone tissue with calcium. I had 3 shots of Xgeva every 6 months when I was on Lupron, because my bone density was down. I was on Lupron for 6 1/2 years and over 11 years I have had 72 radiation treatments. I am on active surveillance and have had no therapy for 1 year. I was told my cancer is gone. Fragile bones are nothing to fool with so make a decision and begin therapy, and above everything else just keep truckin'.

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I started Fosamax because I already had full osteoporosis before I was diagnosed with Cancer and long before I started and ADT. For 5 years before cancer, I was already breaking ribs 2 or 3 times per year. It was not fun. Painful and prevented me from exercise.

After cancer diagnosis, I was on ADT and got a Fosamax fracture with a PSA of 0.2. Kaiser misdiagnosed it as cancer "possible pathological fracture" and did unnecessary radiation to the sacrum. Today my sacrum is very brittle and giving me more trouble. Studies show that Prolia has fewer "side effect" fractures and switched to that as soon as it came out.

I used additionally half an Estrodiol patch 0.1, high dose Vit D, and half a calcium tab from Costco at the advice of an endocrinologist. Was able to build some bone and get back to osteopenia level in about 3 years.

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In 2011, following a bone fracture secondary to ADT-induced osteopenia/osteoporosis, I was on alendronate(Fosamax) for a year or two.

On Fosamax, I put up with continual stomach upset — no actual vomiting, just a feeling of low-level nausea much of the time — and then switched to denosumab(Prolia). At first I received an injection every six months at the oncologist's office. Then my insurance changed its already bizarre rules so as to disallow my oncologist from both carrying it and injecting it. So now I self-inject twice a year.

I find the Prolia injections much easier to use and better tolerated than Fosamax pills.

In the U.S., drug prices have nothing to do with reality. Prolia is a thousand times more expensive than Fosamax. But for me, with my insurance, the co-payment for six months of Fosamax pills was more than the co-payment for one shot of Prolia lasting the same six months. I'm sorry to be costing my insurance company so much more money, but they did somewhat bring it on themselves with their pricing.

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I was Very metastatic to many bones upon initial diagnosis. I've been on Lupron for almost 5 1/2 years. My Oncologist treated me with monthly IV Zometa (zolendronic acid) for a couple of years, and backed off to quarterly IVs after a couple of years. (The Fosamax (alendronate) is a related, older drug, taken less frequently, by people with or without bone mets.) I also could have taken similar more frequent injections of Xgeva (denosumab), which for general osteoporosis also comes in the form of Prolia, taken less often. In prostate oncology, Zometa and Xgeva are pretty common in the USA.

I've never had any adverse effects of taking Zometa, other than the logistical inconvenience of trips to the lab for blood work, and the IVs, themselves.

During the past 5 years I've met a couple of guys who felt some aches or pains or same-day discomfort on initial Zometa, and they just switched to Xgeva injections

I've never personally met anybody who got ONJ or had a long bone fracture after long-term use of either Zometa or Xgeva. I get regular dental care & cleanings, and have told my dentist that I would want to avoid any invasive jaw bone procedures if possible, or at least plan for them ahead of time.

Charles

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I had first prolia shot 2 months ago. No problems noticed. My wife takes fosamax and she has no issues with that.

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I took prolia with adt and after bone mets switched to xgeva. The only apparent side effects are fatigue I believe but not sure if it’s coming from xgeva or estradiol. My bones are in good shape according to bone density test notwithstanding three bone mets since 2017 hit with SBRT.

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