I just was told yesterday in the hospital after he broke femur and had surgery to install rods in both femurs by the Hospitalist Oncologist it was not the radiation that has caused my husbands bones to be so brittle and break..... but all the prednisone he has been on. He was not a candidate for zometa due to jaw issues. We did find out adenocarcinoma ( original adv pc from his dx 2 years ago is in marrow. They said its not cureable but there are other things to keep him going . Someone else said ADT is the cause of brittle bones. Or maybe all above? Is there another bone strengthener anyone can suggest that does not cause osteonecrosis?
What Causes Bones To Break,The Predn... - Advanced Prostate...
What Causes Bones To Break,The Prednisone or ADT?
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Sapmiami
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Both ADT and prednisolone have bone weakening side effects. Also cancer itself due to disturbance in calcium magnesium metabolism might contribute to it. Lack of physical activity, parathyroid abnormalities can also contribute to bone weakening. Honestly, there are many factors which lead to bone weakening and tendency to fractures. Even race of the person plays some role. e.g. Caucasians in general have higher tendency for fractures than Africans and Asians.
I bring this up whenever I can, because I doubt that many doctors track estradiol [E2] in men on ADT.
When E2 falls below ~12 pg/mL, it does not take long for bone integrity to suffer. The remedy is to use the lowest dose E2 patch. It may not even be required daily. Monitor E2 - a target of ~20 is good; it must not rise above 30 pg/mL.
(The exception to the above, of course, is when E2 is the ADT agent. No need to check because E2 will be very high.)
Note that vitamin K2 should be used to ensure that calcium is transported to bone. Avoid high dose calcium. The list of other important minerals includes magnesium, zinc, boron, etc. They need to be in balance with calcium.
Can prednisone cause osteopososis? Yes, but check E2.
-Patrick
I support Patrick's post. E2 patches can also increase bone density again and mitigate other side effects, e.g. hot flushes.
I just read Patrict's and your post. My husband is concerned about more fractures in his spine. He is on Xtandi and has bone mets. I didn't know that an E2 patch can increase bone density. But could it drive the cancer? Should we be including K2 supplements?
No, it will not drive the cancer. These patches, at a higher dose, can be used to fight cancer (off-label). I am not familiar with K2, if Patrick recommends it, I think you can take these.
E.g. these patches 0.1 mg:
IMHO, if the cancer is in his marrow it's also in his bones and that will cause far more problems than ADT and prednisone. I cracked or broke a couple ribs before my diagnosis (and before any treatments), by resting my body weight on them on the edge of the bathtub while trying to clean out a hair clog. At the time that seemed a bit odd, but in retrospect they were probably weakened by the cancer.
Also IMHO, the best thing you can do to preserve bone health is exercise, but this assumes you're starting with bones healthy enough to withstand exercise. If or when your husband is healthy enough to walk, he should do it as much as possible. Every little bit helps.
How bad are the jaw issues and has he been offered Xgeva? Xgeva can also cause jaw issues but gets out of the system far quicker than Zometa if you have to stop it. Jaw issues are not great but neither are broken bones. It's an unfortunate situation where you probably have to choose which problem is worse.
I wish I had a better answer for you, but the first order of business should be to get the cancer under control. Perhaps Xofigo? That's a radio pharmaceutical that will target the cancer in the bones. If he has no soft tissue involvement he might be an ideal candidate.
He already did that. Radium 223. 5 infusions. We are waiting for genomic testing of the bone marrow biopsy now! Thank you!
Just one question. Did you get the hair clog out?
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 11/22/2019 7:45 PM EST - JFK assassination 1963
ADT is probably part of the problem. But if he's taking that prednisone just as a replacement dose (5mg, 1-2X/day) with Zytiga and had Xofigo at the same time, the combination is a known cause of bone fractures. He can try a weaker bisphosphonate. Transdermal estrogen may help. The risk of jaw bone necrosis is relatively small, at least at first, but the risk of crippling fractures seems to be an over-riding concern.
Tall...A you say that ---if he is taking prednisone just as a replacement dose with Zytiga -- what other reasons would someone take prednisone?
It is a powerful antiinflammatory and immune system suppressant, used for many purposes: autoimmune disorders, allergies, graft anti-rejection, brain swelling, etc. It is taken in higher doses for those purposes because it is not merely replacing what Zytiga takes away.
In my case, I will probably be starting Zytiga shortly but I have A-Fib and I read that prednisone shouldn't be used in such cases. I could go the Xtandi route but I also have severe memory issues from the years I have been on ADT plus E-2 patches and Lupron. I am now castrate resistant.
Any suggestions?
Prednisone must always be taken with Zytiga. Whatever youu read does not apply to replacement doses.
Thank you Allen. I will mention this to Dr
Strontium Ranelate could be used to treat osteoporosis:
ncbi.nlm.nih.gov/pmc/articl...
Forteo (Teriparatide) is a medication which increases bone density by stimulating new bone production. This is different of what zoledronic acid and denosumab do, These two drugs reduce bone reabsorption. Teriparatide could be very effective in increasing bone density
ncbi.nlm.nih.gov/pubmed/316...
These could be 2 options you could discuss with his doctors.
Both lead to osteopenia by different mechanisms. There are not a lot of workarounds beyond calcium intake, vitamin D and mechanical stress (i.e., exercise) on the skeleton.
Hey Sapmiami!
tom67inMA mentioned exercise. "Form Follows Function". Personal trainers know that. A bike will give you exercise but the small shocks transmitted through one's feet when running on a surface, even walking and weight bearing results in stimulating one's body to deposit minerals in their bones to meet the strength and structural demands caused by the exercise. Exercise increases bone density. Diet is important. Patrick, pjoshea13, noted that supplementing with K2 is important.
Foods, vegetables that have large amounts of calcium. Spinach, more so when cooked because it "compresses", kale and broccoli are sources of calcium that are also cancer fighters, sort of dual purpose. A little olive oil and pepper will help with absorption--a bromelain pill too.
myfooddata.com/articles/hig...
Maximum Vibrance has I believe, 240 mg of calcium per serving.
If your husband is unable to exercise but can stand there is another way to increase his bone density. In 2016 I became aware of what are called vibration plates. The "snowbirds" in Florida were using vibration plates to maintain and increase bone density and --healing! The big "A" has them now and will deliver one to your door. The NFL started using them in 2017(?) and Gym Source had them for sale. It has been found that vibration plates accelerate healing even from surgeries by increasing circulation.
A link with a little info --
The Many Health Benefits of Whole Body Vibrational Training
fitness.mercola.com/.../04/...
My best to you,
Currumpaw
Great post as usual....Thanks....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 11/22/2019 7:48 PM EST - JFK assassination 1963
Hope someone gave you a suggestion you can use. I like the vibration plate idea. It even has a remote control. I don't even have to bend. Great for slothful people like me. Just wondering if it would help my foot neuropathy. Starting to sound like a real good idea.
It is a great idea. He still cannot walk. But I did get lots of great information from all the replies . And I hope others did,too. The patch was never mentioned to us. Only failed Zometa because of the jaw issue and nothing else was ever suggested. My advice to anyone just starting this journey is read everything and get 3 opinions or more and keep researching. I pray scientists can end prostate cancer soon.
Hey Sapmiami!
Don't be too optimistic about a cure. The money brokers are at work crunching numbers about revenue lost from the Hep C cure and advising their clients that treatments are more profitable than a cure!
I particularly like the part when the infected are cured they no longer infect others maintaining a patient base.
arstechnica.com/tech-policy......
An example in a different way. I have a water heater in an apartment that was manufactured in May of 1956. The brand name is Tragessor. In the mid 90's it's controller failed and it was replaced. I asked about the company, Tragressor, as I hadn't seen that brand before. I was told that Tragressor made a quality product, highly priced and not bought by everyone. That those who were willing to pay the price for the quality heater never had to buy another! The tank is made of copper! The market for Tragessor's water heaters dried up and the company went out of business. The 1956 water heater is still heating water 63 years later!
Sort of a relatable story don't you think?
Currumpaw
An admitted problem with "capitalized medicine". However, as your link suggests, investment in cancer is a better bet because it's not an infectious disease, and a company with a cure can command a much higher price than a competitor with a maintenance drug.
Look at what's happening with generic Abiraterone. It has set the bar for price/performance, so to command a higher price a newer brand-name drug must perform better in some way. Eventually, as treatments continue to improve, it will become very expensive to fund a study that shows that new drug A provides 12 years of median survival compared to a 10 year median with the old drug B. The development costs of a cure will be lower, and can command a very high price.
I'm politically confused right now. While I like the idea of "medicare for all" and "socialized medicine", I do see it killing the profit incentive for creating a cure. "Capitalized medicine" could come up with a cure, but the price may be so high not everybody can afford it.
p.s., I'm really impressed with the quality of my Toyota relative to every other car I've ever owned, it's much better than the Chevy I used to own. Now remind me, which car company went into bankruptcy a decade ago? 
Hey tom67inMA!
I worked in pharmaceuticals for over 14 years. The money involved in research to bring a successful drug to market can't be understated. So many failures until a winner emerges. Somehow I don't see government willing to make that investment.
With Harvoni, Goldman Sachs flat out said that the new patient base was drying up because Harvoni cured Hep C and people were no longer being infected. No new patients!
As for a car--I had a 1968 AMX that was redlined every time it left the driveway. I had that car on roads so rough at close to 100 mph and off road as fast as 75 mph that few of today's vehicles would keep their suspension. I put Monroe 50/50 racing shocks on it and coil overs over the back shocks. Without the advantage of the advances of today's oils and lubricants it still ran strong but was beginning to smoke at around 130,000 miles when my ex-wife totaled it. The only drivetrain repair to the AMX was a timing chain and gears at around 90,000. One trunnion was replaced at a little over 100,000. My cousin owns a garage. It is amazing to look at the suspension on today's cars! If the old one overheated not a big deal. Change the hose, water pump, fix the radiator and fill the coolant and you were done. Today if a car overheats you can expect at least that an aluminum head will need to be resurfaced. Aluminum warps quickly.
I had an RX7, GXL model, the one designed to compete with the Porsche 944. It handled amazingly and had very rugged suspension, yet the rotary engine which had nice performance was a heart breaker!
Toyota--That V6 --Lotus tweaks that engine, puts a supercharger on it and uses it to power their Evora GT!
Medicare for all? I'd like to be 27 years old again too! Really, the world economy is just a game. Smoke and mirrors. Would countries be able to go back on the gold standard at this time? OOOHHH! How revealing that would be!
Currumpaw
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