Insufficiency fracture as a sign of metastasis

[rogerwegner]

Yesterday I was informed that I have an insufficiency fracture of the head of the femur. The source of my severe pain has finally been revealed. Is this metastasis or just a side effect of years of Prolia injections, Should i refuse the upcoming Prolia injection?

[Tall_Allen]

Yes, according to the following study, it should be stopped and the fracture treated surgically. They also recommend recombinant parathyroid hormone (Natpara) along with minimum required calcium supplementation and without Vitamin D (if level is normal) supplementation instead.

ncbi.nlm.nih.gov/pmc/articl...

reference.medscape.com/drug...

[rogerwegner in reply to Tall_Allen]

Thank you I will see my oncologist soon and get this rolling.

[Hidden in reply to rogerwegner]

Good luck ! 🍀👍

[Hidden in reply to Tall_Allen]

😳 wow!

[Hidden]

Based on what I've read, it looks like it might be necessary to stop Denosumab temporarily, but long term the benefits outweigh the risks since these fractures are not common.

In patients with atypical femoral fractures, bisphosphonate treatment should be considered as a possible cause. Interruption of bisphosphonate therapy may be necessary for fracture healing. Re-treatment should be considered if bone density again begins to fall and after a discussion of the benefits and risks with the patient.

And:

Atypical subtrochanteric fractures are rare, less than 0.1% of total fractures in a New Zealand study3. For a population of 10,000 patients at high risk of fracture, bisphosphonate treatment might be expected to prevent 108 hip fractures (and around 750 other fractures) per year and result in three subtrochanteric fractures2. Therefore, the benefit risk ratio for bisphosphonate treatment remains favourable.

medsafe.govt.nz/profs/PUArt...

Here's another article on the subject:

ncbi.nlm.nih.gov/pmc/articl...

[rogerwegner in reply to Hidden]

Thanks for the information. I will bring the docs up to date !

[Hidden in reply to rogerwegner]

Weird when patients have to educate doctors. Don't they ever consult Dr Google themselves?

[rogerwegner in reply to Hidden]

Ow don't let your doc hear you say that

[noahware]

I would think this type of fracture could be a direct or indirect result of the osteoporosis that results from a loss of estrogen, and not necessarily arising from metastasis itself. Have you discussed with docs the possibility of low-dose estrogen therapy either along with, or instead of, Prolia?

[tango65]

You need to consult about stopping denosumab. There is an increase in the incidence of vertebral fractures after discontinuing denosumab. Most doctors agree that once in denosumab always in denosumab.

ncbi.nlm.nih.gov/pmc/articl...

You could discuss to stop denosumab and start other bone agent (zoledronic acid) or go with drugs which build new bone such as Forteo, but I do not know if could help to reduce skeletal events in metastatic PC.

forteo.com/

[rogerwegner in reply to tango65]

Thank you for the information. I will check with my doctors and see if they agree on a path forward for me.

[tango65 in reply to rogerwegner]

You need to be careful with the denosumab, since one does not want to stop it and get into a higher risk for vertebral fractures. Perhaps stopping it and using other bone agents could be safe. There is also the effectivity of other bone agents in relation to bone metastases. Zoledronic acid is effective, but it does not produce new bone. Forteo does produce new bone but I do not know if it can be used in patients with bone metastases.

I wish the best of luck and I am sorry you had this complication.

[rogerwegner in reply to tango65]

thanks

[Hidden]

Well rogerwegner that’s just insufficiently bad news for me too.. I’ve had 3 prolia shots. Joints degenerating in osteopenia. Whoo hoo! Something to look forward to . When I see the women on prolia commercials I say “ that’s my shit” it’ll probably destroy our bones long term .? I expect the heart to go before all else. Sorry for the fracture. This is my pending nightmare on the near horizon . E-2 patches might help?? I get rashes from prolia . Do you ? What can be done about this fracture . Anything? I am sorry that you’re suffering this brutal pain . Please let us know what helps? 😎🙏

[rogerwegner in reply to Hidden]

I have no side effects until this episode. So far they have nothing to suggest except rest and no weight on the leg for at least a month. I am really going to go down hill now.

[rogerwegner in reply to rogerwegner]

I was on Prolia for about 5 years

[Hidden in reply to rogerwegner]

I had just 3 , 6-month shots.

[Hidden in reply to rogerwegner]

I’m sorry . I hate to hear that . .. these bone issues aren’t a joke. You finding a fix could bode well for me and others. I’m pulling for you get some. relief .😫

[Fanger1]

I'm sorry you developed fracture and pain. I hope your surgery can restore function and get you pain free. Like Whimpy, I'm on Prolia too. I've also be taking supplements from Osteonaturals. Good luck Roger🙏

[rogerwegner in reply to Fanger1]

Thanks

[Hidden in reply to Fanger1]

Just two elderly women on prolia .. 😂😂

[Fanger1]

Don't think you're going down. This is just a speed bump in your journey and we're all rooting for you my friend🤙

[rogerwegner in reply to Fanger1]

Thanks for the encouragement. It really helps a lot.

[podsart]

“insufficiency fracture of the head of the femur.” — did they mention AVN a vascular necrosis, insufficient blood supply to femoral head? I had it when I was younger, pain typically felt in groin.

[rogerwegner in reply to podsart]

Thanks I will ask for a print out of the report. All that I heard was that the fracture was from insufficiency and that there was edema in the marrow. It is amazing when you are getting bad news from the doc that your ears or brain stops taking in any more information very early in the appointment

[podsart in reply to rogerwegner]

I also get affected by anxiety affecting my memory and focus during medical visited

[rogerwegner in reply to podsart]

I keep thinking why did I not ask all these questions when I as there at his office.

[podsart in reply to rogerwegner]

I try to write my questions in advance and try to have the appt after I can get lab results, so I can adjust emotionally to any adverse results and more calmly think of the questions

[rogerwegner in reply to podsart]

Those are all good strategies. This is not your first rodeo

[podsart in reply to rogerwegner]

True, been riding this bronc since end 2009

much luck to you

[j-o-h-n in reply to rogerwegner]

Tape recorder or another person with you to act as the scribe...........

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/21/2020 6:27 PM DST

[rogerwegner in reply to j-o-h-n]

Yes , I try to take the wife with to help me listen

[j-o-h-n in reply to rogerwegner]

Next time take the girl friend instead.........

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/21/2020 9:22 PM DST

[podsart in reply to j-o-h-n]

How do you find the dr reacting to being recorded?

[j-o-h-n in reply to podsart]

I actually have never taped a meeting with my MO's but if I did and they objected I would consider changing MO's. It's nothing but their voices and If they think I'm going to take them to court regarding the tape then I would be highly suspicious of their guidance. I no longer call myself or let the hospital staff call me a patient "I am a customer". Plenty of members here are afraid to name their doctors, as if they are gods. I think of them as auto mechanics for my body... Do not get me wrong I have a good rapport with all of my doctors... Take care.... and keep fighting those tiny bastards...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/21/2020 9:45 PM DST

[wagscure259]

Wow, sorry to hear this. From the research I believe the Prolia must be stopped. If you are over 65 I don’t believe a fracture of the femoral head can heal due to absence of blood supply to the head of the femur in most if not all of anyone past the age of 65 where a prosthesis would have to be surgically implanted( hemiarthroplasty)

[rogerwegner in reply to wagscure259]

Well at 77 I guess that an new ball will be in my future for my hip joint. Thanks for the information.

[Hidden in reply to wagscure259]

ouch !😣

[wagscure259]

I would recommend that you consult with an ontological orthopedic surgeon ASAP

[rogerwegner in reply to wagscure259]

I am not sure that we such an animal in Missoula Montana. but I will check. Thanks

[immunity1]

Go with all the above advice but check the status of the fracture, good imaging will show if there is a metastasis there or it is treatment based which should modify your treatment.R

[rogerwegner in reply to immunity1]

I am getting a bone scan next week to get a better picture of my status