Spinal fusion & bone thining

[Chubby42]

Hi guy's.

I recently under went a spinal fusion to try & fix a painful spinal fracture from early March, 2 weeks later I am still having the same pain when I sit or stand for too long.

My Onc has already said my hips are showing wear and tear + thining but has yet to put me on any medication for this only to keep taking more calcium D3, K2 & so on, I currently take 3 & sometimes 4 calcium tablets a day = 4x400mg.

My question is could this have effected my spine from healing properly not been on any bone thining meds.

Just a thought to see if I should be pushing to get some bone thining treatment other than calcium.

Cheers

[Tall_Allen]

The time to begin bone strengthening medicines (Zometa or Xgeva) is after castration-resistance and there has been loss of bone mineral density (BMD) on a DEXA scan. They prevent spinal compression and fractures caused by being on ADT for a long time.

Calcium and Vitamin D do NOT improve BMD if your blood levels are normal. However, it may be necessary to supplement them if taking Zometa or Xgeva. High doses of Vitamin D have been found to lower BMD because it pulls calcium out of bones in order to maintain serum levels. High doses of calcium supplements have been found to be associated with increased prostate cancer.

[Chubby42 in reply to Tall_Allen]

OK thanks TA, so I do need to wait longer then, I have had scans & blood tests & been told I'm not too bad just a slight thining, my hips really do hurt though.

[Tall_Allen in reply to Chubby42]

You may have arthritis in your hips. Maybe talk to an orthopedist about it?

[Chubby42 in reply to Tall_Allen]

So if my hips are showing signs of wear & tear? I just assumed thining was the cause.

[Tall_Allen in reply to Chubby42]

The linings of our joints wear down with age. An orthopedist can diagnose if that is your case with a simple X-ray.

[Jac_J in reply to Tall_Allen]

TA, why begin Zometa or Xgeva after becoming castrate resistant? Why not in the months after starting ADT (after assessment)? Most of the gentlemen on this site are elderly and may already have signs of osteopenia, and if they don't, they probably will soon.

I personally wonder if I should be on low dose Zometa etc and Im much younger and fitter but definitely have signs of arthritis and don't want to wait until I lose BMT to take preventative treatment.

Your thoughts?

[Tall_Allen in reply to Jac_J]

Because the worse side effects of those drugs are cumulative over time. It isn't a good idea to take one until it is needed. It is needed more in castration-resistant (CR) men because they have been on bone-depleting ADT for longer. Also, as bone metastases develop and grow, more bone strength is needed to prevent fracturing. Even when one is CR, there may be little need for them if metastases are small and BMD is high.

[Tall_Allen in reply to Tall_Allen]

They don't fix arthritis. They prevent fractures and spinal compression.

[Jac_J in reply to Tall_Allen]

Yes I thought it would be a cost benefit analysis.

Can these drugs be taken intermittently to mitigate the side effects while still providing some benefit? i.e any studies exist? My hunch would be no as most oncologists (imo) are not really concerned with side effects, only has PSA decreased.

[Tall_Allen in reply to Jac_J]

No, they can't. It was found that over the long term, they were not as effective if spaced out. Most oncologists, I've met are very concerned with side effects.

[tango65]

The cancer is castration resistant with bone metastases, you should request zoledronic acid or denosumab to help reduce bone events (pain, fractures). Calcium supplements should be substituted by a diet rich in calcium . Calcium supplementation has been associated with a higher incidence of cardiovascular complications. If you keep taking Vitamin D you should request a blood level to see if it is indicated to continue supplementation.

[Chubby42 in reply to tango65]

I have had 1 bone met which was on my L2 spine, this is also where my spinal compression was /is but recent surgery has failed to fix my spinal pain.I had fusion L1 to L4 and vertebroplasty.

But this seems to have not worked so I'm thinking it was because of the bone thining & lack of medication.

Couple of months back I was told my bloods were OK.

Thanks

[tango65 in reply to Chubby42]

Severe osteopenia and osteoporosis may compromise the healing of the surgery you had. You could request a DEXA scan, but with castration resistant cancer and bone mets I believe zoledronic acid or denosumab are indicated to try to reduce the incidence of adverse bone events.

[j-o-h-n]

If you need a great hospital for your hip(s) knee(s) go to the "Hospital for special surgery".

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/13/2021 1:21 PM EST

[SViking]

Cedar-Sinai Spine Center is the best in the US. They perform a lot of clinical trials.