Pelvic insufficiency fractures - anything they can do?

[BertieSpring]

Hi everyone, I'm new to this forum and SO pleased to have discovered the wonderful PRDA.

I had radiotherapy a couple of years ago as part of treatment for rectal cancer. I've had bowel issues since low anterior resection surgery (diagnosed as LARS) which over the last 6 months have got progressively worse which led to a diagnosis of PRD - I was very lucky to be pointed in the direction of a gastro consultant who acknowledges it as a thing!

In my surveillance scan back in May, they saw insufficiency fractures both sides of my pelvis and so I was referred to a rheumatologist. He seems to be totally flummoxed by the whole situation. I had an MRI done which confirmed the CT scan and he's now referred me on to another rheumatologist. It came as a surprise at the time but over the last few months, my lower back has got increasingly unhappy which I guess is down to the fractures.

Anyway, my question is whether there is anything that they can do about it? The original rheumatologist was concerned that normal meds for promoting bone growth wouldn't work because the damaged bone cells won't take it up as a normal bone cell would. I've heard bad things about the effects of bone meds on the digestive system and mine is a total mess already so keen to avoid that. Has anyone heard of other solutions? And do they ultimately heal or does it just keep getting worse?!

[SpaghettiBetty]

Hi BertieSpring

I had a sacral/ileac pelvic insufficiency fracture (PIF) following pelvic radiotherapy.

Like most things PRD related I don’t think many health professionals are aware about PIFs. No disrespect to your rheumatologist, but mine had no clue and kept trying to put it down to hormonal changes and didn’t consider the 6 weeks of daily ionising radiation had anything to do with it 🙄

Not really any treatments but lifestyle adjustments will help. I’ve popped some medical advice I was given below:

Absolutely no ‘explosive loading’ eg running/jogging, jumping, even running up the stairs can be bad.

Avoid cola and anything other fizzy drinks with phosphoric acid in as this leaches calcium from your bones, Eek!

There are other things to keep an eye on like osteoporosis or osteopenia, I have regular (every 2 years) DEXA scans to assess my bone density and am on HRT to help improve my bone health (I was DXd at 30)

I’ve been prescribed regular high dose vitamin D supliments (40,000 UI a week) to help my bones - probably worth asking for a blood test to check your vitD as this isn’t routinely checked.

It generally takes time but they will heal, it could take a year but they will get better. Listen to your body, if you’re getting pain make sure you rest.

[Dustyangel]

hi bertiespring

Sorry to hear all the issues that you are having at the moment, im almost 3 years since my last treatment 26 radiotherapy, 14 chemotherapy 2 brachytherapy. I too had pelvic insufficiency fractures, they do heal on there on so i was told and they did. I seemed to get all the so called late/long term side effects as soon as treatment stopped (if treatment wasnt bad enough)! Im sure they didnt believe me at the time but still have issues today regarding bowel bladder pelvic pain lower back pain, i was told vitamin d wouldn't be of much use, long story short i now have been confirmed osteoarthritis in my hips, and basically been told to contact my gp if its bothering me, its bothered me since day 1 ! Sorry i cant help further as i just take Co-codomol and amitriptyline for the pain amongst my other medication for bowel bladder and hrt because i was put in early menopause and to protect my bones it hasnt worked so far! All the best to you. X

[Noshameanalcancer]

BertieSpring , Do you still see your Rad Onc.? S/he will know who to send you to to deal with the fractures themselves. This is not uncommon for pelvic radiation patients, and there are fixes for it. It sounds as if you've been in pain for some time. A radiologist can cement the bones and, from what I hear, the pain goes away almost immediately. As far as your back, it could be nerve damage from radiation; a pain management physician can do an ablation on the nerves in your back to manage the pain until you are able to regain strength in your back. If you choose to wait on the fractures, they will eventually heal on their own, but it does take quite some time. I went through treatment for stage 4 anal cancer and have PRD as well. I allowed my fractures to heal on their own, but it's taken quite some time. The ablations have helped a TON with my back pain! As far as building bone strength, have you been diagnosed with osteoporosis? If so, it's best to take meds to build bone mass. The meds don't have to be high doses, you are your own advocate, and you have the say about what goes in your body. Strength training is important and a pelvic floor P.T. can help loads with that- your med or rad oncologist, or even your primary care physician can refer you to one. If you haven't done so yet, P.F.P.T. will help so very much in all aspects of PRD- I can't recommend this enough!

[Vailgirl]

i also have osteoporosis in only my low back. Im sure the radiation added to it. Finding someone who can help w proper atretching and bine building exerciswa wll help, but im saying no to the meds. I have enough post treatment stomach issues, which they all cause - except for maybe the infusion one. I personally dont trust the meds. Trying to beef up my weight training, and high quality calcium, K2, vit D, magneaium.