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Caring for Your Bones When You Have Prostate Cancer

by Susan F. Slovin, MD, PhD

As we age, we are constantly reminded that we will be experiencing a variety of aches and pains consistent with aging and osteoarthritis. Men with prostate cancer face an additional challenge – keeping bones that may have been weakened by age and inactivity, as well as the cancer itself, healthy.

Men with prostate cancer are living longer, which means that future bone complications can occur. These complications include compression fractures, bone weakness due to metastatic cancer, and cord compression (where disease destroys the bone and puts pressure on the spinal cord below). Interventions are needed to prevent these potentially painful conditions.

Monitoring Bone Disease
Contrary to what some people believe, men who develop metastatic prostate cancer in their bones may live for years. It is not true that all men develop significant pain. Sometimes, bone pain may be the result of arthritis, osteoporosis, or sports activities, not cancer. Causes of bone loss include a diet low in calcium and vitamin D; poor sun exposure; prolonged bed rest; lack of physical activity; and certain medications, such as anti-convulsants and prostate cancer therapies like the hormones leuprolide (Lupron™) and goserelin (Zoladex™).

Bone disease may be benign (osteoporosis, osteopenia) or malignant (metastatic cancer). To find out exactly what is causing bone pain, a variety of imaging studies are used. One test that is used to measure bone density is a type of X-ray called the DEXA scan (or Dual Energy Absorptiometry). This test can help your doctor determine whether you need to take calcium and/or vitamin D supplements. A simple urine test can also measure bone loss.

Low-fat dairy products; dark, leafy greens; and fatty fish are all good sources of calcium, an essential nutrient for healthy bones.

Standard imaging tests can also be used to test for osteoporosis. A CT (computerized tomography) scan can be focused on the lower back, a site where men are more likely to experience osteoporosis. Another method used to assess changes in the bone is MRI (magnetic resonance imaging), which uses magnetism, radio waves, and a computer to produce detailed images of bony structures.

Treating Bone Disease and Pain
When bones are weakened by cancer, they may easily break with a fall or injury. Bones may also spontaneously break without any injury or symptoms other than some mild discomfort. Treatment for bone loss may include a group of compounds known as bisphosphonates, which prevent special bone cells (osteoclasts) from destroying existing bone and weakening it. Zoledronic acid (Zometa™) is one example of a bisphosphonate. This drug is indicated mainly for men with prostate cancer. Another medication in this class of drugs is Alendronate (Fosamax™), but it is used for osteoporosis, not prostate cancer.

Bisphosphonates are FDA approved for a variety of different malignancies. However, a rare side effect of this type of drug is osteonecrosis of the jaw (ONJ), which presents as a heaviness in the jaw, pain, or swelling or infection of the gums. If you are taking a bisphosphonate, you should inform your dentist so that you can be monitored for ONJ.

When a person experiences bone pain in the setting of known bone metastasis, there is obvious concern that the pain may be a symptom of cancer spreading. However, there are other, more common, reasons for bone pain. When in doubt, scans should be performed to assess the status of the bone disease. When bone pain is not a result of cancer metastasis, pain medications (acetaminophen, non-steroid antiinflammatory drugs like ibuprofen) can be given for mild to moderate pain. If pain is more severe, either short-acting or long-acting opiates can be given.

Promoting Bone Health
You should try to eat plenty of low-fat dairy products; dark, leafy greens; and fatty fish, such as tuna, salmon, sardines, herring, mackerel, and swordfish. Sun exposure also has importance, but excess sun exposure should be avoided. You may also want to talk to your physician about whether you should take calcium and/ or vitamin D supplements.

If you are able, light exercise should be part of your plan to maintain bone health. Exercise maintains bone strength and reduces the loss of calcium in your bones. Weight-bearing activities such as walking, swimming, dancing, stairclimbing, or light weightlifting promote bone strengthening by stressing bones naturally. In addition, greater muscle strength from exercise ensures better coordination so that falls can be avoided and injuries to bones can be lessened.

Remember, the purpose of cancer treatment is to not only control your cancer but also maintain your quality of life. Maintaining the health of your bones is an important component of ensuring a good quality of life.

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