A few years ago, one of my closest childhood friends of almost forty years was diagnosed with stage three (hormone-based) breast cancer. She was immediately sent to an oncologist to begin treatment. Her treatment consisted of the following, and in this order:
- Intense chemotherapy for six months
- A mastectomy of her right breast
- Intense radiation for six weeks
- Reconstruction of her right breast using a portion of her lower abdomen
- Breast reduction of her left breast to match the new right one
- Tattooing on the right breast of a faux nipple
- Arimidex (blocks the production of estrogen hormones)
During treatment with Arimidex, she suffered random bone breaking. First, it was a couple of ribs; then, with no warning signs, her femur bone broke out of nowhere. These medications are used to treat breast, colon, or rectal cancer. It works by slowing or stopping the growth of cancer cells.
Hormone therapy is commonly used for the treatment of breast cancer, prostate cancer, and certain types of gynecological cancers. These cancers are often hormone-sensitive, meaning that the growth of cancer cells is influenced by hormones such as estrogen, like my friend, or testosterone.
Hormones are a huge part of our body’s ability to run smoothly. When we stop their production to stop certain cancers, we also face unwelcome side effects that can significantly affect quality of life.
Recently, she was diagnosed with Osteonecrosis, also known as avascular necrosis, that began in her ankles and moved on to her knees, hip, jaw, and spine. The doctors are looking to see if joint or knee replacement could be an option to put, in her words, “Humpty Dumpty back together again.”
According to The Cleveland Clinic, “Avascular necrosis is a painful bone condition that gets worse over time and can affect your mobility. It occurs when something cuts off blood flow to one of your bones. Causes include broken bones, dislocated hips, radiation therapy and alcohol misuse. Most people need surgery — sometimes joint replacement — to ease pain and improve mobility,”.
*Note: All content within this article is meant for informational purposes only and is in no way a replacement for professional medical or psychological advice or support. Seek immediate and appropriate care from a healthcare professional should you or a trusted loved one deem it necessary.
What are the main causes of Osteonecrosis?
We believe she is experiencing Osteonecrosis as a result of chemo and radiation. Additionally, we suspect that trauma from the Arimidex therapy that caused her femur bone to break could also be a strong reason for this painful bone deteriorating disease.
Penn Medicine cites the following possible causes of Osteonecrosis, “Osteonecrosis occurs when part of the bone does not get blood flow and dies. After a while, the bone can collapse. If Osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.
Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic — meaning it occurs without any known cause.
The following are possible causes:
- Using oral or intravenous steroids
- Excessive alcohol use
- Sickle cell disease or any blood condition that causes abnormal blood clotting
- Dislocation or fractures around a joint
- Clotting disorders
- HIV or taking HIV drugs
- Radiation therapy or chemotherapy
- Gaucher disease (disease in which harmful substances build-up in certain organs and the bones)
- Systemic lupus erythematosus (an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue such as the skin, joints, and certain organs)
- Legg-Calve-Perthes disease (childhood disease in which the thigh bone in the hip doesn’t get enough blood, causing the bone to die)
- Decompression sickness from a lot of deep sea diving,”.
They go on to note the following symptoms, “There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:
- Pain in the joint that may increase over time and becomes severe if the bone collapses
- Pain that occurs even at rest
- Limited range of motion
- Groin pain, if the hip joint is affected
- Limping, if the condition occurs in the leg
- Difficulty with overhead movement, if the shoulder joint is affected
- Worsening arthritic symptoms in the joint when the condition deteriorates,”.
Currently, my dear friend is experiencing all of the above symptoms and is in extreme pain most of the time, and nothing yet has helped.
What drugs can affect bone density?
Well, we have determined that my friend has had treatment with many medications, which are highly likely the root of the development of Osteonecrosis. For instance, Osteoporosis Canada suggests that some medications, like those listed below, could be the culprit affecting bone density:
- “Breast Cancer Drugs: Aromatase inhibitors anastrozole
- Prostate Cancer Drugs
- Depo-Provera
- Excessive Thyroid Hormone Replacement
- Anti-seizure and Mood-altering Drugs
- Blood Pressure Medication
- Diuretics
- Prostate Drugs
- Other Drugs:
1. The use of acetaminophen (e.g. Tylenol®) for a period of at least 3 years (dose uncertain) compared to non-users has been associated with an increased risk of fracture.
2. Narcotic and opioid medications used for pain, such as morphine, have been associated with an increased risk of fracture secondary to falling due to the effects on the central nervous system, which may lead to dizziness or changes in balance.
3. Aluminum-containing antacids such as Maalox®, Mylanta®, Amphogel®, Gelusil® and Rolaids® are often taken for the treatment of heartburn.
4. Thiazolidinediones such as rosiglitazone (Avandia®) and pioglitazone (Actos®) are drugs used to treat type 2 diabetes.
5. Antirejection/immunosuppressive therapy such as cyclosporine (Neoral®) and tacrolimus (Prograf®) used after organ transplant may increase bone loss.
6. Heparin is a blood thinner
7. Some cancer chemotherapy,”.
Furthermore, The Mayo Clinic shares the following medications that could help Osteonecrosis, “Bisphosphonates are often the first choice for osteoporosis treatment. These include:
- Alendronate (Fosamax), a weekly pill.
- Risedronate (Actonel, Atelvia), a weekly or monthly pill.
- Ibandronate, a monthly pill or quarterly intravenous (IV) infusion.
- Zoledronic acid (Reclast), an annual IV infusion.
Another common osteoporosis medicine is denosumab (Prolia). Unrelated to bisphosphonates, denosumab might be used in people who can’t take a bisphosphonate or did not tolerate one, such as some people with reduced kidney function,”.
What is Osteonecrosis?
In conclusion, Osteonecrosis, a serious condition linked to reduced blood flow and bone death, often stems from cancer therapies. Addressing underlying causes is essential.