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Bone changes after pelvic radiotherapy

Pelvic radiotherapy can damage the bones in the pelvis, hips and lower back. This can weaken them and may cause tiny cracks. 

We hope the information on this page helps explain why you might have symptoms of bone changes and how to manage them. We are also here if you need some extra support or aren’t sure where to start.

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About bone changes

Pelvic radiotherapy uses radiation to destroy cancer cells, but it can also damage the bones – in this case, the bones in your pelvis, lower back and hips.

Some patients experience some type of bone change after pelvic radiotherapy for gynaecological cancer. Research suggests that over 1 in 10 (14%) will have tiny cracks in the bones, although these may not cause any symptoms.

Symptoms of bone changes

Symptoms of bone changes include:

  • pain in your lower back or pelvis 
  • aching in your hips and pelvis
  • changes to mobility.

The level of pain or aching will be different for everyone – it can range from a mild ache to more severe pain. In the most severe cases, it may affect your mobility and make movement difficult. 

Medical treatments for bone changes

These symptoms may have an impact on your day-to-day life. Whether that impact is big or small, it’s important to ask for support. 

Speaking with your healthcare professional

It is important that your healthcare professional tries to diagnose the underlying cause of the bone changes, rather than simply treating the symptom itself.

You can speak with:

  • your GP
  • your clinical nurse specialist (CNS)
  • your cancer doctor (consultant).

It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history. 

You might be having this conversation years after you have finished your treatment, so it is a good idea to be clear about what is happening. You could:

  • tell them that these bone changes happened after pelvic radiotherapy treatment
  • tell them when the symptoms started
  • tell them how long the symptoms have lasted for
  • explain the impact the symptoms are having on your life – be prepared to give all the details. 

It may be helpful to write down what you experience day-to-day.

Read more about getting a diagnosis >

Possible underlying causes

Although bone changes can present as a specific symptom – for example, pain – they may be happening because of a different condition caused by pelvic radiotherapy. It is important that this underlying cause is tested for. We spoke with experts who told us they sometimes see patients with PRD who have these conditions:

Pelvic radiotherapy can affect the bones in your pelvis, lower back and hips. It may cause tiny cracks in these bones. These are sometimes called pelvic insufficiency fractures. They don’t always cause symptoms, but in some cases will cause pain or changes to mobility.

Pelvic insufficiency fractures can be treated with rest, pain medicines and, in some more severe cases, hospital treatment. It is best to talk to your GP or healthcare team if you have symptoms of pelvic insufficiency fractures.

Pelvic radiotherapy can damage the muscles and tissue around the bones in the pelvis, as well as the joints where the bones meet. These areas can become swollen and sore (inflamed). This is known as radiation osteitis  and the main symptom is pain in the pelvic area.

Radiation osteitis can be treated with rest and pain medicines. It is best to talk to your GP or healthcare team if you have symptoms of radiation osteitis.

If pelvic radiotherapy has caused early menopause, or if you have been through it naturally, you are at greater risk of osteoporosis. This can cause any of your bones to become thinner and weaker, which makes them more likely to fracture or break.

Your GP, hospital healthcare team or a menopause specialist can give you advice about preventing osteoporosis after treatment.

Read about symptoms of menopause >

Possible treatments for bone changes

If you are experiencing bone pain, you may be referred for a bone density scan to assess any damage. This is sometimes called a DEXA scan. 

Read about DEXA scans on the NHS website > 

Depending on the severity of your bone changes, your doctor may recommend any of the following treatments:

There are medicines to help make bones stronger. This can reduce the risk of fractures or breaks. 

Your GP or healthcare team may also suggest taking calcium or vitamin D supplements, as these are important for healthy bones. They will let you know if supplements are suitable for you, based on your medical history and symptoms. 

Read about medicines for bone health on the Macmillan Cancer Support website > 

If pelvic radiotherapy has caused early menopause, hormone replacement therapy (HRT) may be recommended to help with the symptoms. These symptoms can include bone changes, such as osteoporosis.

Read about HRT > 

A physiotherapist works with you to make movement easier and less painful. If bone changes are affecting your mobility, this type of support may be useful for you. Your GP or hospital healthcare team should be able to refer you to a physiotherapist.

A pain specialist is a doctor who helps treat and manage different types of pain, including pain caused by bone changes. Your GP or hospital healthcare team should be able to refer you to a pain specialist. They may also prescribe pain killers to help you manage any aches and pains.

Read about getting help with pain on the NHS website > 

Lifestyle changes for bone changes

There are also lifestyle changes you can make to look after your bones, including eating a healthy, balanced diet, getting as much sunshine as possible, and staying physically active.

Diet 

It is important to speak with your GP or healthcare team before changing your diet. Any changes will be based on your individual medical history and symptoms. The section below is for guidance only.

Calcium and vitamin D are the most important nutrients for strong, healthy bones.

Calcium is found in:

  • dairy products
  • tinned oily fish where you eat the bones, like sardines
  • leafy green vegetables, like broccoli and kale
  • nuts
  • soya beans, tofu, kidney beans and baked beans
  • dried fruit.

The best natural source of vitamin D is sunlight, but it can also be found in:

  • oily fish
  • red meat
  • liver
  • egg yolks
  • some breakfast cereals and spreads.

Read more about diet and bone health on the NHS website >

Exercise

Regular exercise is also good for keeping your bones strong and healthy. This is particularly true of weight-bearing exercises, including:

  • walking
  • jogging
  • skipping
  • tennis 
  • dancing.

Many of these can be done outside, so you get a bonus of more vitamin D exposure on sunny days.

Using weights and resistance bands can also help to build strength, while stretches like yoga and Pilates can improve the flexibility of your joints. 

Your GP or hospital healthcare team will be able to give advice about the best types of exercise for you, taking into account any other health concerns or PRD symptoms.

Getting support for bone changes

We understand that bone changes can have a big impact on your day-to-day life. It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but it’s important that you get support based on your individual situation.

If you are not sure where to turn, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.

Check our Helpline opening hours > 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum > 

If you have general questions about PRD, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service > 

Useful organisations

Royal Osteoporosis Society 

A UK-wide organisation dedicated to finding a cure for osteoporosis and improving the lives of everyone affected by it.

www.theros.org.uk 

Pelvic Radiation Disease Association (PRDA)

A UK charity providing information about PRD. Has an online community as well as hosting national and local events for people with PRD.

www.prda.org.uk

Action Radiotherapy

A UK charity dedicated to improving radiotherapy treatments. Provides information about radiotherapy, including side effects.

www.actionradiotherapy.org 

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • Kurrumeli, D. et al (2020). An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer. Strahlentherapie und Onkologie. Epub.
  • Higham, C. and Faithfull, S. (2015). Bone Health and Pelvic Radiotherapy. Clinical Oncology. 27;11. pp.668-678.
  • Bazire, L. et al (2017). Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature. BJR. 90;1073. Epub.
  • Sapienza, L. et al (2020). Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients. International Journal of Radiation Oncology*Biology*Physics. 103;6. pp.475-484.
  • Uezono, H. et al (2013). Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors. Journal of Radiation Research. 54;6. pp.1102-1109.
  • Meixel, A. et al (2018). From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy. European Radiology. 28;8. pp. 3550-3559.
  • Ogino, I. et al (2003). Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy. Radiotherapy and Oncology. 68;1. pp.61-67.
  • From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy. European Radiology. 28;8. pp.3550-3559
  • Ibid.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected].

Read more about how we research and write our information >

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Date last updated: 
29 Oct 2020
Date due for review: 
29 Oct 2022
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