Bone changes after pelvic radiotherapy

If radiotherapy damages the pelvic bones, it may increase the risk of fine, hairline cracks (known as pelvic insufficiency fractures), which can be painful. The pain is normally in the lower back when you’re moving around, and it can make walking difficult. The pain isn’t usually there when you’re resting or sleeping.  

Pelvic radiotherapy causes early menopause| in younger women. This increases the risk of bone thinning (osteoporosis), but only if you can’t take hormone replacement therapy (HRT).

Always let your cancer doctor or nurse know if you have pain or aching in the bones. This can be caused by a number of conditions, but it’s very important to get it checked. Damage to the bones is a rare late effect of pelvic radiotherapy, so it’s more likely to be caused by something else.

If you have symptoms that last for more than a few weeks, your doctors will need to do tests, such as a bone scan or MRI scan. A special scan called a DEXA scan can also be done to check the strength of your bones. 

Treatment Back to top

Pelvic insufficiency fractures don’t usually need to be treated with an operation, but you’ll be referred to a specialist bone (orthopaedic) doctor for advice. Your doctor will prescribe regular painkillers to control the pain|.

A physiotherapist will show you how to limit stress on the bones and will give you exercises to do. If you’re having problems with day-to-day tasks, an occupational therapist can advise you on equipment to make things easier.

If you have osteoporosis, you’ll probably be prescribed drugs known as bisphosphonates| to help strengthen the bones. Your doctor may also prescribe calcium and vitamin D supplements for your bone health.

Bone health Back to top

You may want to know more about keeping your bones healthy. Although radiotherapy damage to the bones is rare, other factors may contribute to bone changes. The bones naturally lose some strength with age, so this may be a factor. It’s important to follow your doctor’s advice if you have any bone problems. 

What you can do:

• Keep physically active to keep bones strong, but if you have bone problems ask your doctor for advice. Our section on physical activity and cancer treatment has more information on keeping active.
• Keep to a healthy weight to avoid strain on your joints. You may find our section on weight management after cancer treatment helpful.
• Eat healthily to get plenty of calcium and vitamin D, and avoid too much caffeine. You can read more in our section on healthy eating and cancer.
• Avoid smoking – it’s bad for the bones and it increases the risk of certain cancers and other illnesses. Our section on giving up smoking has more information.
• Drink alcohol within sensible guidelines, as alcohol can interfere with the balance of calcium in the body. Current guidelines recommend that women should drink no more than 14 units of alcohol a week.

There’s more information in our section on bone health|.