In 2004 she had been diagnosed with an underactive thyroid and rheumatoid arthritis, both of which can increase the risk of osteoporosis.

Annette began treatment for osteoporosis, starting in 2014. She has an Aclasta (zolendronic acid) infusion once a year, which takes about an hour and takes high levels of vitamin D and calcium. This will hopefully prevent further deterioration of her bones and more fractures.

Annette retired in February 2016 and lives with one of her two adult sons. She has lived all her life in Dubbo and at the time of her back fractures was working at the Mitre 10 hardware shop.

With her multiple chronic conditions, Annette has to pace herself. ‘I have good days and bad days, but I have permanent pain and need to take strong painkillers throughout the day.’

Annette is determined not to let her pain take over her life, however. ‘I find that if I have something else to focus on, the pain doesn’t bother me as much. I have joined the local Pink Angels charity for breast cancer. Thinking about other people helps me to not think about my own problems.

‘As part of the Dubbo study I go to Garvan every two years for a bone density scan. I think it’s great that Garvan is researching the links between osteoporosis and other conditions. Like me, people with osteoporosis often have other illnesses that, along with the medications, also affect their bones. If the links were clear, when people were diagnosed, their bones could be checked at that time, and if necessary they could have anti-osteoporosis medication early enough to save them from fractures. That would be fantastic,’ Annette said.

As part of her breast cancer treatment, in early 2016 Christine’s oncologist referred her to an endocrinologist and x-rays of her thoracic and lumbar spine showed osteopenia. Christine was 61 at the time, living on her own and running her retail consulting business. Christine also works with her dog as part of volunteer therapy at the Randwick Children’s and Prince of Wales Hospitals.

‘Although my oncologist prescribed calcium and vitamin D supplements, I’m still concerned about the impact of Letrozol on my bone density down the track.’

Recently, the endocrinologist has also prescribed six-monthly Prolia (denosumab) injections to protect her bones. Christine’s sister was recently also diagnosed with breast cancer and will shortly begin Letrozol. Her mother developed a significant curve to her spine in the later stages of her life.

While Christine is feeling well and confident that her breast cancer is behind her, she is concerned to protect her bones from the impact of her cancer drugs.

‘Other than cursory discussions on the benefits of exercise to counter loss of bone density, there was no support for this in NSW, so I’m pleased to see that St Vincent’s Hospital and the Kinghorn Cancer Centre (at Garvan) have just introduced a wellness program for post- treatment, covering exercise physiology and social support, which is a step in the right direction.

‘My journey with breast cancer has made me very aware of the importance of research into cancer in general, and specifically, cancer-related osteoporosis. I was offered options in terms of my treatment regime. These options are only possible thanks to research and clinical trials. I chose a less invasive course of treatment and have just passed my one-year anniversary, cancer free. I now have an ongoing treatment plan targeted specifically to reduce the effect of my ongoing cancer drug on my osteopenia,’ said Christine.