A Doctor's Leadership Failure - Ten fractured vertebrae due to a medical oversight and the firm who picked up after him

This is a story of a leadership failure.  A medical mistake made by a senior doctor who neglected to take responsibility for his mistake.   

When he found out my spine was collapsing on September 1 as he did, he should have said, "I'm sorry.  We will figure out what happened and we will fix this.  Biphosphonate injection tomorrow.  Let's try to stop it before it gets out of control." 

That is not what happened.  At all.  His hospital covered for him, but he never apologized or took responsibility for his mistake.  A little apology would have gone a long way.  Quick action may have prevented ten vertebral fractures. 

This is the second time that he made me feel bad for his mistake.  It was his last.  

Here is the timeline of my story of the fallout from the denusomab rebound effect.  

August 31, 2025  I went to my local emergency room with terrible back pain.  I wanted to drive 22 hours to see my mom and felt I needed some kind of doctor's clearance.  I had tried to pull up a locked window sash the previous week and thought that I had maybe slipped a disc. 

I had pain in my upper/mid back and in my lower back.  The ER doctor ordered a CT of my upper back and an x-ray of my lower back.  Nothing in the upper back, but a compression fracture on my L3. 

That's what hurt. 

I dashed home to write my oncologist (NY) and my hematologist (CT) explaining that I had a fracture on my L3.  I did not hear back right away from the oncologist, it was Labor day weekend.  The hematologist told me to come in Tuesday morning. 

September 2, 2025 I went to my local hematologist (CT) the morning after Labor day.  "Did your oncologist give you a booster shot of the bone strengthener in early April?  It is crucial to do that six months after stopping denusomab as the medicine has a strong rebound effect and your bones can get very weak." 

"No, my last shot of Xgeva (denusomab) was on October 1, 2024." 

We both thought it.  Wow, what a screw up. 

I rushed home to research what this 'rebound effect' was and... it is a very real thing (see links below). 

In an attempt to keep bones as strong as possible, Multiple Myeloma doctors prescribe bone strengtheners to their patients.  The medicine comes in the form of a shot and it is painful and makes you feel like you have the flu for a few days.  There are two types of bone strengtheners. 

Denusomab is a drug that can cause irreversible osteo necrosis of the jaw.  It has a terrible rebound effect if stopped without a biphosphonate follow up.   Biphosphonates are bone strengtheners that can hurt the kidneys, which are often vulnerable to Myeloma patients.    

February 5, 2025  I had oral surgery and I therefore had to take a temporary 'holiday' from denusomab for this reason.

May 6, 2025  I was cleared, by the oral surgeon, to resume bone strengthener. 

June 2025  I stopped taking chemotherapy drug bortezamib because I was in the hospital.  

September 2, 2025 I asked my oncologist if he was aware of the rebound effect of denusomab. 

September 5, 2025 My oncologist's office responded "the rebound effect would have happened earlier if they would have happened.  We typically give denusomab for two years, you received it from October 2022 to October 2024."   Furthermore, they were "working on setting up an appointment on September 23 so that I could discuss this with the doctor."  They would let me know if they managed to do it.  

From what I have read,  the more time that passes since the injection, the bigger the risk is of bone breakage.  Read the NIH's article or listen to the podcast below.   

September 12, 2025 I got the MRI and the results said that I had fractures in my T6, T7, T10, L2 and L3.   That is five cracked vertebrae. 

It gets better. 

September 12, 2025 The neurosurgeon I've been speaking with asked me to dash to a nearby hospital to get a flexion x-ray so that he could get a better look at my spine.  That x-ray showed that L1, L2, L3 have compression fractures, adding L1 to the list. Six. 

That's six cracked vertebrae.

September 15, 2025 The T6, T7, T10 and L1-L4 lit up on the PET scan, but it might be inflammation from my cracked vertebrae.  Doctors say that there is no cancer.  Great news.  What a huge relief. 

It gets even better...

September 23, 2025 My oncologist told me that I had osteoporosis that was causing my spinal fractures. This is completely incorrect.  I mentioned that my dexa scan I had in April 2024 said that I had mild osteopenia in my lumbar spine.  I did not have osteoporosis.  I do not have osteoporosis.  

He said that I asked him to stop the denusomab so that I could have oral surgery, (which was true, I had oral surgery in February 2025) to which I responded that I had been cleared to resume bone strengthener by the dentist on May 6, 2025.  This upset him.  Very much. 

He told me I needed to get a new doctor, that the clinician-patient relationship had broken down.   Most importantly, he would not prescribe me the bone strengthener even then, instead he referred me to an endocrinologist. 

He referred me to an endocrinologist instead of giving me a shot of bone strengthener two weeks after he saw that I had 6 cracked vertebrae.  He waited over 3 weeks after the first cracked vertebrae to speak with me, then referred me to an endocrinologist instead of giving me the shot of bone strengthener.  

September 24, 2025 I had kyphoplasty surgery on my T6, T7, T10, L2 and L3.  The surgery seemed to go well.  I was warned that it would take a few days or a week before I felt better.  The kypho surgeon's nurse asked me why I hadn't received a new shot of bone strengthener.  I thought that I needed to wait to have the kypho surgery done.  This helped me understand that I was able to get the shot right away.   Why was anyone asking ME this question?  I am the patient...?

After the surgery I continued to have rib pain and terrible back pain.  I slept sitting in an upright position as I had been doing for the past weeks.  I was in constant pain: 9.5 or 10/10. 

My oncologist's hospital asked him why he thought I had so many breaks.  He said that it was because I had osteoporosis (this is incorrect, I only had mild osteopenia).  He also said that I may have broken vertebrae from coughing in June. 

I did have pneumonia in June.  I have had pneumonia so many times in my life, I would never be able to count them.  I know little about little in this world, but I do know how my body reacts to pneumonia.  I did not cough this summer.  I had trouble breathing but I did not have coughing fits.  I have had coughing fits in the past (over ten years ago) related to pneumonia.  Coughing fits break ribs.  They do not break vertebrae.  

October 3, 2025 I woke up early in excruciating pain, yet again, and walked directly to my local ER.  I burst into tears when I walked in and the doctor did a CT scan of my upper body.  T9, T11 and L1 are all cracked.  L1 was cracked before but not filled.  This brings the total of cracked vertebrae to eight.  It is just a matter of time before the last two crack (T8, T12) they are soft bones in a neighborhood or cement ones.  They eventually did crack. 

Ten cracked vertebrae. 

I walked out of the ER and directly to my local (CT) hematologist's office.  She booked me for bone strengthener on Monday, October 6.  I no longer wanted to wait for Oncology Hospital to give me the bone strengthener.   The endocrinologist was busy and I knew at this rate I would not get the bone strengthener for another few days, maybe a week.  

October 5, 2025  I had tried lidocaine patches, menthol lidocaine patches, oxycodone, cycobenzaprine, tylenol,  gabapentin,  pregabelin and now morphine.  They bring my 9.5 pain down to an 8 on a good day but many make my stomach sick.  Mostly now I use the menthol patches (they work pretty well!) and take tylenol.  The pain doctor agreed to do a steroid epidural Friday if I don't have surgery this week. 

October 6, 2025 I got a shot of Reclast bone strengthener (biphosphonate) from my hematologist in CT, I did not want to wait any.  Endocrinologist is booked for October 8 and shot was supposed to be after that but I was tired of waiting for something so important.  Everything seems to be falling apart. 

October 8, 2025 Kypho surgeon gave me a spot last minute so that I could have the 2nd surgery.  I was so grateful.   I had another kyphoplasty surgery:  T8, T9, T11, T12, L1 were done. 

Total of ten cracked vertebrae fixed.  

I will see the endocrinologist on November 13; 74 days after I was diagnosed with a compression fracture.  This is not the endocrinologist's fault.  He is a busy doctor. 

When this began, I had walked 8k-10k steps every single day (as I have been doing for each of the last 5+ years).  I went to the gym 3 x weekly. I did/do sink push ups, dips and squats every day.  I free lift 5 lb weights.  I am not an endurance athlete, but I am not sedentary.  I try to do weight bearing exercise each day.  When I am told that my 10 vertebrae cracked because I am a 61 year old woman, that annoys me.  When I hear that it was blamed on coughing that I did not do, that annoys me even more.  

November 13, 2025 -  Met with the endocrinologist who was very compassionate.  He was the first person at this hospital to say, "Wow, you've been through a lot." 

He corroborated the idea of the denuomab rebound effect.  He said that I had actually had a very high does of (denusomab) bone strengthener in the past two years (16 shots).   He suggested that I work with a physiatrist and maybe get a back brace to try to help with kyphosis.  Btw - he is going to give me another shot of bone strengthener (biphosphonate) in the next few months.

He was compassionate.  He was the first doctor at this hospital to acknowledge that I had been through a lot.  Ten fractures that have destroyed my ability to stand up straight is a lot.  I never heard one single word of apology, acknowledgement or compassion from the doctor who caused this.  

Hopefully this hospital will help pay for the thousands of dollars of medical expenses that their error caused.   They will never be able to compensate me for the pain, suffering, sadness and destruction of my health that they caused.   Not to mention my physical appearance which resembles that of a hunchback.  It is devastating. 

December 10, 2025 - I am in North Carolina visiting my mother who weighs 81 pounds and is on 9 litres of oxygen.  I have not been able to visit her since this summer because of the collapse of my spine.  I finally jumped on a plane to come and visit her.  I had not yet showed her my profie but soon after I arrived, she said to her nurse, "Look at my daughter, she is a hunchback."   I didn't even know that she had noticed.   My kyphosis is clearly very bad for her to say that. 

I was shocked, actually.  

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Take care of your spine.  Know what medicines you are taking and their side effects.  A defensive doctor who can't take responsibility for their mistakes is a dangerous doctor.  

Keep up on your bone strengthener, especially if you are taking denosumab (Xgeva or Prolia).    MM patients - if you are taking bortezamib and you also stop bone strengthener - talk to your doctor. 

Make sure that you get a shot of a biphosphonate approximately six months after your last denosumab shot.   Zometa (zoledronic acid which is a bisphosphonate with a strength of 4 mg per shot).  It is a little less strong than Reclast, which is the same drug with a strength of 5 mg per shot.  

Do your own due diligence on the meds you are taking. 

...and for the love of Pete, speak up.  Don't be shy if you feel an error was made. 

Sending love and healing thoughts your way.  

DENOSUMAB REBOUND EFFECT   

For some reason, I could only cut and paste this one article below.  

Please google "rebound effect of bone strengtheners" and you will find a lot, on the IMF website, research from the NIH; the articles are everywhere.

https://pubmed.ncbi.nlm.nih.gov/40057981/  (sorry not a hyperlink - please cut and paste)

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

If you prefer podcasts: RheumNow podcast of May 11, 2020 "Don't Drop Denosumab"

Finally - I see a hematologist (CT) who works near where I live so that she can explain things to me, help me think through important decisions and put a second look on what is going on in my cancer hospital.  She is very accessible.   

My cancer and related treatments and medicine is managed by an oncologist at a cancer hospital in New York city (NYC).  He prescribes meds and does tests and talks through important decisions with me.  He prescribed and monitored bone strengthener. 

I learned from fellow patients that it is a good idea to have at least two doctors caring for you and I think that this is one of the most valuable pieces of advice that I have learned from them.   It has made this situation much easier to manage. 

Write me - healingmyeloma@gmail.com

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