Breast Cancer and Osteoporosis

Mini1

I have found a lot of info on breast cancer treatments, studies, etc., about women that developed osteoporosis from BC medication, but very little info on adjunct treatments for women that already have/had osteoporosis when they were diagnosed with breast cancer. I am trying to decide if the benefits of an Aromitase Inhibitor are worth the bone side effects. Any input from others in a similar situation would greatly appreciated.

peggy_j

Some post-menopausal women choose to take tamoxifen instead of an AI, due to concerns of bone loss. You may already be considering this but FYI so you know you have options.

dogsandjogs

I have very severe osteoporosis so after enduring a few months of debilitating side effects I stopped taking Aromasin.  I am 76 and very worried about my bones - having alredy endured a broken hip, three broken vertebrae in my back and a broken wrist.

Perhaps if I was younger I might re-consider----

It is a very personal decision so I don't want to influence anyone one way or the other.

Mini1

Thanks for the responses. I am trying to decide right now if switching to Tamoxifen is the better option. I'm hesitant to change because my current meds have a few less side effects and I am tolerating it quite well right now. Also I've read that splitting the course of meds between the two may be a better option. I will talk to my onco doc to see what he thinks is the best way to go, tamox first than AI, alternating, 3 years of 1 and 2 of the other, or what. From what I've read, a straight course of either has proven to be less effective than a combination of the two, but it seems what's "best" changes all the time. I'm only 55 so quality of life is very importatant to me. I have grandbabies I want to be able to keep up with. :-)

 Thank you again for the responses.

hope2learn

I was diagnosed with breast cancer and by then had osteoporosis.

I have had osteopenia and I had been taking estrogens until the breast cancer.

Around the same time also was diagnosed with osteoporosis. I am post menopausal.

I knew as soon as I  would go off estrogen because of the breast cancer my risk for fracture would double. I decided to go on Tamoxifen for a number of reasons. It did not work out for me I took a long drug holiday, which worries me now. Therefore, in the interim I tried to take strontium.

I have been told recently by a specialist for bones that  when I go on aromatase inhibitors I will have to go either on Zometa, Reclast ( both injections) or Prolia.

I decided I do not want Prolia although it does not have the osteonecrosis risk of the jaw. I am afraid of an immune system reaction. This has to do with my personal health problems.

I did have all my teeth evaluated for risk of osteonecrosis in anticipation for possibly having to go on aromatase inhibitors and bisphosphonates. Since I have periodontal disease, I will need to do the gum surgery before I start on the bisphosphonates. I was told not to do any major dental work for the next five years. I was going to have an implant. I was told could not do that on bisphosphonates. I will have to live without the tooth. I am hesitant about the bisphosphonates, but I do not want to break a bone.

I have tried to read up on what will happen if I have a toothache in the next five years and need a root canal for example on bisphosphonates. How high are my risks for osteonecrosis? I do not have an answer.

Strontium, which sounds promising for women who are not on cancer drugs, has not been researched for women on aromatase inhibitors as far as I know. Does anyone know? It would be great if that would work.

I attach some literature which I have been reading through and which might be helpful to some of you

For anyone on AI ! It appears  based on the research I read , you do not want to delay taking a bone drug when going on aromatase inhibitors.

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Approaches for osteoporosis, (no cancer)

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699648

New Approaches to Osteoporosis ( easy reading)

http://www.suffernomore.com/Pain/Facetdenervation.html

Studies breast cancer plus osteoporosis

Immediate bisphosphonate use with endocrine therapy increased survival in postmenopausal early breast cancer

http://medicalxpress.com/news/2011-12-bisphosphonate-endocrine-therapy-survival-postmenopausal.html

Final 5-year results of Z-FAST trial: adjuvant zoledr... [Cancer. 2012] - PubMed - NCBI

http://www.ncbi.nlm.nih.gov/pubmed/21987386I like to add this, found on google UKGuidance for the Management of Breast Cancer Treatment-Induced ...ncrndev.org.uk/./Bone%20Health%20Guidelines%20-%20FINAL.p... PDF/Adobe Acrobat
There is increasing use of aromatase inhibitors for the. • adjuvant treatment of ... be at high risk of clinically important bone loss and should have a baseline dual energy ...... Strontium ranelate is licensed in most of the world for the treatment of ...

Mini1

Hope2learn - Your condition sounds much like my own with the exception that I found out that I cannot do any osteo treatments. My Rheumatologist thought Prolia might be an option, but because of my own medical condition it is not. I am electing to try the AI for 1 year to see if i can control bone loss through diet, supplements and exercise. I am just not willing to at this point to go on Tamox due to many of the reasons you list above. We'll see at next year's bone density I am able to do so. If not, I will have to look at my options again.

Like you I have done a lot of research since my diagnosis but finding specific info on non-AI related osteoporosis and breast cancer has been challenging. Most of the info out there is in regards to women that get osteoporosis from their AI, not those of us that already had it when diagnosed. Thank you for the links above. 

LtotheK

I can give my opinion from my particular vantage, which is I was diagnosed pre-menopausally, and chemotherapy put me in chemopause.  I begged for a bone density test after treatment, because I have a strong family history. Bingo. Osteoporosis in the spine, osteopenia in the hip and wrist.

 An aside:  to me, the real issue is if they want to intervene with biophosphonates, it looks like it's best done concurrently with treatment.  If I knew then what I know now.  Wish my onc had been more on top of it.  I have huge questions about the bios, however.  The information is increasingly available they don't build proper bone, and may even contribute to ruining the body's ability to do bone turnover.

I am on Tamoxifen for 3.5 more years.  I take Fosamax, as the two years after treatment with chemo and radiation seem to be huge, particularly with menopause thrown in for good measure. 

I have already made my mind up that I will not take the AIs.  It is not worth the extra 4% in BC recurrence compared to the very serious bone loss issues I already face at the tender age of 41.  3.5 years is a ways off, but I will work with a naturopath after giving everything I've got to the allopathic treatment plan.

I can also say that despite being slim, active, and doing everything right with diet and vitamins, I still got this.  In my humble opinion, diet and exercise are no match for those of us with serious family history.

Strontium is getting really mixed reviews.  Looks like there are some good studies, but more research is clearly needed.  And just another "in one person's humble opinion", the body is a crazy complex machine.  If it sounds too easy, it probably is...I have hopes for strontium, but studies seem to indicate it does what the bios do, which is to make the density reading look better than it really is.  I think the biophosphonates are in the same boat, actually.

I generally follow the "for every action is an equal and opposite reaction" philosophy

Mini1

I am asking my Rheumatologist Friday what her opinion of Strontium is. I am scared of the SE's of my AI, but also of the SE's of Tamox. Also, I have read recently on another thread that although Tamox is better while you're taking it, the bone effects after you stop are just as bad. I have to look that up since I have not heard that before. Biophosphates simply make the bone hard. And what do hard things do? They break.

I was recently reading that osteoporosis is not just the thinning of bone. In un (or under) developed countries where there is very little calciuim in the diet they have relatively no osteoporosis. They believe that osteoporosis is not just the thinning of bones but the bodies inability to recreate new bone. Since the differences are seen between undeveloped countries and "westernized"countries, they hypothisize that it is our diet. Big surprise.

Is anyone out there taking DIM? If so, how has that been for you?

LtotheK

Hi Mini, please report back.  My feeling is, yes, Tamoxifen is serious business.  No two ways around it.  However, it is much more time-tested than the AIs.  To me, the "equal and opposite reaction" of stripping the body of any remaining estrogen has yet to be determined.  It certainly has an underbelly.

You are right about the Tamoxifen withdrawl, there is a lot of study around the fact that once you come off it, all the "bone building" quickly reverses and is worse than when you started.

What the bios do is "bulk" the bone, they add bone, but it is not the beautiful struts that actually create bone integrity.  I suppose you can't really trick nature entirely.

A lot of new studies seem to indicate dairy is really a bad form of calcium.  Our naturopaths have been telling us this for ages.  However, I'm wary of studies that compare global diets.  They are sometimes junk science, but more important, I believe our bodies evolve to meet our needs by location.  So, what is good for an Asian woman is not useful to me, for instance.

Tons of info on DIM here, and that is my plan when I come off Tamox.  That is, barring some incredible breakthrough in this horrid disease.

Mini1

LtotheK - I always thought that I was doing good by drinking milk all those years. Now I find that it is bad and actually leeches calcium from your bones. I now use almond milk for smoothies and eat only white, soft cheeses.

I'll let you know what the Dr. says about the Strontium. At my last appt. she ordered quite a bit of blood work to check the various levels of calcium, D, magnesium, etc. I will be interested in that as well.

LtotheK

Check out Coconut Milk by So Delicious!  More calcium than Almond Milk (30 as opposed to 20%)...

Mini1

I'll have to try Coconut milk. I don't drink much of it. I use it mostly for smoothies and on oatmeal. I'm willing to try anything at this point. Thanks. :-)

Chris13

Holy moly, just came across this link with info that moderate alcohol use actually helps prevent osteo. Of course alcohol is considered a risk factor for BC.....

http://www.sciencedaily.com/releases/2012/07/120711100724.htm 

Mini1

Someone else just told me they saved me an article that recommended oe to two 4 oz glasses of red wine. Out for me becuase of other health concerns, but hey, at least you don't have to feel guilty about have a nice glass of wine.

dogsandjogs

My dad's doctor encouraged his daily (one glass) of wine daily.  He was in good health until the end. He died at 95.

kira1234

Does anyone know if the calcium in coconut mild is natural? I guess that's the concern calcium supplements. I was bummed out by the info because almond milk has calcium supplements it's not natural.

dogsandjogs

Don't know, but it might say on the container--

Mini1

From what I've read it is natural. It also contains omega 3 oils and fiber, as well as some trace minerals.

LtotheK

I had to seriously LOL when I saw the post about alcohol.  For my ER+ cancer, I'm to keep my weight down.  For my osteo, my 130 weight is a risk factor (under 132).  For BC, drinking alcohol seems to increase risk.  But now it seems to help osteo???

YOU CAN'T WIN, so have a good time, friends!

Mini1

Ltothek - I asked the PT about the weight thing since I barely weigh 100 and on my diet wil never weigh much more. He said he wasn't sure who came up with that abitrary number, but our bodies bones and muscles are designed to work against each other to create natural resistance. Weight vests and the like can cause damage, and if you are small boned but overweight, you can still get osteoporosis.

Yes, wine, good for one thing, bad for another. Why should this be any diffeerent than anything else to do with this stupid disease?