info from the bone endocrinologist

I had an appt. with my fancy bone endocrinologist and wanted to share some info. I think we've discussed most of this before, but wanted to share this info if it's helpful. As an FYI, he used to be the head of the osteoporosis clinic at a teaching med school and is now semi-retired with a consultation-only practice.

Main points:
1) SERMs and BMD for pre-meno women. He confirmed that SERMs do not build bone for pre-meno women. He said the estrogen "milieu" is different for post-meno women and SERMs. He said Evista shows the same phenomenon. (a non-BC SERM used for bone loss). He emphasized that any bone loss while on tamoxifen would be "subtle" and that my decision to take it should be made w/ my MO based on its cancer-fighting benefits not potential bone loss. In my case, I'm in my late 40s, so he said if I take tamoxifen for the next 5 yrs as I'm approaching meno, (avg. age 51, but could come earlier) my estrogen will drop off before my last period, so in this next five year period I could see some subtle bone loss followed some bone gain as my estrogen level changes.

2) calcium supplements: he said to shoot for 1000-1200 mg a day, including diet. There is no benefit in taking more; your body won't use it. Calcium is very insoluble (unlike water-soluble Vit Bs or Vit C) and can lead to other problems. He said the issue with hardening of the arteries (etc) is a relatively new theory and most of the research is coming from one doc in NZ. (so not widely accepted by everyone yet) Regardless, excess calcium is known to create kidney stones etc. He said to not discount the amount you get from your diet. Prior to the appt. I filled out a complicated grid about my eating habits and he calculated that I'm getting 700-800 mg. a day, so I should only take 500 mg/ day. (I had been taking 1400 mg/day) To simplify, he suggested I get a multi-vitamin for "mature women" that has 500 mg calcium and not take any extra calcium supplement.

3) Vit D. He said the general recommendation on Vit D supplements of 600-800 UI is probably too low and he thinks 1000 UI is probably better. He knows that some cancer researchers are recommending extra Vit D. That's not his expertise but he said there is no known toxicity when taking 3000-4000 IU day. (this should be the max including food and sun exposure). In my case, he recommended a supplement of about 500 IU day. However, some supplements are mega-doses (like 10,000 IU/day) and that's too much.

4) Exercise: He though my level of exercise was fine. I walk ½ hour day, gym 3x/week (including arm weights and ankle weights).

5) Bisphosphonates: the risk of jaw necrosis is around 1:10,000 to 1:100,000 patients. He doesn't think the risk is an issue for most patients. However, I have complicated dental issues (and he knows my oral surgeon's opinion on these drugs) so he agreed that it would be reasonable for me to avoid them.

6) Monitoring bone health. He reviewed my DEXA scan at length. As we've discussed, the T-scores are compared against young women and yes, my hips are classified as osteopenia. He said the Z-scores (age-rated scores) are more important. My spine is good but I'm lower-than-avg on my hips, but he said it's nothing to worry about today. Everyone's anatomy varies. (FWIW, I had my DEXA scan 2 wks after Dx and prior to any BC treatment, even surgery). He used the FRAX website to show the risk of breakage, which is minor. (FYI, FRAX has very little data for young women and it assumes everyone is post-meno). He said the prevailing attitude in the bone world is to look down the road 5-10 years. i.e. there's no benefit today in taking meds today (etc) since I'm "only" osteopenia. But monitoring is important. (get a scan every 2 years or even once/yr on tamoxifen if I'm worried about it). Good diet is important but it's not worth taking other action today to help my bones 40 yrs from now. He also said that the current research on new meds is very promising and expects they'll be new types of meds within the next 10 yrs. (I didn't press him for details)

7) DEXA scans. He said it's important to get scans done on the exact same machine each year (not just the same location). The serial number is listed on the printout (in my case on the lower-right hand side).

Your doc might have a different opinion for your case but FYI in case this is helpful. I was disappointed to hear about the SERMs (for example) but was glad to get an opinion from someone who's a bone expert.