NYTimes: .Patients With Normal Bone Density Can Delay Retests

peggy_j · January 2012

From the NY Times

Patients With Normal Bone Density Can Delay Retests, Study Suggests

http://www.nytimes.com/2012/01/19/health/bone-density-tests-for-osteoporosis-can-wait-study-says.html?_r=1&ref=health

Obviously this is talking about patients with normal bone density but there were some interesting comments like this:

"For years doctors were overly enthusiastic, prescribing it (Fosamax) for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely. They even gave a name, osteopenia, to lower than normal bone density, although it was not clear it had real clinical significance.

Now, osteoporosis experts consider osteopenia to be a risk factor, not a disease, and its importance varies depending on a patient's age, said Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University who was not involved in the study. "

ICanDoThis · January 2012

Yeah, but...

For example, said Dr. McGowan, who was not involved in the study, a woman who had to take high doses of corticosteroids for another medical condition would lose bone rapidly. But the findings "cover most normal women," she said.

Remember, those of us on AIs are having our bones abnornormally affected.

cp418 · January 2012

Ditto - When I started Femara my oncologist does yearly Dexa scan and there was notable bone loss seen which required Zometa.

peggy_j · January 2012

ICanDoThis wrote:

Remember, those of us on AIs are having our bones abnornormally affected.

Yes, I agree. FWIW I thought the article had a few pieces of general info that were still interesting.

lago · January 2012

I have osteopenia, diagnosed before I started chemo and Anastrozole. My onc and PC does not treat osteopenia unless they see real deterioration. My onc just told me to start taking more Calcium. Already taking additional D. After chemo and 5 months of Anstrozole my bone density went down only .1% (there is a decimal before that 1). My mom had osteoporosis and had reversed it on HRT. The docs took her off that because of me an now are going to treat her with one of those injectables. (I'm also thin & white… poster gal for osteoporosis risk).

Annabella58 · February 2012

Me too, add to the risks steroid spray for asthma and tiny, caucasian...

Does anybody know of what to do if one needs a tooth extraction? I have a cracked tooth and onc is pushing for a bone drug. I am pushing against, due to osteopenia (NOT osteoporosis) and terrified on possible jaw necrosis.

Dentist says no way to keep it....there is, he concurs, a risk of jaw necrosis with all extractions, but very much elevated on bone drugs. If I had to extract the tooth, the risk for JN goes up if they put me on a bone drug in the future.

Anyone know if there is one that is not so bad for this potential SE?

Yeesh rock and a hard place.

lago · February 2012

How bad is your osteopenia? Typically they don't treat osteopenia. My onc was going to put me on it when at first they thought the drug prevented bone mets but then she came back from the San Antonio conference (2010) and the new tests said it didn't for premenopausal women. She called me and said we weren't doing this.

peggy_j · February 2012

anniealso, sorry to hear about the cracked tooth.

I'm surprised your MO is suggesting Tx for osteopenia. I met with a bone endocrinologist last fall (former head of the osteoporosis clinic at UCSF) and he said they generally don't treat patients until it becomes osteoporosis. (I posted notes from that meeting in a separate thread, if you're curious). Maybe time for a second opinion, with an endocrinologist who knows a lot about bones? (many are focused on other endo issues)

It sounds like your need the extraction now, prior to taking any bone meds, so I think your risk of JN isn't any higher today than anyone else's. My understanding is that it takes about 3-4 months for the bone to grow in. If you choose to get an implant, many oral surgeons want to wait that 3-4 months, then place the implant and wait another period (2-4 months?) for the bone to grow around the implant before having the general DDS place the crown. Personally I'm planning to avoid bisphosphonates, but knowing you have this DDS issue, I would definitely wait until the DDS Tx is complete. Is your DDS suggesting that any extraction site is at higher risk of JN in the future? I thought after the bone grows in, it behaves like normal bone, but your DDS may know otherwise.

Annabella58 · February 2012

Hi there, I don't think the osteopenia is terrible. Per my GP is may just stay at osteopenia for good. My onc is hyper loving bone drugs due to the y/n do they/don't they prevent recurrence thing. Jury is still out on that one. My GP is against and so am I.

Yes, it is known per all my Drs that any extraction site is at higher risk of JN. The idea being if you've had multiple dental surgeries, that once you take a bone drug, you are at higher risk of JN. That said, tho it is scarey, it's not that common.

I would personally not go the implant route. I'd just get a nice new permanent cemented bridge, but that's me.

I am very happy to know that I am not alone in refusing bone drugs. There are too many unknowns and it has been shown more and more that there is more to this bone issue than originally thought.

Thanks, all. Much appreciated. I will fix the tooth, wait the 3-4 months, then I will address a bone scan. Or not, since there's no point to it, since I do NOT plan on bone drugs.

If I must, then I will cross that bridge later.....

lago · February 2012

This is your body. My old told me that bone density issues happen slowly. If in another year you are still losing bone then maybe you should consider but right now I would listen to your GP.

NYTimes: .Patients With Normal Bone Density Can Delay Retests

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