When to take meds for bone loss?

Member It sounds like you are off hormone therapy now.  When I was on Arimidex and had noted bone loss, my onc wanted me to have IV bisphosphonates and insurance would have covered it.  You might check because you may automatically qualify due to your history.

I had 6 IV's of Zometa over the last three years while on Tamoxifen. The first two years I had ovarian suppression, so they were concerned about bone loss and fractures. I have quite an orthopedic history! In fact, I broke my foot last winter! My doctors are CONVINCED my fracture would have been worse had I not had the Zometa and worn my Mephisto sandals. I am NOT convinced. I broke plenty of body parts BEFORE I took Zometa and I am still havings fractures! Yikes!

Calcium...1200 mg per day, but taken 600 2X daily, and you need to take vitamin D with it so it can be absorbed properly.



Paula

member Sorry I wasn't more clear on what you qualify for.  I believe (at least it was true in my case), that your insurance company should cover a bisphosphonate drug (probably in IV form) due to the fact that a medication you are taking is expediting bone loss.  It was my onc who wanted me to have the infusions.

The non-AI woman with osteopenia/fam hx of osteoporosis would be put on Vit D and Calcium. How much would be suggested by your doc. With the addition of the bone thinning AI, the doc might suggest a bisphosphonate. Bisphosphonates come with their own side effects--ya, oh, great!- so I would suggest you make an appt with you onc to thoroughly discuss the right treatment for you.

You'd think if osteopenia is a new dx for you that the onc would call, but don't slip thru the crack, make an appt to discuss.

There aren't too many down sides to the right amount of calcium and Vit D, but the bisphosphonates are another matter. There, the risk/benefit ratio is more of a big deal. I work for a physician and I see so many women who have a fracture or a compression fracture and that truly can be a life limiting event. I' m on an AI, generic fosamax, calcium and Vit D. (BUt then I've never been a milk drinker.) If you've got a lot of calcium in your diet, you might not be missing calcium, but unless we live a lot closer to the equator, chances are we don't get enough Vit D. Glad you've got that doc appt.

I lost 9.2 % bone density in less than a year on Aromasin.  My MO rec'd Reclast the 1X q year IV biophosphate, but there is the really bad side effect of jaw necrosis and they don't really know the risk of this for women with cancer taking it to stop/slow bone loss. Supposedly, it's lower with the once a year than monthly, but noone knows.

Because of this serious and unknown risk, Dr. Keith Block, who is my nutritional advisor, recommended that I try the Calcitonin salmon nasal spray first, stating he's seen 4-5% increases in bone density in women taking it.  It does have serious side effects, but nothing quite as severe (to me) as the Reclast, so I've started that. I have had what I believe some side effects from it - increased depression/low mood, mild nasal congestion and what seems like some hair loss (a rare side effect). This is after my hair had grown back much healthier and slightly thicker after chemo (3/2/12 last treatment with Cytoxan and Taxotere) than prior to my diagnosis in Sept 2011.

I'll be having a repeat bone density scan in a few months and will let you know the result.  I've included a short excerpt from on this issue from the American Dental Association. We should remember though what all the OBGYNS told us about needing to take HRT to prevent osteoporosis, then telling us all to stop b/c it (the Prempro I was on with estrogen and progesterone) when the Women's Health Initiative showed it caused breast cancer! 

Chelsea

Statement by the ADA; Oral Surgery Literature Reiterates Prevalence is Low

Recently, the American Dental Association (ADA) updated information for the dental patient relative to bisphosphonate medications and the association with development of osteonecrosis of the jaw (ONJ). This one page informational statement, entitled "For the Dental Patient" - "Osteoporosis medications and oral health" can be accessed at http://jada.ada.org/cgi/content/full/140/6/812. ADA members may download the page and nonmembers may use the "guest" function and download the page for a small fee. According to the ADA, the page may be copied as a handout for patients without first obtaining reprint permission from the ADA Publishing Division. 

The informational statement stresses the importance of the bisphosphonate drugs in the treatment of osteoporosis. According to the statement, these drugs help reduce the chance of bone fracture by decreasing bone loss and increasing bone density. It reminds the patient that the drugs have been associated with osteonecrosis of the jaw, a rare but serious condition. This syndrome is diagnosed in a patient who has an area of exposed jaw bone that persists for more than 8 weeks, has no history of receiving radiation therapy to the head and neck, and is taking, or has taken, a bisphosphonate. The statement notes that of the people diagnosed with bisphosphonate-associated osteonecrosis of the jaw bone, 94% are cancer patients receiving repeated high doses of intravenous bisphosphonates; the other 6% have received oral bisphosphonates. 

The ADA encourages the patient to alert their dentist if they are taking a bisphosphonate medication and notes that medical and dental practitioners and researchers continue to research how to prevent and how to treat bisphosphonate-associated osteonecrosis of the jaw bone. The informational statement stresses that the benefits of bisphosphonates, in decreasing the risk of bone loss and bone fractures, outweigh the low risk of developing osteonecrosis of the jaw. It adds that, at this time, there is no known prevention for osteonecrosis of the jaw in bisphosphonates users and that regular dental visits and the practice of good oral hygiene may be the best ways of reducing the risk.

Just jumping in to add a link to the article Bisphosphonates for Osteoporosis and Bone Protection, from the main Breastcancer.org site.

You're all obviously knowledgeable about osteopenia and osteoporosis, but for anyone new to the subject who looks in, there's more in this article on Measuring Bone Health.

• The Mods

Ginger-Are you having any side effects with the Fosamax?  I started Arimidex in February and I'm having some stomach issues.  I had a bone scan and found out I have osteoporosis in my right hip.  My PCP wants me to start on Fosamax but told me to wait a couple of weeks so my stomach will settle down.  I agree so much with your 2nd paragraph. As my brother told me, "stop having so much fun!"

Thanks for your response, Ginger.  Hope you feel better soon and you can climb any mountain.