Femara, Fractures, and Osteoporosis with a Normal DEXA Scan
Just wondering if anyone else is in my situation. I had lumpectomy and Intraoperative Radiation in Feb 2013. Normal DEXA scan in March, Started hormonal therapy in April. I started with Aromasin, then Arimidex and have been on Femara since Oct 2013.
I have not complained about thinning hair and hot flashes and have managed to find ways to minimize the joint and muscle pain, irritability and other SEs. I have been doing weight bearing exercise and am taking calcium and vitamin D3 supplements. I had another normal DEXA scan in May 2015 and thought I was doing well and had avoided bone loss with the AIs.
In July I developed tendinitis in my left hand near my thumb. In Sept I had a fractured patella with no known cause - no fall, no accident, no injury. My knee just started hurting. Pain became more frequent and more severe and within a few days I felt a pop and severe pain when I stood up. The orthopedic surgeon said I have a small bony protrusion on my patella. Lots of people have them but he has never seen one crack before without a precipitating injury. Early Nov I developed trigger thumb in my right hand. Mid Nov the weakness and pain in my hands caused me to drop a pan of hot greasy juice from a pork roast and I fell in the kitchen, suffering a small non-displaced fracture in my left wrist. My wrist is healing well and I got a steroid injection for the trigger thumb. I have been feeling pretty well the last couple of weks.
Last week I saw my PCP and told him about the fractures. He said a fall from a standing position should never cause a fracture. The fact that I broke my wrist when I fell is "osteoporosis equivalent", regardless of the normal DEXA scan. He has started me on Boniva.
I feel like I have been kicked in the gut yet again with this disease. I am so angry that Femara has caused all these problems. I feel totally misled by the normal DEXA scan results - what a false sense of security that normal result gave me. It seems the normal result does not necessarily mean no bone loss. I want to stop the Femara but suspect that will not stop the damage it has already caused. I saw my MO the day I fell but before I knew my wrist was broken. We discussed the trigger thumb. He said stopping Femara would not reverse that and offered Tamoxifen. I refused it because I have a high personal risk of heart disease and stroke and Tamoxifen adds a 10-15% risk of blood clots, according to him.
I want to throw the Femara bottle up against the wall until it shatters and then stomp every one of those nasty little pills into dust. But that won't solve anything.I don't yet know if I am going to do anything differently but am just very frustrated and angry. Has anyone else had the same problems?
Comments
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I was osteopenic prior to breast cancer diagnosis due to a total hyst/ooph 9 years prior, at the age of 45. I had remained stable all of that time with the same degree of bone loss and I could not tolerate oral bone strengthening mess due to a previous GI surgery in '95. After chemo and six months of Femara, I developed a trigger thumb, which did resolve with a switch to Arimidex. You might consider a generic Femara manufacturer switch to resolve the triggers - I had issues with my original formulary, but with a different maker no new trigger. I also had bone loss so was started on bi-annual Prolia injections. After 4 injections I now have normal density. I'm not sure I buy your doc's no fracture from a standing fall theory - I have known a number of non-cancer folks who have had this happen who don't have density issues.
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I wondered about the no fracture from a standing height also, but I found several sites online after talking with him, including these examples.
https://medicine.umich.edu/dept/orthopaedic-surger...
http://www.healthcentral.com/osteoporosis/c/76444/...
http://jbjs.org/content/97/19/1553
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I had been Osteopenia for years (DXd via DEXA - huge family HX). Since IBC DX it has progressed to Osteoporosis which was to be expected anyway. I've been on Femara/letrozole for almost 6 yrs (also on gemeric Fosamax). In those years, I have succeeded in breaking 2 bones in foot (it's Hubby's 'fault . as he had 'found an app' that would let a smart phone function as a 'flashlight' so he put it on my phone and then insisted I had to go out and try it - well we had had a T-storm and I succeeded in slipping in the mud and wound up partly under my PU and with 2 bones in foot broken.). I also slipped on one of the dog bones in the hall - that did 'a good job' on wrist - surgery. With all that said - I am very active 'outdoors' and have succeeded in taking several falls (2 down creek banks, off horse and off bicycle) that were a lot 'worse' fall than the fall Hubby caused or the one from the dogs bone with only a few bruises and slightly sore muscles.
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savgigi-interesting, I hadn't heard the term "fragility fracture" before. My mom was osteopenic. She fell & broke her hip. 5 months later, she fell & broke her other hip. She also sustained a compression fracture in her spine. Just by turning around & flushing the toilet. I've heard it argued that thin bones aren't the problem, poor balance is. I've been working to improve my balance but my mom tried this also. She tried some of the bone building drugs, but there was never any improvement on her osteopenic scans.
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