Arimidex and bisphosphonates?

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LM070917
LM070917 Member Posts: 323

Hey, just wondering how many ladies/guys are on bisphosphonates to prevent bone density lost whilst on arimidex..is it standard? And if you're not, what do your docs say you can do to help prevent osteoporosis from AL?

Suffering from severe acid influx on zometa and not sure I can deal with this for 10 years..but don't want osteoporosis either..ah the choices

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Comments

  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited May 2017

    Lottemarine, are you on IV zometa or oral? That could make a huge difference whether it causes heartburn. FWIW, I'm on another AI and on IV Zometa (1 every 6 months for 2 or 3 years - can't recall which right now). I haven't had any issues with it. Zometa & Prolia are both thought to decrease the risk of bone metastasis as well as osteoporosis, so it's worth trying to find an approach that works for you. Good luck.

  • LM070917
    LM070917 Member Posts: 323
    edited May 2017

    Thanks Hopeful, appreciate your support! I also get zometa IV every 6 months, which I know may be odd to still get reflux, but I find within a week of every Infusion I get a sever bout of reflux.

    I had my third Infusion a month ago and this time it's been really bad. The reflux has lasted 3 weeks now and I can't seem to get rid of it. My doc has prescribed ppis for 6 months, because he thinks I have an ulcer which keeps recurring. The ppis get rid of reflux symptoms but he said won't stop the cause- zometa. ☹️I do get what you're saying about preventing bone metastasis though..

  • Bagsharon
    Bagsharon Member Posts: 200
    edited May 2017

    My MO mentioned at my last visit that Prolia has shown to prevent cancer but insurance will only cover it if I showed signs of osteoporosis so he requested a bone density baseline.

  • Lenn13ka
    Lenn13ka Member Posts: 313
    edited May 2017

    I am on Prolia and Anastrozole with no issues.

  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited May 2017

    Bagsharon - I got my first Prolia shot today (every 6 months). I do not have osteoporosis and my bone density has held steady for 4.5 years on Exemestane. I'm getting it for prevention of bone mets. The triage nurse mentioned that some insurances won't cover it for that reason and that isso sad to me that some business person would tell a patient that they can't have a drug that might prevent bone metastasis despite what the science shows.

  • muska
    muska Member Posts: 1,195
    edited May 2017

    I started Prolia last year and had my second injection this past January. I had mild osteopenia in the spine that was noted on baseline dexa done before I was put on anastrozole. That osteopenia got a bit worse after two years on anastrozole two years later. It is my understanding that many insurances now cover Prolia for women who had breast cancer diagnosis, are on AIs and have osteopenia (it doesn't have to be osteoporosis diagnosis.) A review is required before they approve but if your medical provider submits all required info and you meet the above three criteria - bc diagnosis + osteopenia/osteoporosis + AI - they will cover it. Check with your insurer about the requirements.

    I just saw my MO yesterday and talked about Prolia. She mentioned she would like me to get it for up to five (!) years and to stay on anastrozole for 10 years. My main reason of getting Prolia is not bone density but rather reduction of bone mets risk.

  • CeliaC
    CeliaC Member Posts: 1,320
    edited May 2017

    Joining in here. Started Arimidex (generic) on 4/4/17, so 1 month into this phase of the BC journey. Prolia mentioned at 1 month post-rad followup with RO's Nurse Practitioner. 1st MO followup is on 5/12/17, so not sure when further discussion of Prolia will occur. Dexascan done in Nov 2016 prior to BC Diagnosis showed spine density headed towards osteopenia. Interesting to hear about Prolia and bone mets.

  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited May 2017

    muska - perhaps this is why I had no problem with insurance for Prolia, as I had minor osteopenia in my spine before ever starting exemestane. Not sure if my MO stated that is why she Rx'd, though.

  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited May 2017

    Lottemarine - it's interesting that even the IV zometa causes reflux for you. I wonder how it interacts in the body to create that response? Maybe I'll quiz the nurse the next time I have the infusion...

  • alpLewes24
    alpLewes24 Member Posts: 7
    edited May 2017

    I am on anastrozole and have mild osteopenia. I declined the prolia shot because I did not like the side effect, the locking of the jaw. Am thinking I should have gotten it, no one seems to have any side effects. There were none for you?

  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited May 2017

    Medicare Part B’s guidelines for Prolia eligibility are: ER+ bc dx; postmenopausal; dx of osteopenia; and taking an AI. I hit all the bases. Before that, I kept getting denied, so my first treatment was Zometa I.V. (GERD made Fosamax or Boniva a no-go). Took 5 stabs to find a good vein, spiked a high fever and felt like I had flu for nearly a week. Thank goodness my approval for Prolia came through. Next tx is Sep., next DEXA is Nov. Will tell how badly the letrozole treated my bones and how well (if at all) the Prolia & Zometa ameliorated that damage.

  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2017

    AlpLewes24...

    Locking of jaw? I never heard that SE, although a very few women out of many have had a horrible sounding side effect called "jaw necrosis".

    I had my first injection in Feb and it was a non-event. I never felt anything other than the needle stick to administer the drug.

    Claire

  • Tappermom383
    Tappermom383 Member Posts: 643
    edited May 2017

    Glad I clicked on this thread - I knew nothing about Prolia. Waiting for the authorization for my baseline bone density scan. I'll ask about Prolia when I see the MO in July (after my rads).

    MJ

  • 5LuvBugs
    5LuvBugs Member Posts: 506
    edited May 2017

    I am scheduled to get my first prolia shot tomorrow, I have been putting it off for 4 years due mostly to dental issues. I had surgery, chemo, radiation in 2012/2013 and have now been taking Arimidex 4 1/2 years (yes, I did have all the side effects that go with it) . My mild osteopenia has developed into osteoporosis and if I don't get the shot I have to go off of Arimidex because my bones are getting worse. To tell you the truth, I don't want to take ANY drugs - bet you don't either but it's fear that keeps us going however I only have 6 more months to go and I am proud to say I am almost a 5 year survivor!!!!


  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited June 2017

    FYI - was back at my dentist for a teeth cleaning and discussed the Prolia with my hygienist. She has never seen, in my dentist's practice, someone needing a tooth extraction while on Prolia, but she seem to indicate head and neck radiation would create the same issues. Not stating the "solution" would equally apply to a Prolia dental situation, but she said they sent him to a cancer patient who had had head neck radiation to a hyperbaric therapy before the extraction as mitigation.


  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2017

    Two points about Prolia - first is that it takes a while to show improvement of osteopenia/osteoporosis for those who are receiving it and have that issue - it can be up to two years before you see an increase in density. Also, the OP of this thread is asking about bisphosphonates and AI drugs - Prolia is not a bisphosphonate, it is a monoclonal antibody drug. The mechanism is different than drugs like Boniva, Actonel, Fosamax and Reclast, which are bisphosphonates.

  • Spookiesmom
    Spookiesmom Member Posts: 9,568
    edited June 2017

    Was on arimadex almost 5 years. At the start, was beginning osteopenia. Now have full osteoporosis. Won't do Fosomax because of se. Discussed Prolia with MO last visit. He confirmed the bad interactions with chemo should that become necessary. Tough choices. We are all so different, discuss with your MO and ask questions.

  • tnd22
    tnd22 Member Posts: 65
    edited June 2017

    Glad I clicked on this. I hit all the bases for Prolia as well, even though I am just 49. I have never had regular bone density, always been osteopenic, post menopausal, ER+ BC, started anastrozole a month ago. Will need to check side effects. I would like for my bone density to not decrease any further. I am getting stiffness in my legs because of the anastrozole but am hoping I can tolerate it. I was told there aren't many drugs on the market in the category of anastrozole, to slow cancer growth, is that what others have heard?

  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited June 2017

    It's been my experience that the Medicare guidelines are not as rigid as the "hit list" that Sandy mentioned. I am NOT ER+ I don't take an Al, but the chemo drugs took my bone density back past osteopenia into mild osteoperosis.

    Special K is right. Prolia is not a bisphosphonate. But I'll go for my 3rd injection next month (one every 6 months). Do be sure to have all dental issues taken care of before starting these drugs.

  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2017

    tnd - Aromatase inhibitor drugs include anastrazole (Arimidex), letrozole (Femara) and exemestane (Aromasin). Exemestane differs from both anastrazole and letrozole in that it has a steroidal component, but all three drugs prevent the conversion of androgens into estrogen. Post-menopausal women can also take Tamoxifen, which has a different mechanism in that it blocks the receptors on breast cells rather than suppressing estrogen, and in post-menopausal women it can build bone.

  • tnd22
    tnd22 Member Posts: 65
    edited June 2017

    SpecialK but if you take Tamoxifen, isnt; one of the SE higher risk of blood clots? There are benefits and risk to all I guess,

  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2017

    tnd - yes, there is an elevated clot risk with Tamoxifen, and you are correct - there is a cost/benefit analysis that you and your docs must do for any of these drugs. If you have a family or personal history of blood clots, PE, or strokes that should be factored in when considering Tamoxifen. Many oncologists advise daily aspirin therapy for Tamoxifen patients, and may test for FVL, a clotting mutation that makes one more susceptible. Additionally, for post-meno women, the AI drugs are thought to be more effective at recurrence prevention and are usually the recommendation.

  • tnd22
    tnd22 Member Posts: 65
    edited June 2017

    SpecialK I have been on the Arimidex. My issue is my fear of osteoporosis, which runs in my family. I always thought I'd have trouble with that, not breast cancer. THanks for the info.

  • muska
    muska Member Posts: 1,195
    edited June 2017
    Spookiesmom, what do you mean when you say that Prolia might have bad interactions with chemo should that become necessary?
  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited June 2017

    If ever I were hesitant about starting bone drug treatments, whether oral or IV bisphosphonate or biologic, my resolve to continue has been cemented (no pun intended) this week. Yesterday, a dear friend of mine died at almost 71 after battling back from a broken hip (and severe COPD) a year and a half ago—she had been osteoporotic (she was Latina & Asian, petite and small-framed) for a long, long time before she fell out of her pulmonary-rehab-center bed and broke her hip. She was never weightbearing again—she managed to work her way up to a non-wheeled walker but her arms were so frail that she no longer had the upper body strength to locomote with the walker (in her 50s she'd still kickboxed) and spent the rest of her conscious life using a wheelchair (her DH was her “chauffeur” when her caregiver would finish for the day). We'd last hung out together at brunch the week after Easter. Last week she developed a lung infection she couldn’t shake, had to go on a vent & dialysis (brittle type 2 diabetic) and then her heart failed over the weekend.

    My husband is a cardiologist (a colleague of her DH who is a retinologist at the same hospitals). He told me that if pneumonia is “the old man’s friend,” a broken hip for women >65 can be the beginning of the end, setting off a cascade of disaster that is often fatal within a year or two. So I will pop that calcium, D3, mag. & K2, take those Prolia shots faithfully, and do any kind of exercise that strengthens (or at least protects) my long bones. I miss my friend beyond words, but I don’t want to follow her down the same path.


  • Butterfly1234
    Butterfly1234 Member Posts: 2,432
    edited June 2017

    Sandy. -Thank you for sharing this touching story and my deepest sympathies. I go for my first Prolia injection tomorrow. You helped alleviate mylingering fears and misgivings. Gentle hugs and blessings.

  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited June 2017

    Butterfly and others,

    I may be joining you on the Prolia bandwagon. I just had a dexascan on Friday, and my results show that I have osteoporosis and am at high risk for a fracture! Thanks, Aromasin. Let us know how it goes, Butterfly.

  • Butterfly1234
    Butterfly1234 Member Posts: 2,432
    edited June 2017

    ElaineT

    Prolia injection went well on Friday. No side effects. Another plus for these injections in addition to strengthening bone is it suppose to help with bone metastasis. I'll have to find the research. I'm not due for another dexascan until next year. Sending positive thoughts and energy

  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited June 2017

    Butterfly - the only reason my MO is giving me Prolia is to prevent bone metastasis. My slight osteopenia in my lumbar has not progressed since on Exemestane for 4.5 years. I've had one shot thus far with no SEs.

  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited June 2017

    Butterfly and QuinnCat,

    Good to hear there are no side effects! The bone mets prevention is just an added benefit for me, but I'll take it!

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