Who prescribes your bone building drugs? MO or PCP?

Mommato3
Mommato3 Member Posts: 633
edited July 2017 in Hormonal Therapy - Before, During, and After

Currently my MO prescribes my Fosamax. I'm not real happy with this new MO (old one moved in February). She told me she'd listen to my side effects from Arimidex but in the end she will just tell me to keep taking it. In other words, shut up and take the drug. I've been having some side effects that I believe are coming from the Fosamax. So I'm considering seeing a PCP to discuss all my options. Will a PCP know which drugs are better for possibly preventing bone metastasis? Is there an advantage to one over the other?

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

    I had the option to go with my MO or my GYN. I chose my GYN since I could pop into her office for a shot from the nurse w/o any hassle as long as they had current blood records w/in 30-45 days. Also it is my GYN's office that has always done a DEXA scan every two years for at least 12 years, so there is continuity in my records. She's the one who initiated Boniva & Actonel long before I had breast cancer.

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  • peaches1
    peaches1 Member Posts: 137
    edited July 2017

    My PCP ordered a dexa back in December after I asked her to. I have a sister who is an endocrinologist, who suggested I get one before I go on the femara. When I had one two years earlier, they found out that I had osteopenia. On the repeat dexa, it showed that I still had osteopenia, and it had progressed a little in the spine. My PCP said she would let my MO deal with it. When I went to my PCP for a routine physical, she asked me why my MO had not put me on anything for the osteopenia. I told her that I was told by his nurse that he likes to wait until I have been on femera a while. My MO is really shy though, and the last time I saw him in April he did not even ask me how I was doing on the femera. He just listened to my heart and chest, and then asked me if I noticed anything in my breasts, and then he examined my breast, and told me what I felt was scar tissue. He then asked me when I was seeing the surgeon, and I replied in May. He then told me that he wanted to see me again in August then, and left the room.

    My PCP was not happy that he did not put me on anything, and asked me if I wanted her to put me on fosomax, and I told her that my MO does not like oral meds, and only prescribes prolia or another medicine that you administer by IV. I said that I thought that it was because it helped prevent bone metastasis. Even my Sister when I mentioned that to her she replied that bone metastasis was not something that she knew a whole lot about. I am going to the dentist in a few weeks, and then I will try to call up my MO's nurse, and see if I can be put on prolia. She is much easier to talk too. You need to be cleared by your dentist before you start taking prolia.

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

    Bisphosphanates (Fosamax, Actonel, Boniva, and IV Reclast) do help make bone inhospitable to bone mets. This class of drugs have been in use to treat osteopenia and osteoporosis for many years. Here is a link to some info:

    https://www.ncbi.nlm.nih.gov/pubmed/22307370

    Prolia is a monoclonal antibody, FDA approved in 2011 - so, much newer and strengthens bone by a different mechanism. Here is a link to some info regarding both types of drugs:

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.71/pdf

    http://emedicine.medscape.com/article/1954152-overview

    Anyone contemplating either bisphosphonate use or Prolia injections should see a dentist beforehand to assess general dental health and the potential for invasive dental procedures in the future. Invasive dental work, extractions, implants, etc., all have the potential to cause issues with either class of bone building drugs.

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  • peaches1
    peaches1 Member Posts: 137
    edited July 2017

    They just want to make sure that you don't have any dental problems that need attention. When you get your prolia shot, you are not supposed to have any dental work done other than routine cleanings for six months. I think there is a remote chance that you can develop jaw necrosis if you have dental work right after getting a shot of prolia. Before I started chemo, I had to get cleared by my dentist too, because they did not want me being treated by her while I was having chemo. They were worried about infection. BTW- My dentist who has been practicing probably 30 years, said she has only seen one case of jaw necrosis that occurred after the person was put on osteoporosis meds. She told me that occurred with a guy who was on fosomax.

    I just saw the other post from special K. My MO told me the first time he met me that he always puts his patients on bone building meds, but he does not put them on oral meds. He did not say why. My PCP was willing to put me on fosamax, and I get the impression that she was ready to write the prescription that day.

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  • Mommato3
    Mommato3 Member Posts: 633
    edited July 2017

    My gyn only does my annual pap. I've never seen a PCP. My MO's office is the one that orders my mammograms, DEXA and prescriptions. Gyn's office is much closer than MO which would make it much more convenient. Sometimes I just wonder if there's a doctor that's better suited to prescribe certain prescriptions or to have conversations with.

    Peaches, my new MO starts with Zometa. That is her preferred drug. My previous MO put me on Fosamax in February. She said she's willing to let me go six months with Fosamax and then repeat my DEXA to see if there's any improvement. If not, then Zometa it is. BUT I don't want to pay for the repeat DEXA. Insurance will cover it but I have to hit my deductible first. This is the first time in three years I haven't hit my deductible in the first few months of the year. Sigh...I'm just tired of doctors and their bills!!

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  • Mommato3
    Mommato3 Member Posts: 633
    edited July 2017

    Bosum, be sure to tell your dentist you may be starting Prolia or even a different bone building drug. They will do a thorough evaluation of your mouth to make sure everything looks good and assess if you'll need any work done in the near future.

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

    My new MO put me on Fosamax after my most recent dexa scan revealed that I had osteoporosis and was at high risk of fracture. (Two years ago, when I started Aromasin, I was borderline ostepoenic.) I also have a new OB/GYN, but haven't met her yet (she's on leave because her husband died of cancer and she has young children). I will meet new MO on Wednesday; I will ask her about follow-up scans to see whether or not the Fosamax is working.

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

    No, a filling for a cavity is not invasive, but my MO advises that I not have dental work done soon after receiving the injection. Invasive dental work is an extraction, or an implant or possibly a crown depending on whether or not you also need a root canal. Cleanings and routine fillings are usually ok. I am fortunate that my dentist is pretty well versed in effects of chemo and anti-hormonals on teeth - and bone building agents, his wife is a stage III ovarian cancer survivor.

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  • EastcoastTS
    EastcoastTS Member Posts: 864
    edited July 2017

    Does anyone see an endo. for bone issues? I had a Dexa and will need to go on something. Not a surprise. (Very petite/mom has osteoporosis. I had osteopenia already -- and probably should have asked for meds before but didn't really want to go there unless I had to. My mom had the fear of God beat into her about the jaw issue. I was well aware.)

    I'm struggling to figure out what doctor does what in all this. My MO ordered the Dexa but referred me to an endo, who I am happy to see. I have a PCP appt on Thursday (new one) and have no idea what I'm even going to ask them to do! It's all been done. LOL Endo appt in August.

    I'm on Tamoxifen, btw.

    Hugs to all!

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

    BB - you're welcome! I plan on seeing you right back, lol! And, yes, good plan on growing old together - I'm in!

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

    My PCP is not big on bisphosphonates, especially orals like Fosamax if there are any preexisting upper digestive issues. He believes in weightbearing exercise and D3/Mg/K2 supplementation (he says that Ca’s concentration varies very little depending on intake because of the stomach’s efficient maintenance of homeostasis). My MO starts all her patients on AIs who are at least borderline osteopenic on Zometa infusions, but I have lousy veins in my usable (non-surgery-side) arm, no port (no chemo), and resisted for a long time. My shrink recommended the endo his wife uses—he calls him the “Bone Whisperer.” Said endo wrote me back after seeing my scan (definitely osteopenic), and said “doing nothing is not an option” and that exercise & supplements alone are basically “doing nothing.” He said to lobby my MO for Prolia shots, not Zometa infusions. I did, but twice my Medicare Part B refused to cover Prolia because it wasn’t a “treatment” to be administered but just a prefilled injection I could theoretically buy (had I $5K twice a year for two years burning a hole in my pocket) and was therefore a “drug.” Turfed me over to my Part D carrier, which refused to cover Prolia, period, because cheaper alternatives existed.

    So I gritted my teeth and had one Zometa infusion. Had to have two blood draws because the oncology lab screwed up and let the first tube sit too long. So that was two “sticks,” the second of which was difficult to start. Then it took four more stabs to finally get a usable vein…in my left hand. And the stuff hurt like hell with every click of the pump. Had the “faux flu” for a week and aching bones (I started taking Claritin too late). Told my PCP and he said he would go to bat with my Medicare Part B supplement carrier (BCBS) for Prolia next time around. And my husband (a cardiologist) said that worse came to worst, we could afford the $1200 one shot cost at CVS with a GoodRx coupon.

    But then, my MO’s nurse messaged me that BCBS issued new guidelines for at-least-osteopenic postmenopausal bc patients on AIs—Prolia was approved so long as the shot was administered at a “facility” (i.e., the chemo suite where I had the Zometa) and not just in a doctor’s office. So my second treatment was indeed Prolia, with only a little achiness for less than a day. (Nearly fainted when I saw the size of the pre-filled syringe—almost as big as an Epi-Pen).

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