Help me decide - Letrozole vs Tamoxifen

Hi Lucky. Age is a factor; I'm 61 and if you are on Medicare I'm guessing you are 65+. So I will say first that at our age I strongly suggest you make an appointment with an osteoporosis specialist and not rely on a cancer doctor for advice. My own story is that I already had osteoporosis when I was diagnosed with BC, so have been on Tamoxifen from the start. But some people process it well and some don't, so I wouldn't switch from an AI without a genetic test to see which category you are in. And with osteopenia, the best place to start is indeed with the basics: exercise; calcium-rich food like low-fat cheese, yogurt, and milk; and vitamin D supplements consistently. Hope that helps.

Luckynumber 47, that makes sense to me. Every drug has risks as well as benefits, so I try to start with the basics first (diet and exercise) then the first-round, most proven drug. Hope your April dexa scan brings good news.

Bisphosphonates can be really easy - I have 6 monthly infusions and after the first one there are zero side effects. They have the advantage of refusing recurrence by up to 5% in hormone positive women: just a thought:

I've been on Tamoxifen for almost a year. My MO was going to start me on an AI, but I'd had massive dental work earlier last year and didn't know if there would be more. I was also approaching a silly meltdown over the damn pills - probably cumulative emotion after a year that included my mother dying, the dental mess, a lumpectomy and re-excision, a radical nephrectomy, and 33 radiation zaps. I'd been pretty stoic, even cheerful, up to that point, but for some reason the pill decision had me almost in years. My lovely MO looked at me and said "Tamoxifen it is!" When I mentioned it to my BS, she said it actually helps with bone strength. When I had a Dexa right before the breast cancer adventure, I already had osteopenia and one area of osteoporosis. And since I'd already had a hysterectomy a decade earlier, I didn't have to worry about that issue, plus my PCP already had me on low-dose aspirin.

Thank you Lucky and Alice for your comments.

My RX bottle just says Letrozole and are little burnt orange pills. I've always had low cholesterol test results and would prefer to take aspirin than yet another prescription. My bone density results were worse than my 83 year old mother's and she has been diagnosed with osteopenia decades ago so I'm worried about the bone density as well as the joint pain

I'm concerned that I won't be able to have dental implants should I need them in the future. My mother took fosamax for a short while and had difficulty with her implants.

Thanks again

I am in the midst of the same decision making process. I start Anastrozole only three weeks ago. Side effects are not terrible, but not pleasant either. Hands ache in morning, knees too, biggest problem is fuzzy brain. Some days I feel terrible (especially when I haven’t slept well), other days more or less ok. More fatigue. But my most important concern is bone thinning as I already have the beginning of osteopenia in femoral neck. MO has prescribed a Prolia shot every six months but I don’t want to go down that road. I am doing yoga 5 days a week,silver sneakers with 5 lb weights 3 times, walking on nice days and taking quality calcium/ d3/ magnesium/boron supplements—but afraid it won’t really be enough in the end to counteract the no-estrogen environment of my body. Am seriously considering switching to Tamoxifen and will discuss with doc end of this month

Dear DianeinPA,

Welcome to the BCO community. We are sorry for what brings you here but so glad that you reached out to our members for their experiences. We hope that you will stay active and connected here. Please let us know if there is any help we can provide.

The Mods