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Bone meds while on AI: What questions to ask at next appointment?

Posted by mistymar @mistymar, Jul 7 4:07pm

I was diagnosed last year, surgery, chemo (oncotype +) and radiation and am now on Anastrazole for the last 5 months. At last visit, Dr recommended bone meds - Prolia was first and when I balked, he suggested Reclast. I will see him again on Tuesday for results of latest tests (PET scan and brain MRI) and know he will bring it up again. I did have a Dexa scan done late May and have mild osteopenia (left hip -1.3) but spine was all in the positive numbers. I know he wants me on it to prevent the bone loss that occurs with the ai therapy but all the side effects make me concerned, particularly the Prolia - even though it is the only licensed treatment. From my reading, it seems like I shouldn't be on it at this point - wait a year and see if the value deteriorates but would that be creating a problem I don't want to deal with - ie, bone loss that is now irreversible. Suggestions as to the appropriate questions to ask at the appointment and feelings on taking the meds as a preventative at this point.

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windyshores | @windyshores | Jul 8 5:37am

@mistymar bone loss can be reversed at least substantially with medications like Tymlos, Forteo and Evenity. I was unable to do Reclast during my 5 years on letrozole due to concerns about my afib which have since been discounted. I did Tymlos after letrozole and my spine is actually better than before cancer.

That said, Reclast (and Zometa) are often used along with aromatase inhibitors and it seems to have become more clear that they have some anti-cancer properties especially in bone- since I had my treatment.

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Sue Ellen Murrey | @semurrey | Jul 8 9:43am

I was a bit hesitant too but my endo felt imperative I treat osteoporosis that my Letrozole for invasive lobular cancer put me into within 1 year of starting. I am taking oral Fosamax one daily and will have blood work after 6 months to see if being absorbed as I have chrohns. If not I will probably try Reclast but I wanted to start with Fosamax which has fewer side effects.

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Sue Ellen Murrey | @semurrey | Jul 9 10:22am
In reply to @semurrey "I was a bit hesitant too but my endo felt imperative I treat osteoporosis that my..." + (show)
@semurrey

I was a bit hesitant too but my endo felt imperative I treat osteoporosis that my Letrozole for invasive lobular cancer put me into within 1 year of starting. I am taking oral Fosamax one daily and will have blood work after 6 months to see if being absorbed as I have chrohns. If not I will probably try Reclast but I wanted to start with Fosamax which has fewer side effects.

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I meant that take Fosamax once WEEKLY!

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mistymar | @mistymar | Jul 9 11:42am

So just got back from oncologist. While he’s still mentioning it, not pushing. I don’t feel I fall in the need to use category because as yet, I don’t fall into the osteoporosis category. He will do another bone scan in a year (so at about 15 months on ai) and will see where we stand. He does feel Prolia is the way to go but I am concerned about the side effects and rebound. I did mention the new technology that’s coming out - Osteoboost - and he wasn’t adverse to it but is concerned about its use in cancer patients. So currently no additional meds and we’ll see about next year. Thanks for those who commented.

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windyshores | @windyshores | Jul 9 12:31pm
In reply to @mistymar "So just got back from oncologist. While he’s still mentioning it, not pushing. I don’t feel..." + (show)
@mistymar

So just got back from oncologist. While he’s still mentioning it, not pushing. I don’t feel I fall in the need to use category because as yet, I don’t fall into the osteoporosis category. He will do another bone scan in a year (so at about 15 months on ai) and will see where we stand. He does feel Prolia is the way to go but I am concerned about the side effects and rebound. I did mention the new technology that’s coming out - Osteoboost - and he wasn’t adverse to it but is concerned about its use in cancer patients. So currently no additional meds and we’ll see about next year. Thanks for those who commented.

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@mistymar monitoring sounds good and it seems you have a great doc!

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