Breast cancer treatment and osteoporosis

Posted by jknows @jknows, Feb 24 8:06am

I was diagnosed with triple negative breast cancer in February 2023. I received the Keynote 522 protocol that includes chemo, surgery and immunotherapy. I just had a repeat bone density test and discovered I have moved from osteopenia to osteoporosis. Is this a common outcome from BC treatment and if so how is the osteoporosis treated?

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donnakatherine | @donnakatherine | Jul 26 12:37am

In reply to @brighterdays "Hi! Did your doctor mention the exact higher rate of the 10 year survival? Thank you." + (show)

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donnakatherine | @donnakatherine | Jul 26 12:50pm

In reply to @brighterdays "Hi! Did your doctor mention the exact higher rate of the 10 year survival? Thank you." + (show)

Hi Brighterdays,

I've been chasing this idea around Google Scholar as I consider taking a bone drug and which one. One doctor has recommended Fosamax. Another doctor has recommended Zometa.

A 2024 meta-analysis indicates that breast cancer survival benefits accrue differently to different diagnoses and menopausal status and are small in all cases. This supersedes earlier research, which showed greater recurrence benefits; they discuss why that might be the case.

They also discuss that there is no "standard" standard of care for the adjuvant use of bisphosphonates in breast cancer treatment. It's the wild west.

Here's a link to the article (I found the Discussion and Conclusion sections helpful).
https://www.cell.com/heliyon/fulltext/S2405-8440(24)00824-7
Also, you might find additional helpful articles in the citations.

donnakatherine | @donnakatherine | Jul 26 1:04pm

In reply to @donnakatherine "Hi Brighterdays, I've been chasing this idea around Google Scholar as I consider taking a bone..." + (show)

A 2015 study published in The Lancet said this:

"The effect on distant recurrence was mainly because of a reduction in bone recurrence (10-year risk 7·8% vs 9·0%; RR 0·83, 95% CI 0·73–0·94; 2p=0·004; figure 1)."

Whether or not that's still supported, I don't know.

Here's a link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60908-4/fulltext.

It's mentioned early in the study that Heliyon published (link above).

Sue Ellen Murrey | @semurrey | Oct 22 9:11am

In reply to @beachbabe "Has anyone taken Anastrozole or other AI without taking a bisphosphonate and had no significant change..." + (show)

Hi @beachbabe - Just wondering if you ever started Zometa? After 20 months on Letrozole my DEXA showed -2.7 - so osteoporosis but not tooo bad. I'm 59 yrs old now (57Yrs diagnosed with ILC, lumpectomy and radiation) and had tough time with GI issues after 8 months of Fosamax weekly pill. I am scheduled for first Zometa infusion on 10/28 and starting to think maybe I just punt as side effects so tough but I believe the thinking is our osteoporosis will get worse with 3-5 for more years on Letrozole? Thoughts? xoxoxo

windyshores | @windyshores | Oct 22 11:08am

In reply to @semurrey "Hi @beachbabe - Just wondering if you ever started Zometa? After 20 months on Letrozole my..." + (show)

My endo did not want to do Zometa or Reclast during my cancer treatment with letrozole, and I lost 10% of bone density in the first year alone. I would not have fractured if I had had the support of a bisphosphonate.

With hydration (can be IV if MD agrees and orders), slow infusion (one hour) and tylenol the fluish reaction may be eliminated and will certainly be reduced!

lilacs777 | @lilacs777 | Oct 23 10:01am

I'm 6mo in on AI and very concerned about bone loss, my MO says no need for bone drugs now b/c it takes a long time for the AIs to decrease bone density, but I don't want to wait around to find out its really bad. Does anyone have any high quality calcium supplements you can recommend? I've only been taking Tums for extra calcium, I can't tolerate dairy or fortified orange juice (too acidic). I do take vit D to keep that in the normal range, but looking for suggestions on good Calcium supplements. Thanks!

mjmac | @mjmac | Oct 23 1:40pm

In reply to @lilacs777 "I'm 6mo in on AI and very concerned about bone loss, my MO says no need..." + (show)

Have not done the research but I’ve heard from a healthy 85 year old that Bone Broth is very good for your bones as well as many other things.

windyshores | @windyshores | Oct 23 2:09pm

In reply to @lilacs777 "I'm 6mo in on AI and very concerned about bone loss, my MO says no need..." + (show)

My experience with the quick decline in estrogen from AI's was similar to my experience at actual menopause: fairly big drop in bone density the first year and then a lower rate of loss after that.

I can't do dairy either. There are many calcium supplements out there. I have done Rainbow LIght and Solaray calcium citrate but even mainstream Citracal works. You can also try oat, soy, pea milk though fortification is no different than supplements!