Breast cancer patient also with osteoporosis: AI, Prolia and Reclast

@soggybones, if you are at high risk for breast cancer and have osteoporosis, there is a medication specifically for you called Raloxifene. Of course, it is not without possible side effects. I actually had BC and have been taking it for nearly a year now, and it has been better than any of the other drugs I’ve taken, which had horrible side effects, including Prolia, Fosamax, Evenity, and Tymlos.

@soggybones It's a close call whether I've spent more time researching my breast cancer or bone health. I think my breast cancer treatment options have been less complicated.

I was diagnosed with estrogen positive breast cancer in the fall of 2024 and treatment with surgery, chemo, and drugs following 2025 through now. The drugs included the aromatase inhibitor, letrozole and kisqali.

Although my most recent Dexa scan in August 2025 showed I was holding an osteopenia diagnosis with some slight improvement, my oncologist wanted me on an osteoporosis medication because of a higher FRAX score on my Dexa, my age which was 74 then, and being on letrozole.

Although I wanted to start with an anabolic osteoporosis drug, 2 endocrinologists I saw both ruled that out because my breast cancer was estrogen positive. HRT was an obvious no, alas. Boy, do I wish I'd been on bioidentical HRT before my breast cancer diagnosis.

I cannot tolerate bisphosphonates you swallow because of a history of reflux and I refused to start Prolia because of its potential complications. That left the more powerful and risky Reclast or Zometa which are both zoledronic acid but with different dosages.

I had my first Zometa infusion October 2025. Although my oncologist recommended another infusion in 6 months, I am waiting for at least one year until the next one.

There is breast cancer research looking at alternative drugs to aromatase inhibitor. These are now in clinical trials. One such drug is giredestrant which is a drug category called SERD or selective estrogen receptor downregulator. One more acronym to learn! I don't know much about it but my hope is that it has fewer side effects than aromatase inhibitors including it's detrimental affect on bones. What, if any, other side effects SERDs may have, however, is another question as is how long before such drugs are fully FDA approved.

This is great news! Thank you. I’ll be sure to share with
The doc on my next appointment

@prarysky Thank you for taking the time to share your story! Were you treated for osteoporosis before your breast cancer journey? Did you discuss with your doctor the possibility of maybe taking tamoxifen instead of letrozole? I read that the AI exemastane is less damaging to your bones-did your doctor discuss that option with you? How long does your doctor believe you will need to stay on an aromatase inhibitor? I certainly hope and pray new treatments are on the horizon! I know both breast cancer and osteoporosis treatments have gotten better over the decades. I just hope we're all around to reap those benefits.

@maymore Thank you! I've considered Raloxifene, but it would worsen my already bad menopause symptoms. Still, it could protect my bones and lower breast cancer risk so I am giving it serious consideration. The last thing I need is a breast cancer diagnosis. Even if caught early and is a low grade most oncologists highly recommend starting an aromatase inhibitor and that's something I really don't want.

@soggybones I’m on Reclast which the cancer center approves because it is known to hinder the metastasis to bone from breast cancer. I had DCIS in 2022. With cancer recurrence never 100% guaranteed, I like the protection. I was unable to tolerate oral bisphosphonate, and appreciate only needing one infusion per year.
I’m 71, was at osteoporosis, now at osteopenia - chances are my bones won’t improve more but doctors are happy with my stable numbers. If you’re younger a bone builder might be considered. I believe Reclast has pretty low side effects for most people.

@triciaot Thank you for sharing this. Did you have osteoporosis before you were diagnosed with breast cancer? Or did the cancer treatments cause your osteoporosis?

@soggybones I was not treated for osteoporosis before the breast cancer. I'd held steady in the category of osteopenia for many years and even improved a bit in some years. I used exercise (strength, toning, yoga) and supplements (nattokinase, MK4 and MK7) for many years.

I developed afib about a year before the breast cancer. The afib diagnosis led to Eliquis, a newer anticoagulant which meant stopping the nattokinase. With the breast cancer diagnosis, I needed to stop all supplements but plan to resume the MK-4 soon.

My oncologist has mentioned the tamoxifen but the recurrence rates are not as good as with letrozole so will stay with the aromatase inhibitor while I can tolerate one. Will keep the exemastane in mind, though. Since I seem to be handling the letrozole without major issues, reluctant to try a switch yet.

Healing thoughts to you!

@soggybones I had osteoporosis before cancer. My ob/gym tried to get me to take alendronate for years but I was, stupidly, resistant. I had finally decided to try it, had stomach irritation from Fosamax, and was getting ready to schedule a Reclast infusion when the DCIS was found. I waited about 9 months after surgery to try the infusion. I’ve had 3 annual ones so far. Will see the endo in July. Although 3 infusions is often recommended then a med vacation, I believe because I’m still within the first 5 years after cancer they will continue to recommend yearly infusions. I don’t like taking meds of any kind, but if it will protect me from bone mets in case I have a recurrence, I’m all for it.
I am also on 5 mg tamoxifen. I was thinking I could maybe do just 3 years of tam with the latest research saying its protective. But because my sister had breast cancer I think the 5 years is what they want me to do. Will be going in for scans of all kinds on the 27th/28th.

@prarysky Thank you! Wishing you good health and healing as well.