Letrozole and degeneration of the bone

louisewalters, sometime patients are offered antiresorptive osteoporosis medications to prevent bone metastasis after breast cancer. Your oncologist may want to prescribe zoledronate (Zometa) or denosumab (Prolia) which would protect against bone loss and metastasis. You might look at side effects of each before your appointment.
Chemotherapy and radiation cause bone loss. The fifth to seventh ribs are directly behind the breast in direct line of the radiation. Letrozole also causes bone loss by reducing hormones that can contribute to recurrence.
Some oncologist are using teriparatide, with caution. It restores bone and cartilage. It formerly carried a black box for risk of cancer of the bone, but that has been removed. You might look at this article to see if you would even be willing to take it https://pubmed.ncbi.nlm.nih.gov/40578986/. Your oncologist is likely to be reluctant to prescribe teriparatide.
It's impressive that at 64 your bones had no abnormality anywhere in the skeleton.
I hope you are recovering well and that your appointment is helpful.

I have been on Letrozole for almost 8 years. Still here...celebrate!! I was put on the Zometa plan immediately after my double mastectomy. Help a lot. Now I have terrible degeneration in my spine. Partially due to age and degenerative arthritis. My team has put me on Evenity.
I feel Letrozole is the drug that I must take. Side effects are not fun. Exercise and healthy food choices are critical. Squash _____ CANCER.
Sending strength, great days and hope!
Kris
Sending

@gently such a helpful informative post! Thank you!

Edit - sorry, I neglected to say I have been getting zometa infusions every three months for the past year with minimal side effects.

@gently Thank you for this helpful reply. Great info to take along. I added a note comment as I neglected to say in my post that I am being given zometa.

@roewes07 Thank you! I added a comment that I am being given zometa every three months for the past year.

@louisewalters, you are long past the injury to the bone, bone marrow and fractures and are in recovery from both. The oncologist may want to increase the frequency or dose of Zometa may suggest that you switch to Prolia or may think you've passed by the greatest risk and leave every thing as it is.
You might look at Prolia with a wary eye to considering the medication. It is thought to better protect against metastasis to the bone than Zometa, and adds bone but carries its own set of hazards.

Hi Louise, I had a DEXA scan 11 months before my treatment for DCIS last fall. I had already been diagnosed with osteoporosis in my forearms at that time. Due to hip replacements I was only given a partial scan. My orthopedist had observed some neck and issues with L4 & L5 on hip X-rays. He told me to keep moving with weight bearing exercise, walking, and watching my diet especially for calcium and vitamin D. My GYN had already made those same recommendations. She had also referred me to an endocrinologist. I already had started treatment with Letrozole and radiation by the time I saw the Enduro. She performed additional lab work beyond what the oncologist and PCP had done. She prescribed a bisphosphonate Rx which I stopped after a month due to side effects. I am still searching for a medication to strengthen bones. They have some serious side effects but I have just gotten a list of some newer prescriptions that may be an option with less undesirable problems. If you are given a prescription be sure to ask about all side effects and research based success rates. Keep up your healthy diet and exercises, and eliminate what you must. My next DEXA isn't until November. Letrozole hasn't been much of a problem for me but I'll know more after November after other test results come in. Everyone reacts differently to meds so you and your team must see what works for you. Best to you!

@louisewalters Sounds like your oncologist is top notch!

Haven’t been on letrozole (yet) but been through chemo, radiation, Anastrazole and now exemestane. Had dexa scan before all this started (done same day as mammogram - 3/23) and showed mild osteopenia. Put on Caltrate-D by reg doctor. When I started ai, onco upped to twice daily. I also started fish oil, vit K2 and started strength training 2-3 times a week. Still present at dexa scan 5 months after started ai and he recommended Prolia which I declined (nasty side effects!) so he agreed to redo dexa at a year. Was going to do Zometa if possible at that time because of its ability to decrease bone mets. (Lots of mouth damage from chemo and ai so had to get clearance from dentist). BUT that dexa scan was normal so couldn’t justify any of the bone meds. I’m still doing calcium/D/K2, fish oil and doing joint supplement (Move Free Ultra) that has boron. He’s moved the dexa scan to 2 years so won’t know if it’s still working till then but promising. Also changed my calcium to a calcium citrate because more readily absorbed than the carbonate.