Re: Breast cancer, a-fib, and calcium tablets

1) Calcium doesn't cause or aggravate afib. I have afib and take calcium. Your doc may have wanted to you to avoid too much calcium supplementation because the latest advice is to get it from food, unless allergic to dairy. The idea is too much calcium can end up in the lining of blood vessels not in bones. (Vitamins D and K help with this.) You need 800-1200mg calcium each day, from food and then supplements if still needed, according to all of my docs.

2)Letrozole does not destroy calcium. It eliminates estrogen coming from the adrenal glands after menopause, basically eliminating estrogen in our body.

3) Letrozole does not cause tibia and hip breakage specifically. Are you taking Reclast? That may be what you are thinking of. The tibia and femur fractures are a risk after several years on Reclasst.

4) Letrozole dose cause bone density to go down, due to estrogen deprivation, so Reclast is often prescribed with it, an infusion that affects bone turnover and also may help with cancer, according to some (this is controversial I think).

5) If bone density goes down, fractures are possible, in the spine or anywhere else. But Reclast seems to help with this,

6) You have not been on letrozole long enough for severe bone loss. It is likely you already had osteoporosis before starting it. What are your DEXA scores for spine and hip?

Spine is -1.7
Hips are -2.9 and -2.7.

Last DEXA was 2016 with osteopenia. Do not have score and not on gynocologist doctor's chart from that year.

That is not "severe" osteoporosis unless you have fractured. Your spine doesn't have osteoporosis at all. Your hips do: the borderline for osteoporosis is -2.5.

Letrozole can cause further bone loss if you don't take Reclast or at least another bisphosphonate. Are you taking that?

No. Started Letrozole 3-18-23. Finished radiation therapy 3-01-23.
Medical Oncologist wanted me to start 3-02-23 direct after radiation when I saw her in early January 2023.
Radiation Oncologist said to start two weeks later when I finished radiation 3-01-23.
Medical Oncologist did not say to get DEXA in January before radiation tgerapy. She just did not reply. Said nothing. Don't see her again til end of June 2023.

My former cardiologist took me off calcium tablets in April 2023 and did not say why. I did not ask.

Gynocologist also told me not to take calcium tablets in Sept. 2023.
I drink 2 glasses of milk a day which is 600 mg. of calcium. Eat some green vegerables but do not know if it adds enough daily.

I have to schedule an appointment on Monday with a Dr. who deals in osteoporosis. Referral from gynocologist who was the DEXA referral Dr.

Did fall and break shoulder and collarbone in Jan.
2020.

My oncologist prescribed a baseline DEXA prior to my starting on Anastrozole ( an AI like Letrozole) which also may causes bone loss. I consulted an endocrinologist to plan any mitigation strategy I may need. My bones are in relatively good shape. However, My endocrinologist recommends NO calcium supplementation ONLY calcium from food and Vitamin D ( gel tablets are best as D is fat soluble). I also take K2 which she doesn’t start people on but doesn’t suggest stopping if you’ve started as research suggests it “may” be helpful in directing calcium to bones and away from soft tissue as in arterial plaque. CAUTION: check with cardio about K2 as there are two kinds of K and one has cardio implications.

So food based calcium is what I do! Organic Grass fed non fat or lo fat dairy, Parmesan cheese is hi in calcium, green leafy veggies but some like spinach are hi in Oxalates ( binds calcium) but bok choy, kale, and organic calcium fortified plant milks and Uncle Matt’s Organic OJ ( with calcium and Vitamin D has blue label). The internet has many websites listing foods hi in calcium.

Best wishes 🌸

I don't know how calcium could cause afib. However, I do know there is "magical thinking" and assumptions in the medical community about calcium somehow magically going to your bones to strengthen them. And I DO know there's a reason a coronary artery calcium scan (CACS) - a simple CT of the heart performed without injection of any contrast dyes which easily shows calcification (plaque) in the three major heart arteries, ie heart disease that can lead to heart attacks. Uh... did you catch that? CALCIFICATION. The plaques are made of calcium. That's why it is important (don't listen to me, talk to a doctor who will TALK to you and who bothers to stay up on research -- and there is tons on this) to take vitamin K2 and vitamin D which is needed to keep calcium, simply put, going to bones and not clogging arteries.. don't take my word for it, get someone who is medically literate to look at the research . One possible way excess calcium could potentially contribute to arrhythmia would be if you are not getting enough magnesium. Again, don't take what I say as truth. Read. Ask questions. Think. Consider.. don't panic. But please don't engage in "magical thinking" that calcium tablets just head to bone to keep it strong..

If you cannot get 800 mg calcium with food, it is okay to take a small amount of calcium. I am allergic to dairy and have no choice: I cannot eat that much broccoli and am also allergic to salmon. Since you drink milk @timely, you are probably fine without supplements and probably do get enough with food. Your docs don't want you to get too much calcium. Hypercalcemia is a risk:
https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523 I take D3 and K2 (I get gummies).

How bad was your fall? Did the doctors say your fractures were from trauma or from osteoporosis? Some people have DEXA scores (bone density) that aren't that bad but fracture because bone quality is poor. You will need to be on a bone medicine for sure during letrozole treatment. Hope you are healing well! Sounds painful.

Hi windyshores:

I feel that doctors are so compartmentalized now that they may not look at the bigger picture of your health, your meds or what is needed.

I fell in Jan. 2020 just before Covid of March 2020.
Walked a fairly long distance, walked into a building and fell by the door inside the building. I do not know why. Broke my elbow and shoulder blade and dealt with an orthopedic site which never talked about bone density or getting a DEXA.

I have been taking 5,000 of Vitamin D for years.
Just had an ECHO at end of March. Not taking K.

Have been taking 1,000 mg of calcium and 500 mg of calcium for 2 yr. til April 2022.
Cardiologist said to stop in April 2022 but did not say why.
Saw Medical Oncologist in Jan. 2023. She wanted me to immediately start Leterzole and take it during radiation therapy. I refused and said that I would start after. She never said to go get an immediate DEXA so they would have a guideline for when I started Leterzole. None of the oncology doctors mentioned this.

Will run all this by my new cardiologist.
Have to schedule an appointment with a doctor dealing with osteoroporosis today.

Thank you so much for all your help.
🌹🌹🌹

I was told to not consume citric fruits so check on the OJ, while on letrozole. Check out the website foodforbreastcancer.org

If there was a problem with calcium intake and treated AF, I would think it would be routine to advise patients to lower their intake of calcium, especially if supplements are used in addition to a regular diet that includes dairy. Of course, this changes from patient-to-patient, but I was not questioned about my own diet, and not told to desist from eating as much dairy when I was first treated for my own AF. Besides, you're on a calcium channel blocker which should suffice to keep the heart rate down and any hypertension controlled.

I would consult another internist about your conflicting prescriptions. If you need calcium to keep your skeleton intact, especially your hip joints, then I would be averse to limiting the utility of that prescription.