Osteopenia on Bone Density
I just started taking Femara (Letrozole) about 10 days ago and I just got the results from my DEXA bone scan. It came back as osteopenia. The radiology report recommended screening in 1 year if risk factors are present or medical treatments that cause bone loss. I am 53 and the scores weren't too low all over. - 1.2 in my lower spine, and between -0.5 to - 0.8 in other places scanned. Can anyone share what changes to medications or treatment plans occurred with osteopenia, if any?
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Hi Concernedaboutresults,
You should certainly talk to your oncologist about this but there’s no urgency.
My case was somewhat similar to yours but I was stage 3 which warranted more aggressive treatments. I was diagnosed at 54 and like you had light osteopenia before starting Anastrozole. After two years on Anastrozole, a second DEXA showed increased osteopenia. My MO put me on Prolia for four years. Prolia did wonders, my bone density after Prolia was better than before breast cancer diagnosis. I remained on Anastrozole due to high risk of recurrence. Two years later bone density got worse. My next DEXA will be next year, which will coincide with m being on Anastrozole for 10 years. My doctor’s plan is to switch me to Evista that is said to improve bone density while providing some preventative breast cancer benefits.
Since you probably won’t have to be on AI for very long, you are unlikely to see significant bone loss. Regular exercise, including weight lifting is encouraged. If for some reason your bone density worsens more than acceptable there are several drugs to help and some even provide an additional benefit of reduced risk of bone mets.
Good luck with your treatments!
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I had osteoporosis on my first DEXA scan at age 57. I have been receiving Prolia (denosumab) injections. Since there is thought it also can guard against bone metastases I felt confident it was a good choice for me. Bisphophonates are also protective against mets and restore bone density. What I found interesting about osteoporosis is that the numbers are compared to a normal 25 year old, so not scaled to normal for our age.
At a minimum, I think asking your doctor about calcium and vitamin D supplements is smart. I take 1200 mg of calcium and 2500 IU of vitamin D daily.
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I have been in an osteoporosis familial clinical study for the past 40 years. The original doctor recommended getting the 1200 mg of calcium through diet since it is absorbed better that way. I eat Greek yogurt 3 times a day, drink almond milk and calcium fortified OJ, and snack on almonds and cheese. I take 4000 IU vitamin D and 500 mg magnesium daily. My doctor checks my blood levels of these to keep them within normal range; calcium blood tests tell you nothing about osteoporosis but she runs n-telopeptide urine tests if I am taking bone strengthening meds to check that they are working. I also make sure to do at least 30 min of weight bearing exercise daily. I cycle on and off meds (mostly alendronate since it is the easiest to clear from your system for invasive dental work) depending on whether the DEXA shows osteoporosis or osteopenia. While my four siblings all have hip replacements and other fractures I have fortunately avoided them.
Since the letrozole can leach calcium from your bones a yearly DEXA might be a good idea. I started with an endocrinologist long before I was diagnosed with bc so she continues to monitor my bone health. I hope that by being proactive you can stay in the osteopenia zone.
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Thanks for sharing your experiences. I am pretty sure I won't hear anything until my next appointment. I have already been advised to start citrical with calcium and d3. So I started that just a day or two after starting letrozole. Oh, and is anyone doing light therapy?
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Red light and near infrared light are good for the bones. My husband smashed his elbow and after a complicated surgery which replaced it with lots of plates, screws and a metal joint he used red/infrared light therapy wraps since nothing was helping his severe lymphedema. His surgeon didn't know if it would work but told him to try since it seemed safe and things were looking pretty desperate. It cleared the lymphedema and helped his arm heal so well the surgeon suggested that his fellow look into this for a research topic.
I imagine you would use an infrared sauna for your whole body. I'd love to try it but the only one near me is at a gym, one of the many places my pulmonologist has banned me from.
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Maggie - My son started working for a gym and mentioned the red lights they offer there. He is using them to promote his weight training program. I am so afraid that bone loss will cause my 4-level spinal fusion in my neck (cervical) area to fail while on the letrozole. I have been so careful since my second surgery in 2016 with how I use my neck. I always thought it would be the discs below and above that would give out. I never thought I would be sitting here thinking about the bones in the fusion itself. I'm going to look into them.
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Concernedaboutresults, You might want to check with the ortho who did your spinal fusion first. Our out-of-the-box ideas were based on veterinary treatments for horses. The ortho nixed ultrasound therapy because the vibrations heat metal and could burn tissue. The red/infrared lights work by activating mitochondria and while they penetrate several cm they don’t generate much heat. The fellow had seen infrared being used on brain injuries when he did his neuro rotation as a resident so that made everyone a bit more confident about its safety in humans.
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I would also check with your oncologist on additional calcium and vitamin D dosage. I have not taken any calcium while on Anastrozole. I have a history of kidney stones and my MO was concerned additional calcium could do more harm than good. Good diet turned out to be enough. Your doctor will advise and monitor. You don’t need anything urgently If you started letrozole just recently
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I had 4 level cervical fusion back in mid/ late 90s. Have been on all AIs over the past 10 years. Absolutely NO problem with the fused bones. I do take D3 daily.
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I don't know if Citracal has it and I think Maggie takes it but MAGNESIUM is an important supplement for bone health. My gynecologist told me when I had hysterectomy 40 yrs ago. My PCP says skip the calcium and take in food. As you hardly absorb any from supplements. I drink 3+ glasses of milk a day and there's a bit in multivitamin. There's My calcium. Magnesium 300 mg daily. Vitamin D of course is important too. I'm in the sun lots but mine was tested and found too low. So 5000 units daily of D3. Apparently it also lowers breast cancer risk like melatonin. Who knew.
I'm wondering if the vibrating platform really helps with bone density. I heard the astronauts use it.
Gailmary
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yea, I don't know. I'm taking a multivitamin supplement, a bunch of c, some elderberry, and the critical with calcium and d. I can't drink much in the way of milk and limited on dairy in general because I had my gall bladder out and since developed bile dumping syndrome. Which come to think of it, makes me wonder if any of these vitamins absorb that well or if they just get dumped right back out. It seems getting extra d through sun exposure is a good option. My basic metabolic panel showed all within the normal range which is good too. The only thing off in my labs was total protein right at the cutoff for being high.
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needs to be D3, your body doesn’t make it from sunlight. Not usually in a multivitamin either.
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Spookiesmom - Thanks! I looked at my citrical again and it's only D. But my multivitamin has 2000 IU or 250% of the recommended daily allowance of d3. I am pretty sure the human body makes D3 from sunlight. See references article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC38975...
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I stand corrected. I always heard the body couldn’t.
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So I met with my MO this week and he wants to start me on Prolia injections once every 6 months until I move back into the normal range. What have been your experiences with this drug? I went back through and reviewed previous posts and couple of you already shared some positive results with Prolia and that is promising.Thanks in advance!
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I am preparing to start Anastrozole at the beginning of April and my medical oncologist has now suggested - due to osteopenia in my DEXA scan - that I start on Zometa (4mg via IV every 6 months for 3 years). I'm already taking Calcium (1200mg) and D3 (50mcg) daily and I'm worried about taking all these vitamin supplements - I also take Iron (85mg) and B-12 (2500mg). I'm vegetarian, but I also have high cholesterol (I take Atorvastatin and Ezetimibe and I limit my dairy intake) -- I just feel like I'm on a slippery slope to taking sooo many medications, which I don't like.
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I found it was important to have your Vit D3 level checked. When diagnosed mine was low at 33. My sister is on Zometa and hasn't had any side effects and she was diagnosed with osteopenia. Her cholesterol did go up on anastrozole and she takes lipitor. I am on Tamoxifen because I have osteoporosis and it has helped my cholesterol level. My doctor wanted me to switch for the last 2-years, but I didn't want to take a chance on my bones. I didn't want to take a bone building medication. All you can do is try.
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D3 is soooooo important. When I was tested years ago I was 17, and that's living in Florida. I'm now around 80. I fell 3 times last summer nothing broke, and the D3 had to help.
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17 to 80 that is awesome. I haven't been in the sun or outside much since having knee issues and then surgery. Not to mention Covid. I usually get it checked every 2-years as per medicare . This year it was in the 40's! Hope to get it back up.
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I decided not to take the Prolia and see how I do taking supplements. I hope it turns out okay.
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I recently had my Dexascan and while the results are still within normal limits, I am alarmed that I lost 9% of bone density in the two years since I started anastrozole. Have any of you experienced a similar amount of bone loss?
In addition my cholesterol shot up from last years test. I’m quite worried that I’m trading reduced BC recurrence risk for cardiac and bone issues. Since I was stage 1, grade1 and I’m in my mid 60’s I stopped the AI for now.0 -
My cholesterole, triglicerides, blood sugar, blood pressure all increased after taking an AI. Also my bone density decreased. Is this a coincidence or is the result of the meds. We will see when I get to finish in 2 years.
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All these items are in the range of possibilities. I'm on anastroloze and have experienced some of the same issues. Drat!
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Hi Spookiesmom - good to see you! I have had the same issue. Low Vit D when I was diagnosed, I think it was 10! I have lost 2.8% as of my last bone scan a couple days ago. It's mainly in my lower spine and my MO wants me to do more bone building exercises for my back. I'll be on AI's for 10 years next year, but she still wants me to continue. I had lymph node involvement.
I fell yesterday because of the shoes I was wearing. One of the heels slipped sideways and I came down on nothing so my ankle buckled. No broken bones, just bruised and a good cut on my knee.
I'm currently taking 5,000 IU of Vit D, and 1,200 of Calcium with Vit D daily. PLUS I am getting the prolia shot every six months for the past 2 years.
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@harley07 I lost 10% of my spine after six months of AIs. I did fosamax for 2 and a half years and it did help but then I developed a stress fracture in my femur. I started walking with light hiking poles and my spine has improved even without the bone meds. I also try to eat four prunes a day as I read somewhere they help in addition to 2000 mg D3 and 1200 mg calcium mostly through my diet.
Best of luck
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@bennybear - thanks for the info. Scary stuff that you lost 10% in 6 months. For now (and likely permanently) I have stopped taking anastrozole. I’ve been off it 2 months. Given that my cholesterol spiked and my bone density decreased I cannot justify taking the med with my early stage diagnosis. I feel like I’m trading one problem for two other issues. I am and have been taking Vitamin D3. The MO suggested taking calcium however, PCP is concerned about heart disease due to my LDL levels (although my heart calcium score is zero) so I’m not sure if taking calcium could contribute to heart disease and neither the MO nor the PCP has answered that question.
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I was told to have no more than 1000mg calcium/day and since I eat cheese and other dairy, it ends up to 150/day as a supplement. I also learned that you can overdose on supplements which can create many other issues. Like, fish oil, turmeric, ginger all create bruises. Vitamin B complex, I was getting headaches, and too much calcium damage the arteries. Echanicia interferes with letrozole. And so on.
Less is more :)
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I did ovulation suppression (Zoladex) and AI (Aromasin) for 8 years. Two years after I began, a dexascan revealed that I had full-blown osteoporosis and that I was at high risk of fracture. Once I started Prolia, my bone density improved to osteopenia, and I'm hoping that now that I've stopped OS + AI, my bones will go back to normal. Looking forward to my dexascan in September!
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I was told to split up the calcium into about 300 mg per meal, best from food. I had been taking it mostly at once and your body can’t absorb it.
@ harley07 I think calcium from food is better. I seem to recall you can have high blood calcium if your body leaches it from your bones if you aren’t getting an adequate supply. Too much can also cause kidney stones. Always a balancing act.
The predict score can give you an idea of how much benefit the AIs are. At that time for me it was only a 1% benefit so it was a no brainer to stop,
This time they’re suggesting tamoxifen as I can’t take the AIs, but I am weighing the 2% benefit with all the risks.
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@bennybear - I did run the Predict calculator and it shows a <1% benefit to taking the AI. I don’t know if that changes with my genetic mutation but at this point I’ve stopped the AI. I’ll make a better effort to consume calcium in my diet. Best of luck making your decision with Tamoxifin.
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