Osteopenia on Bone Density

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!

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.

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.

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.

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.

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.

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.

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.

All these items are in the range of possibilities. I'm on anastroloze and have experienced some of the same issues. Drat!

@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

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 :)

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.