Letrozole and osteoporosis
hi. I have osteoporosis due to letrozole. The bone loss is severe and my doc is concidering injection instead of risedronate pills that I am taking now to fight osteoporosis more effectively. I am 5 years out. Why if I reduce the letrozole dosage from every day to every two days? Anyone did this or any of your oncologists recommended this. Thanks
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The Mods
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Hi Margun
Sorry you are dealing with osteoporosis.
I also developed osteoporosis while on AIs. My oncologist never suggested reducing or eliminating the AI, rather she suggested treatment with bisphosphonates (zoledronic acid infusion) plus calcium supplements, which is what I did. It is improving the osteoporosis numbers somewhat.
I would not reduce the AI dosage without consulting and assessing the risk for your particular situation with the oncologist first. AI is systemic treatment very effective at preventing cancer recurrence, can be even more effective than chemo depending on the patient and history. I believe the available evidence is for full dosage of the AI. I dont think the evidence of cancer prevention is there for half dosage of AI, and I dont think the evidence is there either for halving the AI dosage being effective at improving existing osteoporosis or preventing it from getting worse.
Take care,
LaughingGull
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Hi Margun,
Good advice from LaughingGull. Sometimes oncologists reduce tamoxifen doses for those with DCIS but it generally is not done for those with invasive cancer. You could ask your MO whether additional years beyond the five you have done is recommended by doing the Breast Cancer Index Test. Depending on those results you might be able to stop the AI. All the best.
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thank you LaughingGûll and Maggie for your response. LaoughingGull I see your 8 years survivor of triple positive cancer. What an inspiration! You switched to infusion because the risedronate pills did not work? I’ve been told that once started with injections, I can never stop. That I am uncomfortable with, but if I needed, then I have to do what is necessary.
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Hi Margun,
They sent me straight to infusion. I will have my second one soon. Dont remember if this is supposed to be forever or not but I will ask.
LaughingGull
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Margun - I also get Zoledronic Acid (a bisphosphonate) infusions and I have never heard anything about having to take them forever, once started. In fact, I've heard that after a few years it's good to take a break and most people do. I will be having my next infusion in November and it will be the last one for awhile, as both my onc and me think it's time for a break. It will be 2 years for me in November. My understanding is that breaks are advised after 2 or 3 years. My onc and I will re-evaluate things sometime next year and decide whether and when I might start back, but I'm expecting a good 6 months or a year off from all of this.
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hello Threetree,
Because the biphosphonate pills (residrdnate) stoped working, my doc does not think the infusion of the same family will be better. Therefore she recommends prolio. That is injection with his set of side effects and it seems this one cannot be stopped once started.
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Hi Margun, You can stop Prolia by switching to another bisphosphonate like alendronate for a while and then stopping that. You can’t stop Prolia cold turkey because a rebound reaction would make your fracture risk increase. NTx, a urine test, can help your doctor determine when it is safe to stop the second med.
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Thanks Maggie. I am not sure why my doc mentioned that it cannot be stoped without mentioning the possibility to switch and then stop. I hope you are right. I will definitely mention him this. Thanks again
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My siblings stopped Prolia this way. They (and I) have osteoporosis managed by an endocrinologist. I’m surprised by the number of people on bone density drugs who have never had NTx (N-telopeptide) urine tests to see how well the drugs they are taking are working. The Prolia injections are convenient but my sibs transitioned off for invasive dental work. My mother was on these drugs for so long she had multiple spontaneous femur fractures, something we are trying to avoid.
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hi Maggie. It is scary to know that this drug which increases bone density can create fracture . It defies its purpose.
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