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Topic: Dexascans--how often; Fosamax---when

Forum: Bone Health and Bone Loss —

Talk with others about bone density, osteopenia and osteoporosis, and ways to keep your bones strong

Posted on: Jun 5, 2015 09:55PM - edited Jun 6, 2015 12:02AM by SallyS70

SallyS70 wrote:

At the time that I was diagnosed with bc in 2013 at the age of 70, my dexascan showed osteopenia.  My PCP put me on Fosamax.  I had had several dexascans at two year intervals ordered by my previous PCPs.  I am on Synthroid as well as Arimidex;  both drugs can cause bone loss.

Today, I met my new PCP (other PCPs left the Medicare Advantage plan I am on).  She suggested that I should have 3 (maybe more) years between scans and said that bone strengthening drugs were usually not started until osteoporosis developed.  However, she did not take me off the Fosamax.  I pushed to keep my two year dexascan schedule.  Now that I am home I am wondering if dexascan and Fosamax protocols have changed.  Maybe I should wait 3 years or more for another dexascan and ask more questions about Fosamax for osteopenia.

What are your doctors saying about dexascans and bone strengthening drugs in 2015? 

Dx 10/28/2013, DCIS Dx 10/28/2013, IDC, Stage IA, 0/1 nodes, ER+/PR-, HER2- Surgery 11/13/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 12/3/2013 Arimidex (anastrozole) Radiation Therapy 1/6/2014
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Jun 6, 2015 01:56AM micronancy wrote:

I was also diagnosed in 2013, but at the age of 67. My oncologist wanted a bone scan before putting me on hormonals and I already had osteoporosis. I get DEXA scans every other year. Fosamax took my femoral head reading from -3.1 to -1.7 in two years. I'm still not on the homonals though. Maybe after the next scan. As far as I know, the protocol hasn't changed, at least according to my oncologist.

66 at diagnosis Oncotype 13 Dx 1/2013, IDC, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 2/3/2013 Lumpectomy: Left; Lymph node removal: Left, Sentinel
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Jun 6, 2015 09:04AM SallyS70 wrote:

micronancy, it's good to hear that Fosamax is working well for you. Thanks for responding

Dx 10/28/2013, DCIS Dx 10/28/2013, IDC, Stage IA, 0/1 nodes, ER+/PR-, HER2- Surgery 11/13/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 12/3/2013 Arimidex (anastrozole) Radiation Therapy 1/6/2014
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Jun 7, 2015 04:21PM Momine wrote:

My doc is holding off on the bone drugs for now, although I am right on the border to osteoporosis. He says I will probably have to take something eventually, and that when I do, he would prefer prolia. For now, he figures that I am otherwise fit and healthy, so my fracture risk is low

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Jun 8, 2015 07:20PM SallyS70 wrote:

Momine, thanks for responding to my questions.  I plan to discuss the Fosamax again with my new PCP at a future appointment.  Her surprise that it had been prescribed by my last PCP caught me off guard.  I was sorry that my previous PCP left the Advantage Plan, but I like this new doctor.  I am fortunate to have had and have doctors who are willing to answer questions.  I just need to formulate what questions I want to ask.   

Dx 10/28/2013, DCIS Dx 10/28/2013, IDC, Stage IA, 0/1 nodes, ER+/PR-, HER2- Surgery 11/13/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 12/3/2013 Arimidex (anastrozole) Radiation Therapy 1/6/2014
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Jun 8, 2015 08:58PM BrooksideVT wrote:

Every other year is standard for DEXA scans, and is what Medicare pays for. I would definitely not want to extend that period for anyone on a drug that affects bone density, or anyone already osteopenic. You are both, and, like me, are on not one, but two such drugs. Ixnay on the three years. I'm only osteopenic but am on a bisphosphonate because my single pre-arimidex drug created a definite downward slide in my bone density. To tell the truth, I'd worry that a doc who suggested a lesser schedule might be under pressure to keep costs down.

Dx 11/21/2012, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/7/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 2/21/2013 Breast Hormonal Therapy 4/1/2013 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 7/4/2014 Aromasin (exemestane) Hormonal Therapy 11/21/2014 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 9/28/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 9, 2015 12:15PM Momine wrote:

Brookside, I agree. I get dexas yearly, at least on the spine, which is where I have a problem.

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Jun 9, 2015 09:51PM peggy_j wrote:

My understanding is that the recommended interval in every two years. Like someone else said, I'm surprised the new PCP suggested waiting longer, since you're taking two drugs that can contribute to bone loss.

Have you considered talking to a bone specialist? Endocrinologists usually know more about bones than PCPs. Many treat a range of health concerns, like diabetes, and if you ask around, you might find someone who specializes about bone health. I've had consultations with the former head of the UCSF osteoporosis clinic. (FWIW, he recommends DEXA every two years).

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jun 10, 2015 09:29PM SallyS70 wrote:

Brookside, Momine, and peggy_j, thanks for responding since the last time I checked.  I think I will stick to the schedule, dexa every two years and weekly Fosamax, that my last PCP set up for me.  Fortunately, my new PCP is willing to go along with the plan.  I do plan to ask the new PCP about research on which she based her suggestions for change.  This new doctor seems very caring and willing to discuss issues.  She seems new and is taking over for an experienced doctor who was revered by patients.  I'll bet she is getting a lot of questions. 

peggy_j, I have been thinking about going to an endocrinologist for a consultation as I have not been to one since my thyroid was stabilized 19 years ago.  That wonderful endocrinologist turned me back to my PCP after he was sure that my thyroid was on track.

Dx 10/28/2013, DCIS Dx 10/28/2013, IDC, Stage IA, 0/1 nodes, ER+/PR-, HER2- Surgery 11/13/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 12/3/2013 Arimidex (anastrozole) Radiation Therapy 1/6/2014

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