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Topic: Vitamin D and calcium supplements- new study results

Forum: Bone Health and Bone Loss —

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

Posted on: Dec 30, 2017 02:16PM - edited Dec 30, 2017 02:18PM by besa

besa wrote:

https://jamanetwork.com/journals/jama/article-abst...

Just posted this link in the research section but thought it should go here also. Note this is about bone health and NOT about breast cancer.

https://m.medicalxpress.com/news/2017-12-calcium-v...


Dx 2007, IDC, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Dec 30, 2017 02:38PM ElaineTherese wrote:

OY. I've been taking Caltrate twice a day since beginning Aromasin, but it hasn't done anything for my bone density. Before Aromasin, I was borderline osteopenic. Now, after almost three years, I have full-blown osteoporosis. Maybe, I should discontinue the Calatrate? I feel like I take enough meds.....

DX IDC June 28, 2014, 5 cm., 1 node tested positive (fine needle biopsy); 0/20 after neoadjuvant chemo + ALND; Grade 3; ER+ PR+ HER2+ Neoadjuvant chemotherapy starting 7/23/14 ACX 4, Taxol X 12, Perjeta X 4; Herceptin: one year Chemotherapy 7/23/2014 AC Targeted Therapy 9/17/2014 Perjeta (pertuzumab) Targeted Therapy 9/17/2014 Herceptin (trastuzumab) Chemotherapy 9/17/2014 Taxol (paclitaxel) Surgery 1/12/2015 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Hormonal Therapy 2/25/2015 Aromasin (exemestane), Zoladex (goserelin) Radiation Therapy 3/9/2015 Breast, Lymph nodes
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Dec 30, 2017 03:02PM pingpong1953 wrote:

Well, this is discouraging. Right now my bones are OK, but I just started taking letrozole and I'm hoping to avoid taking any of the osteoporosis meds. My mother basically died of osteoporosis (spinal fractures leading to neurogenic bladder, chronic UTI's and eventually sepsis that killed her.) I wonder if a combination of calcium, vitamin D and weight-bearing exercise would be a successful combination? So many choices we have to make.

Dx 4/12/2017, DCIS/IDC, Right, 1cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2- Surgery 5/2/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/5/2017 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Hormonal Therapy 12/8/2017 Femara (letrozole) Surgery 2/27/2018 Lymph node removal: Underarm/Axillary; Mastectomy: Right
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Dec 30, 2017 04:33PM - edited Dec 30, 2017 05:01PM by BarredOwl

These results are from a meta analysis of studies of "community dwelling adults." Is this a practice changing study? If so, what types of people does it apply to? Without access to the full-length paper, it is hard to assess the relevance (if any) of these results for women who have been diagnosed with breast cancer, let alone those who may be on an Aromatase Inhibitor, and/or who have been diagnosed with a vitamin D deficiency and/or osteopenia or osteoporosis, some of whom may be on bone support drugs.

The feature refers to patients from the Women's Health Initiative (presumably the "WHI" study) who received both calcium and Vitamin D. Some publications from the WHI study suggest that WHI was a study in healthy women (with no breast cancer diagnosis at enrollment).

In addition to possible limitations due the nature of the study group, what type(s) of Vitamin D (D2 or D3) and dose were used? What dose of calcium? What was their dietary calcium intake?

In case these findings are not applicable in the individual case, members here should not discontinue recommended vitamin D and/or calcium without first consulting with their physician and/or Medical Oncologist (if they are on an AI).

BarredOwl

Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).
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Dec 30, 2017 05:10PM Towardshealth17 wrote:

I saw this study reported in the press as well. I have been taking calcium with D and K for about 10 years and now that I will be taking a AI, I wondered if the recommendation would be different than for the general public.

Dx 10/6/2017, IDC, Right, <1cm, Stage IB, Grade 2, 0/7 nodes, ER+/PR+, HER2- (FISH) Surgery 11/16/2017 Lumpectomy: Right; Lymph node removal: Sentinel, Underarm/Axillary Radiation Therapy 1/8/2018 Whole-breast: Breast Hormonal Therapy 2/15/2018 Femara (letrozole)
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Dec 30, 2017 06:08PM - edited Dec 30, 2017 06:15PM by chronicpain

This is a poor and flawed statistical study of community dwelling people looking if reported calcium and D intake prevented development of OP, NOT a study of people with known osteoporosis, much less osteoporosis with known decline in bone density from osteopenia to osteoporosis and on AI, and absolutely does not recommend docs move to stopping calcium or D in people with OP.

The Endocrine Society still recommends full-blown osteoporosis be treated not just to target a 25-hydroxy vitamin D over 30 ( even better is 40-60) but in addition to adequate calcium from diet or supplements at 1.2-1.5 gm elemental/day in divided doses, (citrate rather than carbonate if on acid blockers) which alone is rarely adequate, also recommends use of other additional rx, such as bisphosphonate antiresorptives ( alendronate or zometa or similar) or denosumab ( trade name prolia), if no known contraindications. Prolia has additional anti-BC action in bone as a double benefit but insurance does not always cover.

Ruling out other contributing causes of seconday OP is also important (hyperparathyroidism, hyperthyrodisim, etc.), and there are other options too.

Ask your primary care for referral to a board-certified endocrinologist, they are generally the best trained for OP management, not internists, not rheumatologists, not orthopedists, and sadly also not most oncologists.

Weight-bearing exercise, no smoking, and limited alcohol, plus aggressive fall prevention, are also important lifestyle issues.


After a decade of autoimmune problems, Dx 10/2017 at age 63, IDC, Left, 9mm, Oncotype 13, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2-, 11/22/2017 Lumpectomy, Arimidex. Declined radiation.
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Dec 30, 2017 06:37PM - edited Dec 30, 2017 06:40PM by marijen

This is a complicated subject. Also needed is Vitamin K2 and magnesium to balance the calcium and get it into the bones not the tissue. There is a lot more information here:

https://community.breastcancer.org/forum/120/topic...

I was on letrozole for 27 months, started off osteopenic and still am osteopenic. But I wastaking K2, Vit D3, calcium and magnesium everyday, all along the way. Also had three reclast infusions. Two before bc dx and one after. Oh, plus walking almost everyday.



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Dec 30, 2017 08:11PM shepkitty wrote:

This is one of the last paragraphs of the article ;

The researchers noted that thousands of people in this final group were participants in the Women's Health Initiative, a long-term study sponsored by the National Heart, Lung and Blood Institute in the U.S. Earlier reports based on data gathered by the Women's Health Initiative found that calcium and vitamin D supplements were associated with a lower risk of fractures, but only for women who took hormone therapy after menopause. To get a clearer picture of the direct link (if any) between supplements and fracture risk, Zhao and his colleagues opted not to include data from women on hormone therapy.

"Keep passing open windows" Dx 2/2013 Stage IV mets to bones/spine, IDC, Left, 1cm, Grade 3, ER+/PR-, HER2-. Dx 1/23/2017 brain mets. Bone Rads, 2 Kyphoplasty, 1 Craniotomy, 3 Gamma Knife. Xeloda May 2017. DX 11/7/17 DCIS,Left, Ibrance 6/18
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Dec 30, 2017 08:44PM - edited Dec 30, 2017 08:45PM by BarredOwl

In my understanding, in the passage you quoted, they are talking about hormone therapy in healthy women used to ameliorate the symptoms of menopause, as opposed to anti-hormonal (endocrine therapy) in women with breast cancer.

Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).
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Jan 2, 2018 12:22PM marijen wrote:

Besa, here is another study saying Vitamin D might help metastacis -

https://www.cancer.gov/news-events/cancer-currents...

All I know is I had a lot of bone and muscle pain when my Vitamin D was way too low. And will continue taking 5000 IU per day per doctors’ orders


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Jan 2, 2018 12:55PM Hopeful82014 wrote:

Chronicpain - re: this statement "Prolia has additional anti-BC action in bone as a double benefit but insurance does not always cover" it is my understanding that Zometa has the same benefit. In fact, one study I've recently read made a stronger case for Zometa than Prolia in that regard but that, of course, was just one study.

I view a lot of these studies of the effects or lack thereof of Vit. D with a certain skepticism. One issue that arises time and time again with studies involving Vit. D is that the doses used are generally quite low - hardly enough to move the needle if one's trying to increase levels.

Regarding exercise, etc., I've been told and have read it in a variety of reports that not only weight bearing but also weight training exercise is necessary to increase bone density. Weight training's good for us anyway and although it can be boring is generally worth the time and effort.

Dx IDC
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Jan 2, 2018 01:24PM - edited Jan 2, 2018 01:25PM by marijen

This is interesting, Zometa and Reclast have the same zoledroni acid but different purposes.

What is Zometa?

Zometa (zoledronic acid) (sometimes called zoledronate) is a bisphosphonate medicinethat alters bone formation and breakdown in the body. This can slow bone loss and may help prevent bone fractures.

Zometa is used to treat high blood levels of calcium caused by cancer (also called hypercalcemia of malignancy). Zometa also treats multiple myeloma (a type of bone marrow cancer) or bone cancer that has spread from elsewhere in the body.

The Reclast brand of zoledronic acid is used in men and women to treat or prevent osteoporosis caused by menopause or by taking steroids. Reclast is also used to increase bone mass in men who have osteoporosis, and to treat Paget's disease of bone in men and women.

You should not use Reclast and Zometa at the same time.

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Jan 2, 2018 10:14PM chronicpain wrote:

Hopeful, my oncologist was citing this kind of study about prolia as potentially relevant for me, someone who does not yet have bone mets, but has existing osteoporosis ( I have been on an oral bisphosphonate maintenance called risedronate a few years for steroid-induced OP, after prior zometa for several years, so the idea would be to switch to an OP agent that would also benefit bone cancer mets preventively):


https://www.ncbi.nlm.nih.gov/pubmed/8677043


However, this study did not compare prolia in OP doses (60mg SQ every six months) head to head with zometa for *prevention*of bone mets in early stage BC. If you have a cite that said the opposite, i.e., that zometa in OP doses (5mg IV per year) is better for bone mets prevention than prolia in OP doses, could you link to it? I see my MO Friday and we will be making a plan of care decision. I tolerated yearly IV zometa very well when my rheumatologist was allowed to administer it in his office, and am aware low dose prolia is well tolerated too in most, but have not personally had it. Zometa is a little cheaper than prolia now and more likely to be covered by insurance.

For *treatment* of bone mets, a separate issue (though physiologically it may be similar in mechanism) recent data actually suggests prolia at the high bone met doses is better than zometa in high bone met doses at preventing bone complications such asfractures.


http://news.cancerconnect.com/denosumab-more-effective-than-zometa-at-delaying-bone-complications/



After a decade of autoimmune problems, Dx 10/2017 at age 63, IDC, Left, 9mm, Oncotype 13, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2-, 11/22/2017 Lumpectomy, Arimidex. Declined radiation.
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Jan 2, 2018 10:20PM chronicpain wrote:

Marijen, zometa and reclast are just trade names for the same generic agent, zoledronic acid, which is why if taking one you should not take the other as you would be duplicating the same drug.

The 5mg yearly dose is used frequently for osteoporosis in people who cannot tolerate or absorb oral bisphosphonates such as the now very cheap alendronate (fosamax), and they call it reclast. The 4mg dose is called zometa and used at varying frequencies (often monthly or every three months)for cancer mets and a few other less common conditions.

After a decade of autoimmune problems, Dx 10/2017 at age 63, IDC, Left, 9mm, Oncotype 13, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2-, 11/22/2017 Lumpectomy, Arimidex. Declined radiation.
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Jan 2, 2018 10:27PM chronicpain wrote:

Hopeful, I agree with your skepticism about vitamin D dosing, especially since we know many people need higher than recommended minimal daily doses of D due to poor absorption from GI conditions, obesity, interfering meds, and aging. The cited study did not look at vitamin D levels to see if they were adequate.

Also as far as calcium goes, so many people are on acid blockers for heartburn or other GI issues, which interfere with calcium absorption if in carbonate form (like in TUMS or many multivitamins) and are not on calcium citrate, which is absorbed even without acid. People also tend to overestimate their reported calcium intake, compared with actual, when measured

After a decade of autoimmune problems, Dx 10/2017 at age 63, IDC, Left, 9mm, Oncotype 13, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2-, 11/22/2017 Lumpectomy, Arimidex. Declined radiation.
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Jan 3, 2018 12:26AM marijen wrote:

Chronic pain, I figured that out but my point is Zometa claims to be for one set of issues and Reclast for another. Just an observation

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Jan 3, 2018 12:35AM marijen wrote:

Here's another viewpoint on bone density...

http://www.greenmedinfo.com/blog/osteoporosis-myth-dangers-high-bone-mineral-density


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Jan 3, 2018 01:28PM Hopeful82014 wrote:

Chronicpain, I will have to look back for that study, and will post it when found.

Your point about the utilization of calcium is a good one. I was told specifically by my MD to use calcium citrate but I suspect that's frequently the case. Those who are taking PPIs OTC may not receive any advice on the topic at all. What that means for those studies of course is that the effectiveness of the calcium consumed is a great, big unknown and I don't believe I've ever seen that addressed. Good catch!

Dx IDC

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