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Topic: Back pain. Had a DEXA scan and a lumbar spine x-ray. Now what?

Forum: Pain —

Share important questions and provide support to others experiencing breast cancer and treatment-related pain.

Posted on: Jul 31, 2019 03:31PM - edited Jul 31, 2019 04:00PM by LillyDuff

LillyDuff wrote:

(Posted this in the "Bone Health" thread as well.)

I have been taking Anastrozole for nine months now. No real issues other than thinning hair and not sure if this new back pain is even related to that, however started experiencing ongoing back pain out of the blue at the nine month mark. Nothing seems to help other than Tylenol which takes the edge off. I tried resting, which can't find a comfortable position, ice, heat, everything. I can't take Ibuprofen products due to a scarred esophagus and history of gastritis. I exercise regularly, not overweight, and did not injure my back as far as I know.

My PCP office who ordered the tests is referring me to an orthopedic physician. The DEXA scan findings revealed osteopenia. Not sure what to expect long term. I would like to get relief but wondering if this is related to Anastrozole or just "getting old." (I'm 51 years old).

Overall goal besides pain relief is preservation of bone health as much as possible since I plan to be on an AI for ten years, at least that's the plan. I read that bisphosphonates are contraindicated for those who have a history of gastritis and scarred esophagus, which is my case, so I can't take that type of medication. Would my insurance then pay for Prolia shots due to my history of gastritis and esophageal scarring? So many questions. Of course, what scares me the most is "what if" the back pain is a recurrence and we just don't know that yet.

I don't know what "The T12 ribs are hypoplastic." means in the report and worried about recurrence.

Thanks in advance for any input!

************************************************************************************

My DEXA scan results recently were:

EXAM: DXA AXIAL INDICATION: Postmenopausal. Risk factors for osteoporosis include no additional risk factors reported. COMPARISON: No prior comparison.

FINDINGS: Spine: Total BMD of the spine L1/4 is 1.046 g/cm2, with a T-score of -1.1 and a Z-score of -0.1. Left Femoral Neck: BMD is 0.900 g/cm2, with a T-score of -1.0 and a Z-score of 0.2. Left Total Hip: BMD is 0.978 g/cm2, with a T-score of -0.2 and a Z-score of 0.6. Right Femoral Neck: BMD is 0.881 g/cm2, with a T-score of -1.1 and a Z-score of 0.0.

Right Total Hip: BMD is 0.983 g/cm2, with a T-score of -0.2 and a Z-score of 0.7. FRAX evaluation calculates 10-year probability of fracture:

Major Osteoporotic: 4.4% Hip: 0.3% IMPRESSION: Based on BMD, diagnosis is consistent with osteopenia.

FOLLOWUP: 1 year. WHO CRITERIA FOR T-SCORES: < or = -2.5 = osteoporosis < -1.0 and -2.5 = osteopenia > or = -1.0 = normal density.

***************************************************************************************************

Lumbar spine x-ray results were:

Document info Result type: XR Spine Lumbosacral Minimum 4 Views

XR Spine Lumbosacral Minimum 4 Views

Report EXAM: LUMBAR SPINE INDICATION: Backache, unspecified

COMPARISON: CT abdomen/pelvis 6/2/2015

VIEWS: 4 FINDINGS: BONE DENSITY: Normal mineralization.

VERTEBRAL BODIES: The T12 ribs are hypoplastic. No fracture, endplate demineralization or lytic/blastic lesion. Small endplate osteophytes are present at L1-2.

DISK SPACES: The L1-2 disk space is narrowed.

ALIGNMENT: Mild dextroconvex curvature of the lumbar spine with apex at L2.

JOINT SPACES: Mild L5-S1 facet arthropathy.

IMPRESSION: 1. Lumbar spondylosis most evident at the L1-2 level. 2. Mild lumbar dextroscoliosis with apex at L2.


Dx 4/25/2017, IDC, Left, 2cm, Stage IIB, Grade 3, 0/4 nodes, ER+/PR-, HER2+ (FISH) Chemotherapy 5/15/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 5/16/2017 Perjeta (pertuzumab) Targeted Therapy 5/16/2017 Herceptin (trastuzumab) Surgery 11/14/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 1/25/2018 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/18/2018 Prophylactic ovary removal Hormonal Therapy 9/30/2018 Arimidex (anastrozole) Surgery 11/16/2018 Reconstruction (right): Fat grafting Surgery Hormonal Therapy Arimidex (anastrozole)
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Aug 3, 2019 07:47AM edwards750 wrote:

Back pain for BC patients is scary. We are all afraid of a recurrence but your doctor says it’s osteopenia which is no walk in the park but still a much less severe DX.

I have osteoporosis. It can be brutal at times. My MO prescribed Arimidex my first year post surgery and that was a mistake. Arimidex attacks the bones. She switched me to Tamoxifen after one year but the damage was already done.

Definitely monitor your back pain though and if you don’t get done kind of relief talk to your doctor.

Good luck!

Diane

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Aug 4, 2019 09:38PM jessie123 wrote:

Lillyduff --- I've also developed new back pain, but I think it's muscle strain from laying on so many hard tables through treatment. Also I have shoulder and upper back tension -- probably from looking down at my computer for months researching BC. Anyway, today a friend of mine told me the ten's units work wonders on pain and tension. She recommended the amazon's choice one so I ordered it today. It's less than $30.00. I had osteoporosis in my hip when I was younger from large doses of Lupron --- it never hurt. Osteoporosis is not supposed to hurt. It's just bone thinning. I guess in severe cases if there is a fracture it would hurt, but the bone thinning alone is not supposed to hurt.

Dx 11/2018, LCIS/ILC, Left, 2cm, Stage IB, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 2/21/2019 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/15/2019 Whole-breast: Breast
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Aug 6, 2019 10:01PM LillyDuff wrote:

edwards750

Thank you for your reply. I have an appointment with the Ortho. physician soon and will find out more. I would like to push for an MRI for more information and go from there. My back pain continues but this could be from SE and/or just getting older.

Dx 4/25/2017, IDC, Left, 2cm, Stage IIB, Grade 3, 0/4 nodes, ER+/PR-, HER2+ (FISH) Chemotherapy 5/15/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 5/16/2017 Perjeta (pertuzumab) Targeted Therapy 5/16/2017 Herceptin (trastuzumab) Surgery 11/14/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 1/25/2018 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/18/2018 Prophylactic ovary removal Hormonal Therapy 9/30/2018 Arimidex (anastrozole) Surgery 11/16/2018 Reconstruction (right): Fat grafting Surgery Hormonal Therapy Arimidex (anastrozole)
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Aug 6, 2019 10:03PM - edited Nov 13, 2019 01:22PM by LillyDuff

jessie123:

I will get to the bottom of the pain. I have an appointment soon with the ortho. physician and will push for more answers. I would like to get an MRI to have a better scan to see the root of the pain, if that's possible, and go from there. To be continued, I guess.

Thanks for your reply.

*** Update: I did get an MRI and it showed a slipped vertebral body and associated bone spurs. The doctor told me basically I have arthritis now in my spine from wear and age. Nothing can be done but exercise and PT unless I want to get on medication for arthritis. Thinking about the PT for next year may help.

Dx 4/25/2017, IDC, Left, 2cm, Stage IIB, Grade 3, 0/4 nodes, ER+/PR-, HER2+ (FISH) Chemotherapy 5/15/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 5/16/2017 Perjeta (pertuzumab) Targeted Therapy 5/16/2017 Herceptin (trastuzumab) Surgery 11/14/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 1/25/2018 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/18/2018 Prophylactic ovary removal Hormonal Therapy 9/30/2018 Arimidex (anastrozole) Surgery 11/16/2018 Reconstruction (right): Fat grafting Surgery Hormonal Therapy Arimidex (anastrozole)

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