Endrocrinologist & bisphosphonate?

Chelee · 06-19-2007, 05:51 PM

I just had a 2nd opinion and one question I had was about my last DEXA scan results said osteopenia and it recomended I be put on a Bisphosphonate. I've asked my onc about this several times and she doesn't think its necessary. So the 2nd opinion onc said a bisphosphonate is usually given when you have Osteoporosis. I *thought* it was suppose to be started *before* it gets that bad?

When did your onc start you on a bisphosphonate and why? Did any of you start when your showed up to be osteopenic?

She also told me to see an Endrocrinologist & discuss this with him. Have any of you been referred to an Endrocrinologist for your bones?

Chelee

MDW · 06-19-2007, 08:01 PM

These two articles seem to agree with your oncs that it is not necessary to take a biophosphonate for osteopenia

Second Thoughts - washingtonpost.com

The Brittle Truth About Your Bones

Chelee · 06-19-2007, 11:40 PM

MDW, Thanks for posting those links. Very informative. I'm still curious as to why I see so many women that have been started on a biophosphonate with only osteopenia?
But I've done some more reading on this tonight and it does look like its better to wait till later to start on one. I was more concerned because my DXA scan indicated that I was at a doubling of hip fracture risk, due to a problem with my hips and the added Femara. It said I have multiple risk factors and should be given consideration for the addition of a bisphosphonate.

My 2nd opinion really wants me to see an endrocringnologist about this and another issue I am having. So I will get his professional opinion.

Thanks again MDW, I really appreciate your reply.

Chelee

Cosmo · 06-20-2007, 04:37 AM

Hi Chelee,

My oncologist just recommended that I go on Fasomax as my bone density decreased 9% in a year of chemically induced menopause and Aromasin. I currently have osteopenia. He also referred me to a endocrinologist to discuss my options. I have an appt on Friday and will let you know what I learn if you'd like.

Karen

Debra · 06-20-2007, 07:52 AM

Chelee -

I too just found out I am osteopenic. I am 42 yrs old---had a hysterectomy in December and am on Arimidex. I have been taking Fosomax for 2 months now and having no problems with it. HOWEVER, it is interesting you posted this question because I too am wondering if I really need to be on it. I would rather not take meds if I don't need them of course. I am very good at taking my vitamins, extra calcium and Vit. D as well as eating foods that contain calcium. I am thinking that is suffice.
I could have been osteopenic BEFORE all of this and maybe for many years. I am contemplating stopping the fosomax and talking with my GENERAL doctor (not oncologist) about whether or not I should be on it. I will request another DEXA in 6 months to a year and if there is no change, I am not going to worry about it. My oncologist even admitted that his focus is on my cancer only and that I should see my primary doctor for "detailed" care such as preventative issues.

tricia keegan · 06-20-2007, 01:56 PM

Chelee thanks for posting this. My last dexa scan showed some bone loss to my spine and I was given fosamax. I also take nexium for chemo related eosophagus problems and read recently the nexium may interfere with the fosamax by blocking calcium absorption! It's very confusing which one I should stop if any but will discuss with my Dr again when I see him.
Thanks again.

Barbara2 · 06-20-2007, 02:20 PM

My thyroid numbers were in the high, normal range, and I also had a report that said I was entering osteopenia due to Arimidex, so my onc sent me to an endrocrinologist. I have always wondered, though, why he didn't just give me a bisphosphonate; why was it necessary to see an endrocrinologist. I never did know the answer, but was glad to get the bisphosphonte to start slowing down what was happening in the bones.

Prior to breast cancer, my bone density tests were very good.

The endrocrinologist put me on Actonel for the osteopenia. One year later the bone density test showed improvement in density, so I am still taking it.

I think most oncs want to prevent osteoporosis, so they give the bisphosphonate early on in order to slow down the decreasing of bone density; some oncs even give a bisphosphonate when the patient starts Arimidex or an AI of some kind.

I also have read where cancer looks for weak places to set up shop and multiply, such as areas of the bone that have decreased in density.

Bev · 06-20-2007, 08:49 PM

Hi Chelee,

I also have Osteopenia. Was surprised as I exercise and am not petite and just entered chemopause.

They have just told me to take 1500 mg Ca. That could change in the future, I guess. Will see see the Onc in Aug/Sept and likely find out more. BB

Becky · 06-21-2007, 04:01 AM

My gyne gave me a DEXA scan 2 days after my oophorectomy. I was just a bit off on the spine reading but great in the hip and neck. My gyne conferred with my onc and they put me on every 6 month Zometa treatments (the IV biophosphanate). I just got the order to do another DEXA (it will be almost 2 yrs since the last one) and that one will determine if I continue every 6 months or move to once a year.

You need something if you are osteopenic (as I was becoming) so you do not get osteoporesis.

Chelee · 06-21-2007, 08:09 PM

Karen, Yes, I would like to hear what you learn from your Endocrinologist visit. Thanks, I appreciate that as it will be a while before I get into one. Will look forward to your post.

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Debra & Tricia, The more I read about this and hear from other women it seems to be no set answer. So many women that have started on them when just osteopenic...but yet other onc's say they should NOT be started yet. I can find lots of info to support both ways when I google this topic. So I can't wait to see the Endocrinologist and get his opinion. If he says no to me...that will be THREE no's. I have other bone issue's so I really thought they would want me on something now verse's later. Or at least do what Becky's GYN & Onc both agreed on...which was to give her Zometa twice a year at least. I think that is a great way to handle this.
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Becky, That is exactly what I thought. But since I don't have a good relationship with my current onc...I went up to the City of Hope & got an onc opinion there on my last DEXA scan & its recommendations that I start on a bone strengthener. The onc at City of Hope said its not needed now but to see an Endocrinologist. There is SO MUCH information to digest on this subject. Can't wait to see what an Endo says.

Thanks to all for your input.

Chelee

Cosmo · 06-23-2007, 07:37 AM

Hi Chelee,

I met with the endocrinologist yesterday. He's running some blood tests and urine tests so I don't really have any answers yet. Apparently my bone density was pretty low before I started chemically inducing menopause and taking the Aromasin, which i wasn't aware of. Because of this, he is concerned that there is another cause for the osteopenia and is running some tests. It seemed pretty likely that I will be going on Fasomax though. I'll let you know when I find out more.

Karen

Chelee · 06-23-2007, 12:41 PM

Karen, I *just* recieved my authorization in the mail today to see an endo. I hope they get me in asap! I need answers about my bone issues and another problem with my FSH. Since I've had a ooph my FSH has DROPPED to peri-meno range. My onc blew it off but my 2nd opinion onc at the City of Hope said there IS a problem. She even said she did NOT want to scare me but asked if I had a recent brain MRI? She said that is NOT right & she spoke to 3 doctors up there and they want a whole battery of test run on me. So until they figure out whats wrong I am NOT on any AI's. So I need to get in soon.

It sounds like a sure bet you will be started on something if your bone density was already low before chemo. Its a good thing you went to see this doctor. So now you have to wait for all the test results to come back...that sounds like what I will be doing. I wonder what other things can cause bone density to be bad? When you get any answers I would still be interested.

Thanks so much.

Chelee

Andrea Barnett Budin · 06-26-2007, 01:29 PM

Hi Karen and all! Let me share my experience. (My med tale is in my signature below.) After Taxotere I took a bone density test and was diagnosed w/osteopenia. I was alarmed. But for a little met bc I was in good shape, though somewhat blown away by the side effects of that chemo.

My GYN consulted w/a rhumatoidologist/friend and said he suggested I be put on a PROPHYLACTIC dosage of Fosamax (1999) -- a HALF dosage, back in the day when we took it every day vs once a wk or is it now once a mnth? Any way, I followed the recommendation. Not a big deal. 5 yrs later I was taken off Fosamax (half dosage). Why? Because there's no reason to stay on it. Every thing is great!

I had thought that I was hoping for "retarding" further deterioration. I had no idea the condition could improve! I just had a bone density test (now 4 yrs later) and I am told YOUR BONES ARE BEAUTIFUL! Osteopenia still gone.

I would not do nothing w/osteopenia, which can surely and especially worsen w/chemo! This is too important an issue to be ignored.

I wish you luck, Karen. Please tell us the rest of your story. Even in the midst of a harrowing ordeal such as we face (as Survivors or not, we are all still WARRIORS). ANDI