Forum Discussion
Osteoporosis & letrozole (Femara)
Hi there, I was diagnosed with early stage breast cancer July 2017. I have had a lumpectomy, chemotherapy & radiotherapy. I was given the all clear from breast cancer on 10th Aug 2018..... my 62nd birthday. A great present to be sure.
As ongoing treatment I take letrozole daily (2.5 mgs) as my cancer was oestrogen receptor positive. I have just had a bone density scan & been told I have osteoporosis - the doctor feels it may have been exacerbated by the Letrozole reducing my oestrogen levels. We discussed different treatments - weekly/monthly tablets, yearly injections. He also suggested my surgeon might decide to change my meds. He mentioned Tamoxifen is gentler to bones. However when I read the side effects I was a tad worried. It mentioned blood clots, uterine cancer, nausea etc. I will have a follow up with my breast surgeon to discuss but wondered if anyone had advice on this area. I've coped well on Letrozole, but maybe some of you are doing fine on Tamoxifen.
Cheers, Sue
28 Replies
- Perhaps it's something that the BCNA can add to their long list of requests to the Health Minister...
@Danielle_BCNA - Oops antiresorptive therapy are the medications used to treat osteoporosis including bisphosphonate tablets , denusomab injections etc
- @kmakm re the quote I provided.
PBS ( Pharmaceutical Benefit Scheme) provides some medications at concessional rates provided criteria are met.eg 6 monthly Prolia injections for osteoporosis cost either $38 ( PBS price) or $275 ( non PBS price) . Using this example , to qualify for the PBS price you must be diagnosed as having osteoporosis AND either be over 70 or have had an osteoporotic fracture.
The quote from the College of GPs suggests PBS criteria needs modification in the light of international guidelines regarding the treatment of patients on Aromatase Inhibitors who have developed osteoporosis.
There are no implications for you if your bone density is fine. However should your bone density become osteoporotic having a chat to your onc won’t alter the COST of bone building medication as that is governed by PBS criteria but the selection of type of medication is a matter of mutual decision.
Sorry to have confused the issue - just pleased to see guidelines from the medical profession acknowledging the impact of AIs on bones and suggesting that change needs to be made in pricing medication for treatment of those whose bone density has been damaged. - @Sister The current guidelines say four serves of dairy a day, low fat as we have the cholesterol issue on Letrozole as well.
We have to do weights, but especially load bearing exercise as well for bone density. So skipping rope, or just plain jumping, aerobics, dancing, climbing stairs, hiking.
Staying well in survivorship is time consuming... - This link may help for those that are now starting to wonder about their bone density and or osteoporosis
https://www.bcna.org.au/health-wellbeing/physical-wellbeing/bone-health/
Take care - According to my oncologist, the short answer is that unless you actually have osteoporosis (not just osteopoenic) or have had a fracture caused by osteoporosis, any preventative treatment is at your own cost. And, in my case, the possible issues with existing medication need to be taken into consideration.
- Glad it's not just me @kmakm! It's funny how you get used to language when you need to.
My bone density is good at the moment according to the baseline scan and I do want to keep it that way. Living where I do, I know that I am low on D for a large part of the year. I've always loved my dairy and suspect that I get around half of the recommended calcium per day. I will have to talk to my onc when I go back on a few weeks about this.
When I got my bone density results back, I went online to try to understand what they meant (onc had gone through them but I don't trust myself to remember everything). I had a chat to my kids about what I had read and how important it was for them to ensure that they are getting adequate calcium in their diets. The girls, at least, seem to have been listening, as they have been working out what they should be having and increasing their intake (which had been falling off). - I am newly menopausal (caused by cancer trratment) and on an AI. My DEXA was fine (onc said as expected for my age). I don't really understand the above paragraph @Romla. Sorry! Should I be having a chat with my onc about this? Is there something I could be doing that I'm not? Thank you, K
- This is the interesting bit.
International consensus guidelines6,9 recommend that anti-resorptive therapy should be initiated in AI-treated women not fulfilling the above criteria if the lowest BMD T-score is ≤–2.0 or if more than two fracture risk factors are present, and be considered where there is a >5–10% decrease in BMD in one year of AI treatment, or 10-year absolute risk of a major osteoporotic fracture of >20%, or of a hip fracture of >3%. However, this is outside current PBS of Australia subsidy criteria. - @primek These are the first guidelines to acknowledge women taking AI and osteoporosis - it’s a start.
