Osteopenia and the use of prolia

 These are just my thoughts - that's all they are, not medical advice or medical knowledge.  First of all, I'm 69.  I think osteopenia is to be expected at this age, and it is the precursor to osteoporosis which is not a good thing, regardless of whether one has a history of cancer or not.  I was on Arimidex and developed osteoporosis and was advised by my oncologist to do my reasearch and decide which bisphosphonate I wanted to take.  I only got confused by trying to make a decision myself.  My primary care physician looked at my dexa and said "not yet".  I chose not to take a bisphosphonate (at that time) and I don't think that made my oncologist very happy.  Moving forward about a year - I have permanent hairloss from Taxotere and that makes me very unhappy and I wondered if the arimidex contributed as it can cause hairloss.   I talked with my oncologist about quitting the arimidex altogether in an attempt to see if it made any difference to my hair.  She said she didn't feel good about that, but did feel perfectly fine about switching me to Tamoxifen - which can also be "good" for your bones.  My next dexascan showed improvment and put me back into the osteopenia group.  Now 6 years after by initial diagnosis in 2010, I am off Tamoxifen, too.  I will have a dexascan at the start of the calendar year.  I don't know what I'll do if a bisphosphonate is recommended at that time.  I do exercise and do keep my vitamin D and calcium levels up.  We'll see what shows up next.  I think the bisphosphonates help build bone density and do provide some protection from bone mets.  Happily I have not had mets and I really don't expect any as my cancer was stage 1b (clear nodes) and a small tumor.   I do not want to break bones under any circumstance, and do want to keep my bones as strong as possible.  It is a dilemma.

I attended a lecture Monday night from an academic oncologist who addressed hormone therapy side effects.  It was his impression that the bone pain, osteoporosis, etc., is not from the medication, but rather how our individual bodies react to lack of estrogen, which is what the meds are designed to do.  They work really well doing that.   I guess they are a "better" drug than a SERM (of which Tamoxifen is one) for ER+ postmenopausal breast cancer, but by what percentage and what does that percentage mean to you?  Standard of care is aromotase inhibitors for post menopausal ER+ patients, not Tamoxifen.  I was surprised when my oncologist switched me from an AI to Tamoxifen, but I think her recommendation was made because I didn't want to take Arimidex anymore (I had NO side effects), not an either or scenario.  For me, the result was increased bone density.  Was it worth it?  I dunno.  I also did not have the ugly side effect of Tamoxifen of blood clots, strokes, etc. which are not a side effect of the aromotase inhibitors. I don't have to worry about developing uterine cancer as I already did that on my own, and have had a hysterectomy.   Lots ot think about.

BTW, not taking Arimidex had no effect on my hair.  Still gone - probably forever.

Good luck in making your decision.  We need to make our own decisions in concert with with our oncologists tell us.  They can't predict how for sure any individual is going to react to any treatment , but they can and will provide us with their recommendations based on experience and data releveant to our own medical history.  Get all the facts that are pertinent to you, not what worked or didn't work for someone else.

Suzanne