Arthritis and bisphosphonates

Posted on behalf of AndieT

I have been on Letrozole now for just over 3 years and following a recent dexa scan a decrease in bone density has been detected. I have been told that I do not have osteoporosis but am osteopenic which I understand may or may not lead to full blown osteoporosis. My dilemma is that the oncologist has started me on bisphosphonate tablets. This means that I can no longer take the arthritis tablets that I have taken for 13 years because the two cannot be taken together, so I must rely purely on painkillers. According to my GP there is no actual treatment for osteopenia, what the oncologist is prescribing is a treatment in case it gets worse- it may not. Painkillers only partially deal with my arthritis pain. Following a DX for IBC 4 years ago, 12 months treatment for a wound left from an infected seroma and lymphoedema I am finding this very hard to accept and wondered if anyone out there has any suggestions. Thanks Andie

What about switching to Tamoxifen which doesn’t affect bone density. I know the current thinking is if you are post-menopausal then AIs are better but you clearly have bone issues so continuing to take Letrozole won’t make them any better and more than likely will lead to full blown osteoporosis.
Might be worth speaking to your onc about this. Tamoxifen can be taken by both pre and post menopausal women.

Andie - I’m sure there are quite a few ladies on here who have similar issues to you and are on a cocktail of drugs that help. Hope they’ll be along soon to say what they’re on. Think you need to discuss with your team what your priority is regarding pain management vs risk etc. Mum has arthritis and has been on letrazole equivalent for a number of years but hasn’t had/needed anything for bone thining. I am on arimidex and bisphosphonate by IV but no arthritis. I also have a calcium tablet each day. My OH has been prescribed a bisphos tablet to counteract possible bone thining while he’s on a steroid and doc told him to have the calcium tablet daily too so it might just be a case of you having your old drugs regime, no bisphos but have a calcium tablet instead…

Just a few thoughts…
There are other non-bisphosphonate treatments for osteoporosis/osteopenia, the National Osteoporosis Society is a good place to look.
Definitely a calcium tablet - these aren’t cheap so hopefully you can get this on prescription.

My own background… dx with osteoporosis 2001, a year after hysterectomy/ovaries removal (no HRT). Prescribed alendronate tablets.
Bc/bone mets dx 2006 (yes, I’m living proof that it’s possible to get breast cancer/bone mets even when taking a bisphosphonate) - had a DEXA scan at which I was actually no longer in the osteoporosis bracket, thanks to bisphos, they are good drugs for those who can tolerate them.
Had 3 years on letrozole, also IV pamidronate and Zometa, but am now on oral chemo and ibandronic acid tablets, and prescription Calcichew at half usual dose.
I do have a touch of arthritis in neck and probably elsewhere… well, I am 62… but I don’t take/need meds so I can’t answer your q re drug interaction.
And I do eat/drink dairy (preferably low-fat versions, they are higher in calcium) and lots of calcium-rich foods.

Thanks Ladies

I am already on Calcium and Vit D tablets and have been since starting the Letrozole. Unfortunately although the Onc ordered the dexa scan he told me that there was no need for me to be followed by both the surgical team and the oncs so discharged me from the oncology side of things. I know about the osteopenia because he wrote to me and told me to deal with my GP, who is doing her best to advise me but really leaving final decisions up to me. I feel a bit lost ‘again’