Exmestane -bone density the risks?

Hi ladies,

I have pasted part of an article I found this week.

"The drug exemestane, which is used to treat breast cancer and is also in trials to prevent the disease developing in postmenopausal women, significantly worsens age-related bone loss, according to a study from Canada.

The findings, published in The Lancet Oncology, suggest that the cancer-protective effects of the drug need to be weighed against the risk of bone fracture, and that any women prescribed the drug to prevent breast cancer in the future will need to be carefully monitored for bone effects".

I wondered if any other ladies had seen this article that was published on the 7th this week? I came by it when I was looking for something else.

It depressed me a bit, as I am on Exmestane, and have been for about 3 years. I only saw the oncologist on the 2nd Feb. and I was told nothing about this then, in fact I have never really been told anything about the risks in relation to bone density, although I was sent for a scan, and I have got to go for another one next week.

I feel a bit like “I’m devilled if I do and devillied if I don’t”, like so many cancer experiences and treatments you find yourself between a rock and a hard place.

I don’t know whether to go and discuss it with my GP, or just ignore what I have read and continue as I am. A broken bone or cancer? No contest really is there?"

I wonder what any body else thinks?

What are your experiences and thoughts?

Sarah

Hi Sarah,

As I understand it, all the aromatase inhibitors can cause loss of bone density, which is why we are supposed to have a bone density scan soon after starting. My scan showed very mild osteopenia so a month after starting exemestane I also started a bisphosphonate. I’ve been told that as the osteopenia is only very mild, there is a good chance that as well as preventing further loss the bisphosphonate may even get me back into normal bone density. I’ll have another scan in just over a year.

I switched to exemestane from tamoxifen because of endometrial lining thickening, so I’m keen to stay on exemestane and I feel better all round on it than I did on tamoxifen. Personally, I’m not worried about the bone loss because in my case it is being addressed and monitored. I do make sure that I get a fair amount of weight bearing exercise and am certainly more conscious about ensuring this than I was before. I assume that your initial scan must have shown good bone density so hopefully if you have had any loss it won’t be a problem.

Good luck for your next scan!

Eliza

Hi Sarah

I thought you might be interested to read our factsheet on the subject of Exemestane, there’s lots of information in there about the treatment and side effects.

Here’s the link:

www2.breastcancercare.org.uk/sites/default/files/bcc46_exemestane_aromasin_factsheet.pdf

I hope you find this helpful.

Best wishes

Louise
Facilitator

Hi,
I am wondering why I have not been given bisphosphonates as I too have osteopenia and am on Femara. I had a scan 2 years ago which showed osteopenia, then I had another scan recently when I started on the Femara. The doc said I did not need treatment as there were no changes between the scans. Is this correct, does anyone know?
Have had osteoporosis in the past and am at higher risk as I am Coeliac as well.
Thanks,
Kathy

Hi Kathy,

I think there may be some debate about using bisphosphonates for those with osteopenia as my oncologist suggested that I should discuss with my GP whether I should take one (but did say that I should start calcium and vitamin D supplementation). When I saw my GP, she was of the opinion that I should take the bisphosphonate but I don’t think that is necessarily a universal position. Perhaps your team are not so pro-bisphosphonate, especially as the scan showed no deterioration. Were you told when you should have another scan? The results of the next scan might be the deciding factor …

The factsheets etc available on bone health don’t seem to be particularly helpful on this issue, so that may indicate that there isn’t consensus on how to deal with it.

Eliza xx

Hi Ladies

I had my bone density scan and I had to wait 3 weeks for the results. There has been a change in my bone density! So the gp has prescibed calcium. I haven’t had a specific diagnosis from my gp, but I was told signs of osteoporosis were there. So this is after 3 years of exmestane. Has any one else had a deterioration after their bone scan and 3 years of being on the drug? ):