Zoledronic acid infusion instead of tablets for osteoporosis

I have stage one breast cancer and am now on anastrozole without chemo or radiotherapy. I have just been diagnosed with osteoporosis in a recent DEXA scan. GP wants to put me on Zolendronic acid infusion instead of tablets after knowing that I’m a breast cancer patient. I am really worried about the side effect of osteonecrosis. I read that it would happen more often in patients having infusion than tablets. Should I request tablets instead of infusion and should I discuss this with the breast department first?

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Dear mf32, Yes do discuss with your cancer team. My treatment plan included zoledronic acid infusions but I have refused them in favour of weekly tablets on the advice of my dentist. Most patients opt for the infusions as its less hassle than a weekly tablet but the choice is yours. Macmillan has a good booklet entitled Bone Health which is very informative. I wish you well. Love Tulip x

Hi @Tulip29 thanks for the information. Zolendronic acid is not included in my cancer treatment plan. It’s only for treating osteroporosis. I understand taking Anastrozole will cause bone thinning which will affect my bone density further. I want to reduce the side effect like getting osteonecrosis as I have teeth problem as well.

I had zoledronic acid IV every six months for 3 years. I was unaware tablets were an option until I read your post!
Definitely talk this through with your care team. Get all available information before you make any decisions. :pray::heart:

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Certainly a good idea to discuss with your team. I’ve had 5 infusions so far and all fine (including having to have a tooth extraction) but there are slight risks, as well as the advantage of a slight preventative effect to stop the cancer returning (hence your doctor’s suggestion).
I was slightly on the osteoporosis scale but my bone density has improved 4% since the infusions and I’ve moved back into osteopenia. I’m on anastrozole too.
Good luck with your decision.

Hello, I was on daily tablets. They are a nightmare to take - 1st thing in the morning, can’t eat for an hour after, only water for 30 minutes after and be upright for either 30 or 60 mins (can’t remember - more than likely an hour because of what comes next…)

I go swimming at 7am, it meant I had to take my tablet at 6am (as you are not upright swimming). I was waking up at 5am ready to take the tablet. Every single day! Within 2 months I was waking up at 4am!

I asked my onc consultant about changing. I was prepared to change to a weekly or monthly tablet. I really wanted the 6 monthly infusion.

She jumped in before I even finished my rationale of the daily tablet affecting my quality of life to offer the 6 monthly infusion.

I’ve just had my 5th of 6.

Yes I was concerned about the jaw side effect but… it’s so rare. I chat to an onc practitioner nurse in the week before my infusion (she checks all OK) and my dentist is all over me and saw me ahead of starting the tablets and changing to the infusions.

Talk to your team and dentist.

The minuscule risk has never bothered me.

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Hi JeanAnn, may I ask whether you need to go to the hospital to do the tooth extraction?

Hi - I had osteoporosis diagnosed some years before ILBC in 2020. Was already on denosumab injections every 6 months and latest Dexxa was normal. Onco reassured by rheumatologist that I would be fine on anastrozole as denosumab is so effective. Friends who have infusions have had side effects and continue to have fractures - it is cheaper than denosumab but medics are coming round to the fact that denosumab (originally developed for bone cancer) is a wonder drug and the savings are on not having to treat future fractures Do some research on the various options via O and ask for what is best for you. You can take Tamoxifen instead of anastrozole or letrozole to avoid osteo risk but if you already have osteo then denosumab is a magical drug! Royal Osteo Society has good info on options. Good luck

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Hello again, Just wanted to add that I also have osteopaenia (-2.5) so close to the borderline for osteoporosis. I was wary of the 6 monthly infusion in case I had a bad reaction and the dentist told me that if I had this drug as an infusion then he would have to implement a special treatment protocol every time I saw him. I felt more comfortable opting for the tablets because, if I do react badly I would have only one weeks worth of the drug in me which is easier to stop if required. My oncologist was happy for me to have Ibandronate 50mg weekly instead of Zometa. Unfortunately I couldn’t have that because I cannot swallow tablets but Alendronic Acid comes in a soluble version under the brand name Binosto. It is not recommended as a treatment for preventing recurrence but it is a suitable option for osteoporosis. Hope this helps. Love Tulip x

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Yes, I had to. At first my dentist was, yes, I’ll take it out. Then he got cold feet when he had seen my medical history of bisphosphonate infusions I was referred to the hospital and they (reasonably) wanted to save the tooth and advised me to go to a private clinic and have a root canal. I’ve never had anything like this and was terrified! Then they saw a crack in the tooth and thought it wouldn’t be successful anyway. I did have to push to get my appointment sorted but did so. My next infusion was postponed to allow the extraction. Hope you get sorted.

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Hello, I’ve been on zoledronic acid infusions since June 2020. I have been fine. I have my teeth checked every 6 months. I drink a lot of water after the infusion and try and take it a bit easy.