Posts Tagged ‘Breast Cancer’
Recently a patient asked me to review all osteoporosis medications for her to consider and choose from. We had already optimized her Calcium intake, 25-hydroxy Vitamin D level, Protein intake, Multiple Vitamins & Minerals, and Exercise program. These had all helped substantially, but not enough for her peace of mind. She feels that she needs osteoporosis medication too. Here they are:
The American Society of Clinical Oncology received bad news about Breast Cancer Patients this week. A study of women with breast cancer, being treated with Aromatase Inhibitors (AI), was presented at the 2014 Breast Cancer Symposium. AI is a great treatment for breast cancer, however…
AI is known to decrease bone strength and to increase Fracture Risk. How many of these patients were evaluated for their bone health? Only 54%. How many got a repeat evaluation to check to be sure that their bone health was not deteriorating? Only 46%.
Of those tested, 43% had a DXA T-score in the “osteopenia” range. In this situation, FRAX is needed to calculate Fracture Risk. 41% of this group met guidelines for treatment with medication to prevent bone loss and Fractures. Of those who should have been treated, only 23% were.
Aromatase Inhibitors (AI) do a great job treating Breast Cancers which are Estrogen dependent. The AI wipe out all Estrogen thereby depriving the breast cancer of a needed stimulus.
Unfortunately, Aromatase Inhibitor treatment will also do considerable damage to your bones unless you take medication to protect your bones. The good news is that we have medication which can completely offset the harm AI treatment could do to your bones. But, you have to take it, and the sooner you start, the better.
Prolia (Denosumab for Osteoporosis) is specifically approved by the FDA for use in patients using Aromatase Inhibitors (AI) for their breast cancer. Prolia is specifically for women without metastases. Prolia can delay and/or prevent matastases when given early. Xgeva (Denosumab for Cancer) is used if metastases are already present.
Denosumab (Prolia) mimics the natural process that keeps OsteoClasts (the cells that gobble up bone) under control before menopause. OsteoCytes release Osteoprotegrin (OPG) when Estrogen (or Testosterone) is on board. OPG controls the formation and activation of OsteoClasts by blocking RANK-Ligand, which is necessary for OsteoClast formation and activation. This decreases fracture risk.
Prolia mimics OPG and blocks RANK-Ligand, thus blocking bone resorption by preventing OsteoClasts. It is a RANK-Ligand Antibody. It is like birth control for OsteoClasts. Prolia is given as a shot under the skin twice a year. Prolia is very effective at first, but begins to fade by 6 months. Without another injection , Prolia has totally lost effectiveness by 12 months after the last shot.