Posts Tagged ‘Fracture Risk’
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.
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.
Breast cancer is the most common cancer in women. Some women have a family history of breast cancer. They are at especially increased risk. Unfortunately, most women who develop breast cancer do not have a family history. Therefore, all women must be considered to be at risk for breast cancer.
Some breast cancers are stimulated by estrogen. Women with a family history of breast cancer should generally avoid taking estrogen. Exposure to estrogen beyond age 70 is associated with increased breast cancer risk.
Hormone Replacement Therapy does carry an increased risk of breast cancer, especially in women over 70. Most physicians advise stopping HRT before age 70 for this reason.
There are 2 estrogen-like medications which actually decrease breast cancer risk. They do this by competing with a woman’s natural estrogen for the estrogen receptors in breast tissue. Raloxifene (Evista) and Tamoxifen both can occupy the estrogen receptors in breast tissue and block their activation by the woman’s own estrogen. This protects the woman from developing estrogen dependent breast cancer by about 70%.
Tamoxifen is approved for both prevention and treatment of breast cancer. Tamoxifen does not harm bone. The more aggressive modern breast cancer treatments (Aromatase Inhibiters) do harm bone. Unfortunately, Tamoxifen has not been shown to preserve bone either.
Evista preserves bone and decreases Fracture Risk. More about preventing breast cancer and decreasing fracture risk next time.
Jay Ginther, MD
Modern Hormone Replacement Therapy (HRT) is safe in most women through their 60′s. 20 years ago, when Progesterone was included in the formulation, HRT was associated with heart problems. Estrogen alone in modern HRT avoids this issue, at least until age 70. Recent studies have shown that modern HRT actually decreases heart disease deaths in women in their 50′s.
Modern HRT is most commonly used to treat menopausal symptoms. However, human estrogen is what naturally preserves bone in a pre-menopausal woman. Restoring human estrogen will also preserve bone in a post-menopausal women. You can postpone Osteoclasts Gone Wild eating away your bones!