Arimidex-referral to Endocrinologist

[dizzybuff38]

I had a 5 yrly review with my bc surgeon last week. I have been on Arimidex for 4 yrs. A recent DEXA scan showed significant bone loss since starting Arimidex, compared to the one done prior to commencing Arimidex. I have Crohn's and had steroids for 30+ yrs, so that DEXA was ordered by my gastro. I am now on weekly self injected methotrexate which is doing a great job in keeping the Crohn's in remission.

I have osteopenia, osteo-arthritis in both hips, hands and feet, and had 2 spontaneous fractures in either feet last summer. My bc surgeon wants me to continue with Armidex because of lymph node spread but is concerned at further bone depletion. He is referring me to a Professor of Endocrinology here in England for another opinion.

I have been taking Alendronic Acid weekly, and Calcichew/Vit D for the past year, but have recently read a New England Journal of Medicine report on a 3 yrly study of Zoledronic Acid, given as a yearly infusion, rather than the weekly tablets of Alendronic Acid. They had remarkable results - a 41% reduction in hip fractures. I discussed this with my surgeon and he said these infusions are being done at my hospital, which has just been affiliated with a new medical school in the South West, so guess we are now getting really good doctors who are not only clinicians, but also doing research. The Professor I am being referred to has a particular interest in Arimidex side effects/fractures/bone loss, hence the referral.

Could you advise me what an Endocrinologist can do? Are Zoledronic infusions popular in the US to counteract bone loss in post-menopausal women with breast cancer? My history of steroids is a big factor in my future treatment.
Many thanks for any insight and advice.
Liz.

[Cleveland Clinic]

Dear dizzybuff38,   Alendronic acid (referred to here in the US under the brand name Fosamax) and Zoledronic acid belong to a class of medications called bisphosphonates.  Bisphosphonates work by interfering with the action of osteoclasts.  An osteoclast is a type of bone cell that removes bone tissue that normally functions with another type of bone cell the osteoblast to control the amount of bone tissue produced.  The interference with the osteoclast function decreases the rate of bone reabsorption and indirectly helps to increase the strength of the bone.

Both alendronic acid and zoledronic acid have been FDA approved for treatment of postmenopausal osteoporosis.  Zoledronic acid is currently being studied for the prevention of bone loss associated with aromatase inhibitor therapy in postmenopausal women with breast cancer.   The endocrinologist will take into account your history as well as current therapy and condition when making recommendations for treatment of osteoporosis in your individual case.    

[dizzybuff38]

Many thanks for your enlightening and erudite response to my question.
Liz.