Osteoporosis and Breast Cancer

Dear Doctor
I am 45 years old, and last year I completed treatment for stage II breast cancer (surgery, AC+T, radiation). Due to severe joint pain I declined Arimidex, and it turns out that was lucky, because I have just been diagnosed with advanced osteoporosis (T-score =-3.2). I think I am young for this diagnosis. Could this have been caused by the chemo? and Is Tamoxifen a good treatment for osteoporosis? My doctor discouraged it because I have a history of endometriosis.

[CCF-RN,MSN-JS]

Dear OhMary, After age 35, and particularly after menopause, bone resorption gradually begins to outstrip bone formation, resulting in a slow loss of bone mass. Over time, usually many years, bone mass reaches the low end of the normal range: osteopenia. If loss of bone mass continues long enough, osteoporosis is the result. Osteoporosis may be moderate, associated with an increased risk of fracture, or it can be severe, associated with actual fractures.

Loss of bone mass is an inherent part of the aging process of men and women, although it tends to affect women more. Our bone mass is less dense than men's to begin with, and we tend to live longer, allowing more time for bone aging. Bone mass is greatest in women's 20s and 30s; it stabilizes between 30 and 40, and over 40 there is slow loss of bone strength. After menopause, there is a five- to seven-year period of accelerated bone loss; then the rate slows and returns to an age-related rate.

The aging process has a greater effect on bone loss than the presence or absence of estrogen. Smoking, prolonged bed rest or inactivity, being underweight, and certain medications can increase bone loss (early menopause brought on by chemotherapy can produce significant loss of bone strength, starting during chemotherapy). Weight-bearing exercise increases bone mass. Tamoxifen tends to stabilize bone strength, but for the first year of taking it, pre-menopausal women may experience bone loss; post-menopausal women may have some bone strengthening.  Discuss with your oncologist your individual situation, and what might be recommended in your case.  

[rkmsim]

My mom is 80 and has osteoporosis so she is taking Tamoxifen after having treatment for breast cancer.  I took Tamoxifen for 5 years and am now on Femara (much like Arimidex).  I'm also now on Fosamax due to some loss in bone density which I'm sure is partly due to the Fosamax, but also probably partly due to age as well.  If you do take Tamoxifen and have problems with leg cramps and muscle/joint aches, I found that exercise helps immensely to eliminate the cramps and greatly reduce the aches.