Osteoporosis Prevention for chemo induced menopause

I had chemotherapy for stage 4 hodgkins lymphoma, and was put into post menopause due to cancer treatment,.  I was put on the birth control pill for five years and it then created a large dvt, blood clot in my leg and now I have been on heperin therapy for the past six months.
In addition, I am on synthroid and have have been hyperthyroid and my dose was just altered from 0.88 to the alternating dose of 0.75.  I am also on nexium 40mg every alternate day due to the severe acid reflex from chemotherapy.  I had a normal bone density in September and was wondering, would it be wise to take reclast infusion in order to prevent osteoporosis since my ovaries have ceased to work and I am a 32 year old young women.  In addition the nexium created ibs for me, meaning now I have constipation, and my diet is very limited to just lentils, chickpeas, with 1 or two pieces of bread.  I am taking carbocal calcium pills which have 500mg and 400iu of vitamin d per pill.  I take two per day.  Sometimes I take one pill and drink one litre of milk since 4 glasses contain 400 iu of vitamin d.  Does each glass of milk contain 100iu of vitamin d or should I take 800 iu of vatamin d in additon to the milk?

yours sincerely

Indersonu

[Machelle Seibel, MD]

It is very difficult having to go through treatment for a cancer and then have to deal with menopause. Since you've had a blood clot on the pill, taking estrogen again certainly carries some risk. One thing you can do is ask your doctor to check a blood test for any blood clotting factors that could have increased your chance of a blood clot. Some of then are homocysteine, Leiden factor, anticardiolipin, and B-12 deficiency among others. Estrogen can cause a loss of B vitamins and being low on that can contribute to a clot. So a multivitamin can be helpful for that.

The best way to know if you are low on vitamin D is to check it with a blood test for 17 OH Vitamin D. If your value is below 40, it is low and if it is below 20 it is very low. If osteoporosis is a worry, then there are several medications such as Fosomax, Boniva, and other bisphonsphonate medications that are often used before reclast.
also talk to your doctor about estrogen alternatives for other symptoms such as hot flashes. Examples of alternatives are soy and flaxseed. Replens, an over the counter moisturizer, is also very effective for vaginal dryness.
Machelle M. Seibel, MD