Bisphosphonates relating to breast cancer

Hi All,

 Just a quick question if I could.

What prompts the onco to give biphosphonates? What are the circumstances? 

I am covered for these on a health insurance policy and have read that they are not given on NHS. 

If they are something I would be likely to be offered I'd like to understand the implications / complications.

Thanks

Thank you for this , I have heard it before .   Alendronic acid contributed to a bout of gastritis I had recently and I decided to stop it ,at least for a while ( I had been taking it for 2 years ) The GP said this was a good idea , and mentioned the micro crack situation .  I have heard before ( I am not sure where ....)that it is the issue of " holes " in the bones , which theoretically allows secondaries to infiltrate .....

I asked the onco about all this last week when I went for the trial drug monitoring , but she was vague , and she said " your bones are thin , you should take it " and she would not be drawn into a discussion of risks / benefits...... I get much more information from this site than I do at the hospital , thanks to all of you who contribute !  best wishes .... 

Hi Maxine

My understanding is that they are available on the NHS but only to post menopausal women with ER+ BC who are taking aromatose  inhibitors such as Letrozole. I am currently on Tamoxifen which is for pre-menopausal women and don't have them, but have had blood tests to check if I am now post menopausal- I see the oncogist on 4 July and if I am will be offered some sort of bio phosphate alongside whocever new tablet I will be prescribed. These aromatose inhibitors can affect the bones so this is why the biophosphates are also prescribed.

im sure if I've got this wrong someone will correct me!

cheers

Jo x

You're absolutely right Jo. The AIs cause calcium to leach out of the bones so bone strengthening drugs are prescribed to counter that. Also, both biphosphonates and denusomab have been shown to reduce the risk of bone mets so are commonly given to people who had lymph node involvement.

I don't know what the situation with the NHS is of course lol.

Hey Jo, that's mostly right. But I am ER0, HER2+ and getting them. It is only for post menopause though. It's something to do with oestrogen helping to deposit calcium in the bones. Which is why I went on HRT 10 years ago when I had early menopause.

xx

Hi Karen

Thats interesting to know , I'm ER+ and HER2+ , I thought it was just for ER+ , I'm always amazed at so many different variations and treatments etc .

Cheers

Jo x

That's my understanding too Jo.

I asked during chemo and told only for post menopausal women. But now I am having zoladex to shut off my ovaries and starting letrozole, so I think I will ask again.

Gay xxx

I had early er+ invasive bc.  Had a mastectomy and was put on Letrozole.  I am post menopausal. I did ask about biophosphates but the surgeon seemed to think the jury wasn't out on them.  This was late last year. I am taking adcal after a thyroidectomy years ago and my bone density was good when tested.  Not sure what to think of all this but feel I am  on enough drugs already and not enjoying Letrozole as it is.

Hello everybody, just caught up with the discussion.  Very glad to hear everybody's views.  It's a growing area - our local CCG has only just approved them for post-menopausal breast cancer. Given the state of NHS finances they obviously think that my taking them will save them money on future treatment!

The data indicate that as a post-menopausal woman I could improve my overall 10 year survival rate by 3% by taking bisphophonates. Read the Results 1st para in the excellent digest of the original Lancet paper here: https://www.cancer.gov/types/breast/research/adjuvant-bisphosphonates-meta-analysis This was confirmed in discussion with my onc, and tbh my husband was keen for me to reduce the risks any way I can.

But LOL, like Optimistic my drugs are still in the packet! I had a mental checklist before starting the dratted things.

1) I saw the dentist for a check up and all looks good, so lowered risk of osteonecrosis (which does sound horrific) due to extraction and I don't have dentures. He also said risk was lower with tablets but data comes from osteoporosis patients, who seem to take a lower weekly rather than daily dose. Hmm.

2) Looked up the incidence of the atypical femoral fractures and they are rare: https://www.iofbonehealth.org/atypical-fractures-and-long-term-bisphosphonate-use . 

3) Last ones I'll discuss with my GP - a) why daily tablets not weekly? b) Leaflet suggests you can eat after 1/2 hr as long as you stay upright for 1 hour.  But what happens if you don't eat after?  I'm trying a 16:8 fasting diet at the moment. 

Anyone had experience of the last issue?  

Hello. I'm in the process of having bisphosphate - Zoledronic Acid - it's really complicated isn't it - thanks for those links - I'll have a read!. My onc feels that the tablets are same in terms of side effects as the injections (An issue  is that the drug 'binds to the bones' for around 15 years I think - so even after you have hopefully received the benefit it is still in your body). There are other drugs that don't bind for so long but these aren't licensed for BC use- so you could be taking them for no advantage! My onc thinks that given the side effects are the same, injections are easier. I've had my wisdom teeth out (with a speacilist dentist - which I'm glad about as I'd never have got around to it if it wasn't for this and  they were giving me heaps of problems). Should have first injection in two weeks but still not sure whether to go for it or not - so this thread is really useful!