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| Aromasin Pills Photo © Karl Stephan |
Aromasin (exemestane) is an important drug for estrogen-positive breast cancer patients.But, like many cancer drugs, it comes loaded with trade-offs. It helps many patients prevent a recurrence of estrogen-sensitive breast cancer by blocking your body's estrogen production. But taking Aromasin produces menopausal symptoms: the classic hot flashes, fatigue, joint pain, and even bone thinning. A recent study was published in The Lancet by a group of oncology scientists in Canada and America, looking at the effects of Aromasin on bone health. They concluded that, "Exemestane worsens age-related decreases in bone mineral density by about three times, even in the setting of adequate calcium and vitamin D intake."
Chemotherapy as well as hormonal follow-up therapies can cause bone density loss (osteopenia) and sometimes when a women takes an aromatase inhibitor after her primary treatments, her bones may continue to thin out until she has osteoporosis. This loss of bone density and strength can take place even if she is taking sufficient calcium and Vitamin D to guard her bone health. The study, led by Dr. Angela Cheung, followed 242 women over 2 years on Aromasin (exemestane). All of the women had a baseline bone density scan and none of them were taking medicine for osteoporosis. These women were divided into 2 groups - one took Aromasin and the others took a placebo. While all the women showed some bone thinning at the end of two years, the group on Aromasin fared worse in their bone density.
Most women lose some bone density as they age, even if they never have cancer treatments. Estrogen levels drop during menopause, when your ovaries stop making the female hormones. Taking calcium and Vitamin D can help delay bone thinning, as well as weight-bearing exercise. If you can't tolerate calcium carbonate very well, try calcium citrate instead (it is easier to digest). Your doctor may recommend preventive drugs such as Fosamax or Actonel, to help treat bone loss. You may also need to have annual bone density scans as part of your well woman checkups, to monitor your bone health.
I was diagnosed with breast cancer almost 10 years ago, and took Tamoxifen for 2 years, then Aromasin for 3 years. Many women complain of the side effects of both these drugs - I know I did! - but we keep taking them because we want to avoid the return of cancer. I haven't taken hormonal therapies for 5 years now, but my bone density loss continues to progress. Who knows how long the effects of Aromasin will be with me? My latest mammogram showed no signs of cancer (Hooray!) but my bones are weakening like a much older lady. The good news is - I hope to live longer after breast cancer than I would have 20 or 30 years ago, but I must be more vigilant over my brittle skeleton. That's a tradeoff I'm willing to take, hot flashes and all.
Has Aromasin given you any trouble? Let me know by leaving a comment here.
Source: Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial. Dr Angela M Cheung MD,Lianne Tile MD,Savannah Cardew MD,Sandhya Pruthi MD, et al. The Lancet Oncology - 7 February 2012.
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Thank you for the informative article and for sharing your personal story. You’re right, I think, about the trade-offs: you might rightfully complain about side effects, but if the drug helps you live a longer life you’ll take those side effects.
I only had once concern with the reference to Fosamax. People should be aware of the current studies (and fosamax lawsuits) regarding long-term use of bisphosphonates like Fosamax. Ask your doctor if you’ve taken it for more than a few years. I’ve heard from women whose prescribing physician (sometimes an OB/GYN) was unaware or only slightly aware of the issue, while orthopedic physicians who treat the fractured femurs seem to know more. Always talk these issues over with a doctor, of course, before stopping medication.
Thanks again!
Although the study claims that the women were taking adequate calcium and vitamin D…I would like to know if they received vitamin D blood tests during the study. The recommended daily intake (RDI) vastly underestimates how much supplementation is required during the winter in northern regions. I was taking 2,000IU daily and fell below the acceptable range by January. I now take 5,000IU in the winter because adequate vitamin D can improve calcium absorption dramatically and is essential for the prevention of osteoporosis. Did this study assume that the women were getting enough vitamin D or did it include blood tests?
I don’t know if it was due to Aromasin or having been treated with chemo twice for breast cancer, (Once 15 years ago and once 5 years ago). but just now at age 60 I developed an aggressive type of leukemia and have just been diagnosed and started treatment for it.
For me, the Aromasin caused the least of the creaky, painful joints. My bone densities were always the best they could be. I couldn’t take the other preparations as I could hardly walk when I took them. Finally I was put on Aromasin and could tolerate the little bit of creaky I had.
I’m taking arimidex and am having some symptoms like achy joints etc but I’m also takin vit d3, 1000 units/day. My MD measured my vit d level and found it low, so increased the dose to 2000 u/day. I haven’t had a bone density test since two years ago and it was normal then. should I have another done now since I’ve been on the arimidex for two years?
I have been taking Arimidex for over 5 years now, following surgery, chemotherapy and radiation for statge IIIB breast cancer. I started out with osteopenia, then moved to osteoporosis which has worsened in the last couple of years. I did have a Vitamin D screening, was low, and increased my dosage, plus do daily calcium. I was on Boniva for a while, but am also concerned about the side effects of these drugs marketed to improve bone density.I don’t know whether it’s better to go back on Boniva and take my chances with possible future fractures, or to take my chances for potential bone issues without it. I want to continue the Arimidex as long as possible to lessen chances of recurrence, but what’s a girl to do?
Re Osteoporosis – I developed this after being on Aromasin. Researched what European cancer care does to help – and discovered that special weight-bearing exercises are the key to possible reversal – or to stop developing.
Many women in Austria are put on an exercise regime the moment they are given Aromasin. This was too late for me after I had developed this, but I went to Austria, found out about exercises – see http://healthspanews.com/exercise-is-fun-in-austrian-alps/
and doing these for a year, my specialist says I have increased bone density by 21%. Just a thought but hope it helps.
Here’s more on using exercise to help with osteoporosis :
http://after-cancer.com/?s=Osteoporosis
Thanks for the info and link, Verite! I’ll check it out. Maybe I need to tell my hubby I need to go to the Austrian Alps (for medicinal purposes only, of course)! Thanks again and great to hear of your success.
I’ve only been on letrozole daily,an AI since dx.
I also get a monthly infusion of Zometa for bone strengthening since I am Stage IV with bone mets.
This plus calcium and Vit D3 will hopefully prevent osteoporosis.
Yes Aromasin is causing me to lose bone density. Osteoporosis runs in my family also. However, my research has indicated that exercises esp weight bearing, isometrics and yoga can improve bone density. Also, magnesium, vitamin D3, Vit K(meniquine), boron and strontium citrate all help with this. I cannot take any of the meds due to GI disorders. Finally, a Pyrill Links urine test will show how much bone you are losing.
I have been on arimidex for 3 1/2 years and have bone density done every year. I had taken fossomax before the cancer of some bone thining, but when standards were revised I was taken off the fossomax. My oncologist and obgyn have kept careful watch on my vit D levels, calcium, and bone density and so far there has been no change in my bone density since I began the arimidex. I am very thankful.
I have taken Aromasin for a year. I am so afraid for my bones as I have osteopenia and trouble with bones. I also take every four weeks drug for bones, named zolendronic acid (five treatments). I have hot flushes. Please, let me know if it is good for my bones as they weaken from day to day.
Thanking in advance, yours sincerely,
N. Novicevic
Just stopped Aromasin 3 weeks ago. I had 10 more months left to take it but it was a quality of life issue for me. I’ve had major fatigue on it, some joint pain and other lesser SEs, but for me, the fatigue was the hardest one to deal with. So I chose to stop it, with my oncologist’s blessing. Since going off it, the fatigue has gotten worse (go figure) and hot flashes have come back big-time! I’m hoping this will soon pass as it washes out of my system.
I forgot to mention the bone loss. Major bone loss. My onc wanted me to go on Reclast but I refused. Took Boniva for 3 years prior to diagnosis. I do yoga (tree pose 3 x day has shown to build bone). I walk several miles a day and take calcium, vit D and eat a very healthy diet. My bone loss stabilized after going off Boniva. It should be much better now that I’m off the Aromasin.