Adjuvant Bisphosphonate Treatment

The standard American lifestyle is not conducive to bone health.

In fact, 54% of post menopausal women in the US have osteopenia, loss of bone mass, and a precursor to osteoporosis.

Treatments for breast cancer – chemotherapy, radiation and surgery – plus Tamoxifen or an aromatase inhibitor, further reduce your estrogen levels, and the likelihood of osteoporosis increases significantly.

I’m often asked what medications I think are best to support your bone health when taking an aromatase inhibitor, or, to a lesser extent, Tamoxifen.

Two of the main medications given through infusions are:

Denosumab/Prolia (generic)

Brand name: Prolia®

How it works: prevents formation of osteoclasts, which are known to remove bone tissue prevents the development of bone-removing osteoclasts

Mode of administration: injection once every 6 months

Zoledronic acid (generic)

Brand name: Reclast®

How it works: improves bone strength by reducing osteoclast activity

Mode of administration: intravenous infusion, once per year/once every two years

Common side effects: “allergic reactions; small increase in cancer risk

The difficulty with receiving an infusion is, if you’re having serious side effects, you can’t “turn it off”.

So if you have a choice, I recommend taking a pill.

The main bisphosphonates are:

Alendronate (generic)

Brand name: Fosamax®

How it works: strengthens bones by slowing the rate at which osteoclasts remove bone

Mode of administration: oral tablet or solution, daily/weekly

Common side effects: gastrointestinal problems, such as trouble swallowing, inflammation of the esophagus, and ulcers, osteonecrosis (death of bone tissue) in the jaw (rare)

Alendronate (generic)

Brand name: Binosto®

How it works: improves bone strength by reducing osteoclast activity

Mode of administration: oral effervescent tablet dissolved in water, taken weekly

Common side effects: gastrointestinal problems, such as trouble swallowing, inflammation of the esophagus, and ulcers, osteonecrosis (death of bone tissue) in the jaw (rare)

Ibandronate (generic)

Brand name: Boniva®

How it works: improves bone strength by reducing osteoclast activity

Mode of administration: oral tablet monthly or intravenous injection every 3 months; only women

Common side effects: risk of fracture of the thigh bone (femur) with more than five years of use (rare)

Risedronate (generic)

Brand name: Actonel®

How it works: improves bone strength by reducing osteoclast activity

Mode of administration: oral tablet daily/weekly/monthly

Common side effects: irritation at the injection site; flu-like symptoms—headache, muscle aches, fever; fracture of the thigh bone (rare); osteonecrosis of the jaw (rare)

Risedronate (generic)

Brand name: Atelvia®

How it works: improves bone strength by reducing osteoclast activity

Mode of administration: oral tablet weekly, only women

Common side effects: irritation at the injection site; flu-like symptoms—headache, muscle aches, fever; fracture of the thigh bone (rare); osteonecrosis of the jaw (rare)