Aromatase inhibitor may speed decline of bone density

Dr. Keith Roach M.D

Aromatase inhibitor may speed decline of bone density

DEAR DR. ROACH: I’m a 72-year-old woman, still working, and I stay very active by walking and lifting weights in the gym. I have been taking anastrozole for breast cancer, and my bone density has decreased over the past five years, with a T-score in my hips of -1.5 and -3.3 in my spine. My doctors want me to take Fosamax once a week. I am apprehensive due to the warning about esophageal reflux. My brother died of cancer of the esophagus. Am I foolish to wait a year for the next test? — J.F. ANSWER: Many women in their 70s will develop osteoporosis, but those using a medication like anastrozole (Arimidex), which inhibits aromatase (a necessary enzyme to make estrogen) usually see faster and steeper drops in estrogen and, consequently, bone strength. This leads to increased risk of an osteoporotic fracture. The recommendation for treatment of osteoporosis is more aggressive for women taking these types of drugs.

Your spine is now at -3.3; anything worse than -2.5 is when treatment is recommended. I say start treatment now, not in a year. You are at risk for a fracture before the end of that period.

The risk of esophageal reflux with alendronate (Fosamax) is low if it is taken properly: on an empty stomach with a full glass of water, and you must remain upright for 30 minutes. The risk for esophageal cancer also does not appear to be increased in people taking alendronate. Still, if you don’t want to take it, Fosamax is not your only option. In people who have a reason not to take Fosamax, once-yearly zoledronic acid (Reclast or Aclasta) is effective and is given intravenously. A recent study on women with osteopenia showed that the IV infusion of zoledronic acid prevented fractures. Between the osteoporosis and use of Arimidex, I think your benefit is likely to be large. *** DEAR DR. ROACH: I suffered from constipation for years, and after consulting with a gastrointestinal specialist, I was prescribed Mira-LAX. I take it every morning and have added fiber to my diet. The program has been successful. How wise is it to continue MiraLAX indefinitely? Should I worry about side effects? It has been quite pleasant to be free of constipation worries. — Anon.

ANSWER: MiraLAX is a non-absorbable chemical called polyethylene glycol. It passes through your system, bringing water with it, which makes stool less hard and easier to pass. It is very safe for shortterm use. If used excessively, it can pull sodium and potassium out of a person’s system.

If you are taking in enough fiber, it should be possible to decrease the MiraLAX without worrying about constipation again, but it’s OK to use MiraLAX as needed. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.