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Bisphosphonates okay with aromatase inhibitors?

Page last modified on: March 17, 2010

Question from Pierced: I take letrozole for early-stage breast cancer. A DEXA test showed I had lost some bone mass -- mild osteopenia. My oncologist said to wait until osteoporosis happens before starting bisphosphonates. With the Z-FAST trial and other results, do treatment guidelines now allow use of bisphosphonates to prevent osteoporosis? I am already doing everything else that is recommended.: Answer —Carol Kaplan, M.D.: I think that the use of bisphosphonates with aromatase inhibitor therapy differs between oncologists. There is no clear right answer as to what point in the spectrum of bone density loss bisphosphonate therapy should be started. The Z-FAST trial confirms the suspected belief that use of bisphosphonates can combat the bone loss associated with aromatase inhibitor therapy. I take into consideration a patient's overall health and make sure they understand the risks of bisphosphonate therapy when embarking upon a discussion about bisphosphonates with my patients. There are definitely times when I will start therapy in the osteopenia setting, but whether starting earlier versus later translates into less bone fractures is not clearly understood.

On Wednesday, June 18, 2008 our Ask-the-Expert Online Conference was called Updates from the 2008 ASCO Annual Meeting. Generosa Grana, M.D., F.A.C.P. and Carol Kaplan, M.D. answered your questions about the latest research advances on screening, treatment, side effects, and more.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Generosa Grana, M.D., F.A.C.P. is the director of the Cooper Cancer Institute and heads the division of hematology/medical oncology at Cooper University Hospital.

Carol Kaplan, M.D. is an assistant professor of clinical medicine in the Rena Rowan Breast Center at the Hospital of the University of Pennsylvania. Her work revolves around the clinical care of breast cancer patients, as well as teaching medical students and house staff.

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