Breast Cancer or Osteoporosis: Which is Worse?

PJ Hamel Health Guide
  • There are times when, presented with two choices, your answer is “neither.” Maybe your mother gave you a choice: swallow some big honking cold tablet, or drink that fake-cherry liquid that screams “nasty, nasty!” through your mouth, down your throat, and up your nose as you try to gulp it down. Or your sister asked you to choose from her two selections for bridesmaids’ gown: one a really blechhh taupe color, the other designed to show all kinds of bare chest and shoulders that you’d rather keep hidden… “Which one do you like?” “YUCK, neither!”

    Of course, you didn’t tell your sister that her taste in dresses was somewhat lacking. And you probably told your mom you’d skip the cold remedy, but she ignored you and plopped the little cup of icky liquid in front of you anyway and stood there, arms akimbo, waiting to make sure you drank it. There are times when your choices are limited to bad and worse, but you have to choose anyway. That’s where I find myself heading now.
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    Every 2 years, since treatment, I’ve gotten a DEXA scan to track my bone density. Tons of you out there do this as part of your post-cancer routine. DEXA scans are recommended for premenopausal women in early menopause because of breast cancer treatment; and postmenopausal women of any age who take aromatase inhibitors (Arimidex, Femara, or Aromasin). They’re also recommended for all women over age 65. So if you find yourself in any of these groups, you’re probably familiar with the DEXA machine. It measures the bone density (read: strength) in a certain part of your spine, and in one hip. Your doctor watches these results over time, to see if your bones are becoming less dense: weaker, more likely to fracture, trending towards osteoporosis, that unwanted aside effect of aging that as women, not just cancer survivors, we ALL try to avoid.

    I had my every-other-year DEXA scan recently, part of a regular 6-month cancer check-in. And my usually upbeat, cheerful oncologist came in and said, “Hey! Look at my face. See this frown?” That was his way of introducing bad news into our ordinarily casual topics, things we discuss as he peers into and taps and prods me (the latest pies each of us has enjoyed; the challenges of raising teenage daughters). Dr. Schwartz handed me the printed results of my DEXA scan, and carefully walked me through the jumble of X-ray pictures and charts and percentages. Bottom line: my bones are slowly being destroyed. Probably by the aromatase inhibitor I’m taking to fend off a cancer recurrence.

    He said we should do some more tests before deciding on a course of action. He asked if I was taking a daily dose of 800IU vitamin D (yes); if I was exercising (yes, every day, including lifting weights twice a week). We discussed sunlight (an important source of vitamin D), and calcium. It appears I’m doing everything right; it’s just the result that’s wrong.

    That’s the thing about cancer; about all illness, really. You can do everything you’re supposed to, be the perfect patient, and it doesn’t work. You still get sick, or the cancer comes back, or your bones deteriorate. When you get right down to it, good health is a roll of the dice. We may think we can control our destiny. And certainly, we can improve our chances of staying healthy by eating right, exercising, not smoking and drinking, losing weight, all that blahblahblah we hear and read constantly. But at the end of the day there’s no guarantee. We can’t ensure healthy survival after cancer any more than we can totally prevent car accidents by driving safely. Random chance always has the upper hand. And we have to deal with the consequences.

  • I’m guessing, when the test results are in, that I’ll start taking Fosamax or some other bone strengthener. Hopefully that’ll work. If not, my doc intimated that it may come down to this: keep taking the Arimidex (thus lowering my risk of cancer recurrence by about 20%), and face the real possibility of osteoporosis; or stop taking Arimidex, hopefully prevent osteoporosis, and open the door a crack for cancer.
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    Hey–can I choose “neither”?

    For more information on osteoporosis treatment and bone health, visit our sister site, where you can find advice from Dr. Neil Gonter, hear the latest on generic treatments (like Fosamax) and more.
Published On: March 11, 2008