Bone Drugs May Reduce Breast Cancer Recurrence and Death - But at What Cost?

Patient Expert

Several recent meta-analyses (grouped results of research studies) show that aromatase inhibitors (AIs) are more effective than tamoxifen at reducing breast cancer recurrence and death in post-menopausal survivors. AND that adding bisphosphonates – osteoporosis drugs – to the mix is even more effective than using an AI alone. But – at what cost to your comfort and quality of life?

Aromatase inhibitors yield better results than tamoxifen

Here are the facts: A recent study from Great Britain's Oxford-based Early Breast Cancer Trials Collaborative Group (EBCTCG ) indicates that aromatase inhibitors are 30 percent more effective than tamoxifen at preventing a breast cancer recurrence in post-menopausal women with early-stage breast cancer (i.e., the cancer hasn't left the breast).

And, AIs are better than tamoxifen at keeping you alive, as well: 15 percent better, in the 10 years following diagnosis.

So, what's the big news? AIs have routinely been prescribed for post-menopausal survivors for a decade or more. Younger survivors take tamoxifen; older ones, an AI (Aromasin, Femara, Arimidex).

The "new" news is this—there's finally enough data to prove what our oncologists have long surmised: AIs are more effective than tamoxifen for older survivors. So if you're a post-menopausal, hormone-receptive breast cancer survivor, make sure your oncologist offers an AI as your first line of long-term treatment.

Osteoporosis drugs added to aromatase inhibitors are better still

Now that we've established you should take an AI, here's some brand new information: adding a bisphosphonate to the mix provides even more protection against both recurrence and death than simply taking that AI alone.

During the first 10 years after diagnosis, a bisphosphonate added to an AI will reduce your risk of metatasis to the bone – the most common recurrence site – by 28 percent, compared to taking an AI alone. And it'll reduce your risk of dying by 18 percent.

What's a bisphosphonate, you ask? Think Boniva. Or Actonel. Or Fosamax. Any of those drugs you see advertised for treating osteoporosis and/or osteopenia: bone loss.

Since one of the main side effects of taking an AI is bone loss, it seems like adding a bisphosphonate would be a no-brainer: reduce your risk of recurrence/death, AND treat bone loss at the same time. If you're taking an AI (or about to start), ask your oncologist about taking a bisphosphonate, too.  Win-winBut bisphosphonates can come with severe side effects

Well, not so fast. Bisphosphonates come with some potential side effects that are extremely uncomfortable, ones that can significantly alter your quality of life.

I took Actonel, one of the most common bisphosphonates, for nearly a year, trying to counter the bone loss I was experiencing from Arimidex. And it was so hard on my digestive system I finally had to stop. Cramps, nausea, diarrhea, all striking randomly, are not only extremely uncomfortable; they make it very difficult to plan and to live a normal life. Dining out, air travel, even simply going to the movies, all became risky endeavors due to my gut.

Thus my frustration upon reading the comment of one Dr. Robert Coleman, a British doctor commenting on the new EBCTCG study: "These simple, well-tolerated treatments should now be considered for routine use… to both extend survival and reduce the adverse effects of cancer treatments, such as the aromatase inhibitors, on bone health."

Bisphosphonates are neither simple (they involve a fairly complicate daily regimen of early rising and diet), nor are they routinely well-tolerated. Plain and simple, they're caustic; they come from the same base as chemical fertilizers. And they can wreak havoc on your digestive system.

Pain vs. gain: what's your choice?

Sure, all of us breast cancer survivors are interested in reducing our risk of recurrence and death. But before you jump on this new information and ask for a bisphosphonate to go along with your AI, think hard: How much potential pain is worth the potential gain?

Quality vs. quantity of life. It's a tough decision, and only you can make it.

See more helpful articles:

A Guide to Breast Cancer Treatment

Risks and Benefits: Understanding the Statistics That Affect You

Aromatase Inhibitor FAQS

Bisphosphonates: the Drugs We Love to Hate

Can't Take a Bisphosphonate?


"Two Classes of Generic Drugs Can Reduce Breast Cancer Deaths." Clinical Oncology News -. July 24, 2015. Accessed August 1, 2015.

Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.