Discussions that mention tamoxifen

Osteoporosis board

Quote from Oldbones:

Every person is different but if you have a BMD that shows osteoporosis, you never know who will suffer a fracture until it happens. So what do you do.......? Try to prevent a fracture or wait until it happens? After it happens (as it did to me), your life changes and nothing is ever the same. If I had a DEXA scan before my fractures, I would have been very upset with my doctor if he had not told me there were some meds out there that might help.

You have a very good point there, Oldbones. However, that's not the message that Ms. Sanson is trying to convey in her book. (That's the problem with debating the merits of a book you haven't read.) She doesn't advocate not getting a DEXA scan. She advocates using it as just one of many indicators on which to base a diagnosis and treatment, and to use Z scores instead of T scores. (I'm not going to get into the problems with the DEXA machines themselves. Do a Google search using Miller pitfalls bone as the search words and read the associated abstract.) The problem is that so many well women are being scared into taking drugs based solely on that one thing, low BMD, when they may not need it at all.

The research to support this is out there. If you read the results of the huge Fracture Intervention Trial, you will see that while all of the women receiving Fosamax did gain BMD, it did not have a significant effect on preventing fractures in women who had low BMD without previous fractures. The numbers of new fractures occuring during the study in those women were already very low, something like 3% of 4000+ women if I remember correctly. The group taking Fosomax dropped to 2%. To put it in perspective using Numbers Needed to Treat, 60 women without fractures or other risk factors other than low BMD would have to take Fosamax for 3 years in order to prevent ONE compression fracture, with the other 59 women being treated with an expensive drug whose long-term side effects are unkown at this time.

Since I don't know your story, I can't speak to the likelihood that you might have been diagnosed early, before your fractures. Apparently, the more risk factors you have, the higher your likelihood to have future ostoporosis-related fractures. I don't remember all of the risk factors, but a few are: age, corticosteroid use, hyperparathyroidism, smoking, other health problems, lack of exercise, early menopause, moderate-to-heavy coffee consumption, small frame/slim physique, and others. There were some 16 in all, I just don't remember them all.

It is my understanding that the research is not aiming to underdiagnose those like yourself who would've obviously benefited from early intervention. It only indicates that the disease may be being overdiagnosed and that many well women are now on medication they may not need and that could potentially harm them. I am hoping that I fall into that category, but I can't know for sure unless I ask for some other reinforcement of the diagnosis, such as a spinal X-ray, urinary calcium, testing for HPT etc. Until that time I have postponed treatment with any kind of biphosphonate including the Zometa which I now have grave reservations about.

Meanwhile, I'll continue taking Evista (I'm in my 4th month of taking it) because I am a breast cancer survivor and my oncologist has me on it temporarily until I become post-menopausal. So far I haven't had any adverse effects, but then I didn't have side-effects from Tamoxifen either and a lot of women have trouble with that.