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edge

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Reply with quote  #1 

Managing AI-Induced Musculoskeletal Effects – Part 4: Summary

 

 

·       AI-Switching
Response to AI therapy, and its  adverse events, shows considerable individual variation, so women finding one AI's side effects intolerable can try switching to a different AI, preferably across class: thus if on one of the two non-steroidal AIs anastrozole (Arimidex) or letrozole (Femara), try switching to the steroidal AI exemestane (Aromasin), and vice versa, although switching even within class (from anastrozole (Arimidex) to letrozole (Femara), or vice versa) should be tried.
 

·       Endocrine Fallback
For women on AI therapy, this involves falling back to tamoxifen, and although tamoxifen can also be associated with many of the adverse side effects of AIs, the profiles are different, with less musculoskeletal adverse events on tamoxifen, and more importantly, typically with lower severity.

·       Endocrine Promotion: From AI/TAM To Fulvestrant (Faslodex)
Women on either AI therapy, or tamoxifen therapy who are postmenopausal, can be promoted to the pure antiestrogen fulvestrant (Faslodex), either if indication is met – progression on, or intolerance or contraindication to, previous endocrine therapy – or off-protocol.  Fulvestrant is at least as effective as both the AIs and tamoxifen but typically more tolerable, with appreciably less likelihood of musculoskeletal adverse events.

·       Endocrine Promotion: From TAM To AI Therapy
Women experiencing adverse events on tamoxifen, and who are postmenopausal, can try switching to an AI; although there are typically statistically more musculoskeletal adverse events on AIs than on tamoxifen, this is not always so given wide individual variation.

·       LD-TAM (Low-dose Tamoxifen)
Women experiencing adverse events on tamoxifen may consider in conjunction with their managing oncologist, the alternative of LD-TAM, at 5mg / daily.

·       LD-TAM + HRT
Women experiencing adverse events on tamoxifen may consider in conjunction with their managing oncologist, low-dose tamoxifen plus hormone replacement therapy (LD-TAM + HRT).

·       VLD (Very Low Dose) Estrogen Add-Back
Women experiencing adverse events on endocrine therapy, whether tamoxifen or AIs, may consider in conjunction with their managing oncologist
the option of VLD estrogen add-back regimen,  implemented with any transdermal patch delivering 0.015 mg estradiol (roughly equivalent to a quarter of the Estraderm MX 25 brand of transdermal patch), replaced twice weekly (or the equivalent dose and regimen using another estradiol patch - Alora, Climara, Esclim, FemPatch, Menostar, Vivelle, among many others).

 


 

·       Calcium and Vitamin D
Calcium and Vitamin D are critical to bone health and should be dosed at 1500mg calcium citrate or phosphate daily (not carbonate), and 3000 IUs / daily of Vitamin D as D3 (cholecalciferol).

·       Bisphosphonates

§         All anti-osteoporotic bisphosphonates have some modest propensity for benefiting bone pain, and risedronate (Actonel) and alendronate (Fosamax) are the two most optimal oral anti-osteoporotic bisphosphonates in the US in terms of complete bone benefit, namely against vertebral, non-vertebral, and hip fractures, while the bisphosphonate clodronate (Bonefos) is the most optimal outside of the US.

§         Outside of the US the non-bisphosponate strontium ranelate (Protelos) is at least as effective as these.

§         Although not as effective or as consistent in action as Actonel, Fosamax, Bonefos or Protelos, the anti-osteoporosis agent, calcitonin-salmon (Miacalcin), used as an intranasal spray  provides a significant degree of analgesic (pain-relieving) effect and may be used to supplement an existing anti-osteoporotic agent with Miacalcin for its pain benefit.

§         IMPORTANT CAUTION:
For anyone on any bisphosphonate, it is imperative to take precautionary steps to minimize the rare, but serious, risk of
osteonecrosis of the jaw (ONJ): I have developed evidence-based guidelines for the prevention and management of ONJ in my detailed Consumer Alert: Osteoporosis Drugs - A Pain in the Jaw? It is strongly advised that all bisphosphonate users follow the recommendations set forth there.

 


 

·       Analgesics: NSAIDs

§         NSAIDs provide some appreciable benefit of relief from the musculoskeletal adverse events of endocrine therapy in approximately 46% of patients.  Agent-specific individual variation is broad and women should try more than one agent (no less than 48 – 72 hours on each, preferably 7 – 10 days if there is any early sign of benefit however small). 

§         Given that the topical NSAID diclofenac sodium (Voltaren Gel) is both safe and effective for pain control, and non-inferior to oral diclofenac, there is strong motivation to first explore a trial of a topical NSAID before orally administered NSAIDs, and topical Voltaren Gel may in addition be particularly effective for TMJ (temporomandibular joint) dysfunction.

 

·       Analgesics: COX-2 Inhibitor Celecoxib (Celebrex)
Adding celecoxib (celebrex)
400 mg bid to an AI regimen can both reduced arthralgias as well as improve AI response rates, and there is preliminary evidence of added antitumor activity.

 


 

·       Atypical Analgesics

§         The opiate fentanyl transdermal patch (Duragesic) has some reported benefit, and should be initiated at low doses, increasing by 25mcg (micrograms) one each fourth day if needed.

§         In addition, a trial of the non-narcotic non-addictive novel agent tramadol (Ultram, Ultracet) may provide some appreciable level of pain relief without opiate side effects. 

§         Acetaminophen provided some appreciable relief from AI-induced musculoskeletal adverse events in approximately 26% of patients.

§         Glucosamine (1500mg/daily) + chondroitin (1200mg/daily) provided some appreciable relief from AI-induced musculoskeletal adverse events in approximately 13% of patients, but the low response rate may be partially due to the poor quality control of over-the-counter preparations (see the full discussion in Part 3 of this series for specific brands to avoid, and ones to try). Topical glucosamine has been also found of benefit (see below).

 


 

·       Topical Analgesics (Natural)

o         Traumeel S
Besides the topical NSAID Voltaren Gel discussed above, there are several natural topical analgesics. The homeopathic ointment, Traumeel S was found at least as effective as Voltaren Gel, with a trend toward superiority of Traumeel S over Voltaren Gel on motility-related variables; Traumeel S has also been found effective in significantly reducing the severity and duration of chemotherapy-induced stomatitis.

o         Comfrey / Kytta-Salbe
The comfrey-based German analgesic product Kytta-Salbe, applied at 2g 3X daily for 3 weeks, has been found effective in reducing pain and increasing mobility and quality of life.

o         Arnica / Atrogel
A topical arnica gel, called A Vogel Arnica Gel and marketed as Atrogel (from BioForce), applied by rubbing in a 4 cm (1.6") strip of the gel to any affected joints 3 times daily for 3 weeks, without washing hands for 1 hour after application, is as effective as a NSAID gel in reducing pain intensity, number of painful joints, and duration and severity of morning stiffness.

o         CFAs (Cetylated Fatty Acids) / Celadrin / InflameAway Celadrin
CFAs or cetylated fatty acids (under the Celadrin brand, also as InflameAway Celadrin cream) have been shown to be of benefit in pain relief from osteoarthritis, when applied to affected areas on an as needed basis (the dosage with the alternative oral Celadrin preparation is three capsules daily), and with no side effects or drug interactions.

o         Topical Glucosamine / JointFlex
A topical cream of glucosamine sulfate, chondroitin sulfate, camphor and peppermint oil (marketed in the US. as JointFlex) is effective in the pain relief of osteoarthritis and related joint disorders, with approximately one-third of JointFlex users having their chronic osteoarthritis pain completely, or nearly so, eliminated within eight weeks or less, with most benefits seen by week 4.

 


 

·       SAMe Analgesic

o         S-adenosylmethionine (SAMe) can relieve symptoms of arthritis and other bone related inflammatory disorders as effectively as powerful standard anti-inflammatory drugs (NSAIDs) and the COX-2 inhibitor celecoxib (Celebrex), and without the adverse GI and other events,  although the full effect of SAMe may require 4 weeks of administration at 1200mg/daily, and unlike other analgesics, the benefits of SAMe continue to increase with time compared while those of the others remain constant.  And SAMe may in addition provide some appreciable antidepressant activity.

o         Given the exceptional power of SAMe, patients requiring maximal relief from endocrine therapy induced musculoskeletal adverse events may opt for multimodal therapy of SAMe plus a topical analgesic of either Voltaren Gel, or one of the natural analgesics such as Traumeel S, Atrogel, Kytta-Salbe, Celadrin / InflameAway, or JointFlex, possibly even further supplemented with an atypical analgesic such as acetaminophen.    

 


 

·       Omega-3 Fatty Acids (OFA) Analgesic
3 grams of omega-3 fatty acids from fish oil reduces pain intensity of joint symptoms in arthritic and related disorders, with patients who also add olive oil (one to three tablespoons) to the daily regimen experiencing even greater symptom improvements, reducing joint pain intensity, morning stiffness, number of painful and/or tender joints, and the need for NSAID consumption.

·       Exercise
A regular exercise program that may include stretching exercises, such as yoga or body sculpting, as well as some resistance (strength) training, seems to mitigate some of AI-induced musculoskeletal adverse events

·       Acupuncture
Acupuncture twice weekly for 6 weeks is a safe and effective treatment for AI-induced arthralgias, with improvements in body pain, pain severity, and pain-related functional interference.

·       Desvenlafaxine (Pristiq)
The new antidepressant, Desvenlafaxine (Pristiq) nearing final FDA approval has been found to improve measures of pain, well-being, and functioning, while also improving hot flashes, managing sleep disturbance and cognitive impairment with minimal sexual side effects. 



Constantine Kaniklidis
Medical Researcher
 
edge@evidencewatch.com

edge

Chief of Research
Registered:
Posts: 1,129
Reply with quote  #2 

Managing AI-Induced Musculoskeletal Effects – Part 4: Summary

 

 

·       AI-Switching
Response to AI therapy, and its  adverse events, shows considerable individual variation, so women finding one AI's side effects intolerable can try switching to a different AI, preferably across class: thus if on one of the two non-steroidal AIs anastrozole (Arimidex) or letrozole (Femara), try switching to the steroidal AI exemestane (Aromasin), and vice versa, although switching even within class (from anastrozole (Arimidex) to letrozole (Femara), or vice versa) should be tried.
 

·       Endocrine Fallback
For women on AI therapy, this involves falling back to tamoxifen, and although tamoxifen can also be associated with many of the adverse side effects of AIs, the profiles are different, with less musculoskeletal adverse events on tamoxifen, and more importantly, typically with lower severity.

·       Endocrine Promotion: From AI/TAM To Fulvestrant (Faslodex)
Women on either AI therapy, or tamoxifen therapy who are postmenopausal, can be promoted to the pure antiestrogen fulvestrant (Faslodex), either if indication is met – progression on, or intolerance or contraindication to, previous endocrine therapy – or off-protocol.  Fulvestrant is at least as effective as both the AIs and tamoxifen but typically more tolerable, with appreciably less likelihood of musculoskeletal adverse events.

·       Endocrine Promotion: From TAM To AI Therapy
Women experiencing adverse events on tamoxifen, and who are postmenopausal, can try switching to an AI; although there are typically statistically more musculoskeletal adverse events on AIs than on tamoxifen, this is not always so given wide individual variation.

·       LD-TAM (Low-dose Tamoxifen)
Women experiencing adverse events on tamoxifen may consider in conjunction with their managing oncologist, the alternative of LD-TAM, at 5mg / daily.

·       LD-TAM + HRT
Women experiencing adverse events on tamoxifen may consider in conjunction with their managing oncologist, low-dose tamoxifen plus hormone replacement therapy (LD-TAM + HRT).

·       VLD (Very Low Dose) Estrogen Add-Back
Women experiencing adverse events on endocrine therapy, whether tamoxifen or AIs, may consider in conjunction with their managing oncologist
the option of VLD estrogen add-back regimen,  implemented with any transdermal patch delivering 0.015 mg estradiol (roughly equivalent to a quarter of the Estraderm MX 25 brand of transdermal patch), replaced twice weekly (or the equivalent dose and regimen using another estradiol patch - Alora, Climara, Esclim, FemPatch, Menostar, Vivelle, among many others).

 


 

·       Calcium and Vitamin D
Calcium and Vitamin D are critical to bone health and should be dosed at 1500mg calcium citrate or phosphate daily (not carbonate), and 3000 IUs / daily of Vitamin D as D3 (cholecalciferol).

·       Bisphosphonates

§         All anti-osteoporotic bisphosphonates have some modest propensity for benefiting bone pain, and risedronate (Actonel) and alendronate (Fosamax) are the two most optimal oral anti-osteoporotic bisphosphonates in the US in terms of complete bone benefit, namely against vertebral, non-vertebral, and hip fractures, while the bisphosphonate clodronate (Bonefos) is the most optimal outside of the US.

§         Outside of the US the non-bisphosponate strontium ranelate (Protelos) is at least as effective as these.

§         Although not as effective or as consistent in action as Actonel, Fosamax, Bonefos or Protelos, the anti-osteoporosis agent, calcitonin-salmon (Miacalcin), used as an intranasal spray  provides a significant degree of analgesic (pain-relieving) effect and may be used to supplement an existing anti-osteoporotic agent with Miacalcin for its pain benefit.

§         IMPORTANT CAUTION:
For anyone on any bisphosphonate, it is imperative to take precautionary steps to minimize the rare, but serious, risk of
osteonecrosis of the jaw (ONJ): I have developed evidence-based guidelines for the prevention and management of ONJ in my detailed Consumer Alert: Osteoporosis Drugs - A Pain in the Jaw? It is strongly advised that all bisphosphonate users follow the recommendations set forth there.

 


 

·       Analgesics: NSAIDs

§         NSAIDs provide some appreciable benefit of relief from the musculoskeletal adverse events of endocrine therapy in approximately 46% of patients.  Agent-specific individual variation is broad and women should try more than one agent (no less than 48 – 72 hours on each, preferably 7 – 10 days if there is any early sign of benefit however small). 

§         Given that the topical NSAID diclofenac sodium (Voltaren Gel) is both safe and effective for pain control, and non-inferior to oral diclofenac, there is strong motivation to first explore a trial of a topical NSAID before orally administered NSAIDs, and topical Voltaren Gel may in addition be particularly effective for TMJ (temporomandibular joint) dysfunction.

 

·       Analgesics: COX-2 Inhibitor Celecoxib (Celebrex)
Adding celecoxib (celebrex)
400 mg bid to an AI regimen can both reduced arthralgias as well as improve AI response rates, and there is preliminary evidence of added antitumor activity.

 


 

·       Atypical Analgesics

§         The opiate fentanyl transdermal patch (Duragesic) has some reported benefit, and should be initiated at low doses, increasing by 25mcg (micrograms) one each fourth day if needed.

§         In addition, a trial of the non-narcotic non-addictive novel agent tramadol (Ultram, Ultracet) may provide some appreciable level of pain relief without opiate side effects. 

§         Acetaminophen provided some appreciable relief from AI-induced musculoskeletal adverse events in approximately 26% of patients.

§         Glucosamine (1500mg/daily) + chondroitin (1200mg/daily) provided some appreciable relief from AI-induced musculoskeletal adverse events in approximately 13% of patients, but the low response rate may be partially due to the poor quality control of over-the-counter preparations (see the full discussion in Part 3 of this series for specific brands to avoid, and ones to try). Topical glucosamine has been also found of benefit (see below).

 


 

·       Topical Analgesics (Natural)

o         Traumeel S
Besides the topical NSAID Voltaren Gel discussed above, there are several natural topical analgesics. The homeopathic ointment, Traumeel S was found at least as effective as Voltaren Gel, with a trend toward superiority of Traumeel S over Voltaren Gel on motility-related variables; Traumeel S has also been found effective in significantly reducing the severity and duration of chemotherapy-induced stomatitis.

o         Comfrey / Kytta-Salbe
The comfrey-based German analgesic product Kytta-Salbe, applied at 2g 3X daily for 3 weeks, has been found effective in reducing pain and increasing mobility and quality of life.

o         Arnica / Atrogel
A topical arnica gel, called A Vogel Arnica Gel and marketed as Atrogel (from BioForce), applied by rubbing in a 4 cm (1.6") strip of the gel to any affected joints 3 times daily for 3 weeks, without washing hands for 1 hour after application, is as effective as a NSAID gel in reducing pain intensity, number of painful joints, and duration and severity of morning stiffness.

o         CFAs (Cetylated Fatty Acids) / Celadrin / InflameAway Celadrin
CFAs or cetylated fatty acids (under the Celadrin brand, also as InflameAway Celadrin cream) have been shown to be of benefit in pain relief from osteoarthritis, when applied to affected areas on an as needed basis (the dosage with the alternative oral Celadrin preparation is three capsules daily), and with no side effects or drug interactions.

o         Topical Glucosamine / JointFlex
A topical cream of glucosamine sulfate, chondroitin sulfate, camphor and peppermint oil (marketed in the US. as JointFlex) is effective in the pain relief of osteoarthritis and related joint disorders, with approximately one-third of JointFlex users having their chronic osteoarthritis pain completely, or nearly so, eliminated within eight weeks or less, with most benefits seen by week 4.

 


 

·       SAMe Analgesic

o         S-adenosylmethionine (SAMe) can relieve symptoms of arthritis and other bone related inflammatory disorders as effectively as powerful standard anti-inflammatory drugs (NSAIDs) and the COX-2 inhibitor celecoxib (Celebrex), and without the adverse GI and other events,  although the full effect of SAMe may require 4 weeks of administration at 1200mg/daily, and unlike other analgesics, the benefits of SAMe continue to increase with time compared while those of the others remain constant.  And SAMe may in addition provide some appreciable antidepressant activity.

o         Given the exceptional power of SAMe, patients requiring maximal relief from endocrine therapy induced musculoskeletal adverse events may opt for multimodal therapy of SAMe plus a topical analgesic of either Voltaren Gel, or one of the natural analgesics such as Traumeel S, Atrogel, Kytta-Salbe, Celadrin / InflameAway, or JointFlex, possibly even further supplemented with an atypical analgesic such as acetaminophen.    

 


 

·       Omega-3 Fatty Acids (OFA) Analgesic
3 grams of omega-3 fatty acids from fish oil reduces pain intensity of joint symptoms in arthritic and related disorders, with patients who also add olive oil (one to three tablespoons) to the daily regimen experiencing even greater symptom improvements, reducing joint pain intensity, morning stiffness, number of painful and/or tender joints, and the need for NSAID consumption.

·       Exercise
A regular exercise program that may include stretching exercises, such as yoga or body sculpting, as well as some resistance (strength) training, seems to mitigate some of AI-induced musculoskeletal adverse events

·       Acupuncture
Acupuncture twice weekly for 6 weeks is a safe and effective treatment for AI-induced arthralgias, with improvements in body pain, pain severity, and pain-related functional interference.

·       Desvenlafaxine (Pristiq)
The new antidepressant, Desvenlafaxine (Pristiq) nearing final FDA approval has been found to improve measures of pain, well-being, and functioning, while also improving hot flashes, managing sleep disturbance and cognitive impairment with minimal sexual side effects. 



Constantine Kaniklidis
Medical Researcher
 
edge@evidencewatch.com

Calico

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Goddess Forever
Registered:
Posts: 2,525
Reply with quote  #3 
Thank you for the update!!!

Would a estradiol level (normal lab, not sensitive test) of 19.4 be a reason to go from Femara to Fulvestrant? (I have some muscle/bone pain in hip and glutes that I thought might be from a fall on the oposite knee on my trail in January, which developed weeks later but all the physical therapy is useless. I am actually thinking it might be the Femara or Fosamax, actually I am now on the generic which is a bit more with bone pain, especially at night and in my feet of all places. I take more Turmeric and fishoil now and it seems to help. If I was without these supplements, I would be on major painkillers)

Thank you for all your time and assistance!

__________________
~ There are lies, damned lies and statistics ~
CurlyGirly

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Reply with quote  #4 
Hi

Does anybody know why we are to take
  calcium citrate or phosphate, rather than carbonate?  Also, if I drink 3-4 glasses of milk, and eat yogurt and cheese daily, should I still supplement with 1500mg of calcium?

Jan

edge

Chief of Research
Registered:
Posts: 1,129
Reply with quote  #5 

Calico:

 

By itself that estradiol level as an isolated reading - and given the known limitations of the standard estradiol assay - wouldn't automatically warrant a switch to fulvestrant (Faslodex), unless this were a consistent pattern confirmed via a high- or ultra-sensitive assay and/or relief from skeletal/muscular adverse events (like bone arthralgias and/or muscle myalgias) was needed, or a superior form of antiestrogen therapy was desired, since high-dose fulvestrant (at 500mg / monthly) was recently demonstrated to be superior to AI therapy.  But this is certainly worth discussing with your oncologist.

 

Jan:

 

The Case for Calcium Phosphate

The superior benefits of calcium phosphate (what bones are in fact made of) are founded on the research of the eminent Robert Heaney at Creighton, head of  Creighton Osteoporosis Center, the foremost authority in calcium nutrition /physiology and bone pathology, as well as on the research of numerous other expert calcium and bone physiologists, and the results of Heaney's just completed clinical trial, now pending publication,  sponsored by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the Office of Dietary Supplements (ODS), on "Adding Phosphorus to Osteoporosis Drug Treatment" (NCT00074711) demonstrated the added benefit of the phosphate calcium salt over the non-phosphate comparator.  In addition, several of Heaney's recent studies have demonstrated the importance of the calcium source used, and the superiority of calcium phosphates in assuring adequate calcium absorption, mineralization and bone formation.

 

So the intake of appropriate levels of calcium is important to maintain proper bone mass, since bone mineral (hydroxyapatite) is actually a form of calcium phosphate.  In his now classic review, Heaney and Nordin concluded,  given  that for many populations - such as the (1) elderly, (2) those with osteoporosis or osteopenia, and (3) those with nutritionally deficient diets - phosphorus intake may not be sufficient, calcium supplementation therefore should be in the form of phosphate salts. And his seminal review and commentary “The Calcium-Phosphate Connection” observes based on the evidence that when high doses of extra calcium from non-phosphate (carbonate, gluconate, lactate, citrate, or other organic salts) sources are consumed , a significant interference can occur with the absorption of the phosphorus from food sources, concluding that "the prudent course would be to . . . use a phosphate salt", especially, but not only, for those " with low dairy and meat intakes".  

 

Also note that you can safely disregard the oft-cited claim, always in  error, of the putative poor absorption of the phosphate salt: several different investigators have shown that acid production is not necessary for calcium absorption from calcium phosphate, as long as the salt is coingested with food. 

 

Avoid Calcium Over-dosing

As to dosing, it is prudent to not exceed approximately 1200mg daily of calcium supplementation (1000mg daily if one is a substantial users of diary and high-calcium dietary items), since typically an additional 300mg will be available from diet and from other sources such as a multi-vitamin, delivering the  optimal daily target of 1500mg; although low calcium is unsafe, high calcium can have it's own share of safety concerns (including cardiovascular), and there has lately been some provisional evidence suggesting increased cardiovascular mortality from regular high (in excess of 1500mg/d) levels of calcium consumption.



Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

Calico

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Goddess Forever
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Posts: 2,525
Reply with quote  #6 
Many thanks,
I will talk with my onc in April again.

I heard about the calcium too, my family practice doc mentioned that she suggests 2000 mg a day, even higher than the onc and bone scan doc with 1200.

Much appreciation for your thorough explanation!!!

__________________
~ There are lies, damned lies and statistics ~
CurlyGirly

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explorer
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Posts: 10
Reply with quote  #7 
Dear Constantine,

Thank you for the explanation as to why we should supplement with calcium phosphate. It not requiring stomach acid for absorption is also important to me since I'm taking a PPI. There's so much conflicting information on the internet, it can be quite confusing.

Take Care,
Jan

ShirleyHughes

Wild Woman
Registered:
Posts: 176
Reply with quote  #8 
Hello, Constantine.  I haven't been here in a long time.  And a SHOUT-OUT to our dear Gina!  
 
I will be seeing my onc soon.  I had a dexa on July 1.  I haven't talked to the onc, but I have been told by the radiology center where I my dexa that I had osteopenia NOW..fun...a long story on how I found this out without talking to my onc first.  My question is...what do you think about strontium citrate?  Strontium ranelate (Protelos) is, if I understood you correctly, not available in the U.S.  I have been reading about the citrate form and it also advises not to take it with our calcium supplement..to take at least two hours apart.  Also, some references say it's better to take a night. 
 
I don't want to take a bisphosphonate.  However, somewhere I read that when taking strontium that the dexa can be inaccurate.  I believe, if I remember correctly, say if one had a 14% gain in bone density it would be actually about 7%.
 
I found strontium citrate at Vita Cost (and other places).  I have ordered a 2 month supply.  I don't know what my onc will think, but I would like to try this before taking a bisphosphonate.  The dose is 680 mg, two capsules to be taken at night in one dose.
 
So, what do you think?  I'm just a poor cancer survivor  trying to do a few alternatives. 
 
Thanks!
Shirley
edge

Chief of Research
Registered:
Posts: 1,129
Reply with quote  #9 

Shirley:

 

Welcome back! 

 

Now as to strontium citrate, you correctly noted that the proven anti-osteoporosis drug is strontium ranelate (Protelos), not citrate, which is not yet approved in the US, and there is  no evidence  that  the citrate salt has any comparable, or even any, activity at all.  Sources here in the  states and elsewhere have been hyping, hawking,  and luring people to  the wholly unproven citrate salt, which however is  absent not only even an iota of human clinical evidence of benefit (for  anything at all, not just osteoporosis), but we have absolutely no supporting data even at the preclinical or in vitro data level.  Of course the lack of evidence  of activity does not automatically guarantee no efficacy, it's just  that  (1) nothing supports its use, and (2) efficacy is unlikely (and nor does it follow that one salt of an element will behave the same as another - there  are numerous examples to the contrary).  

 

Furthermore, and perhaps even more critically,  we have no safety studies, short-  or long-term, on strontium citrate and therefore cannot assume it safe  for use against osteoporosis (or any  other condition or disease), and strontium - in any form - can have adverse renal (kidney) and must not be  coadministered with calcium or calcium-containing foods, and there is some concern of strontium consumption raising  the risk of infections, among other possible adverse effects.  So  without any evidence of benefit, and with no evidence of safety, strontium citrate supplementation currently has no compelling scientific motivation. 

 


Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

ShirleyHughes

Wild Woman
Registered:
Posts: 176
Reply with quote  #10 
Thank you so much, Constantine, for your quick response and advice.  I received the darned Strontium..LOL 

I have been searching the web hoping I'd find something, let's say, more natural.  I do not want to take a bisphosphonate.  I'm beginning to think that these bisphosphonates do not work the same for every person.  I suppose that doesn't make sense.  But I hear it works for some and others not.   However, I have not seen my onc yet, so I do not know what her suggestion will be. 

I think I'll just go and bang my head against the wall.   

Again, thank you so much.
Shirley
nosurrender

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Reply with quote  #11 
Shirley, why don't you want to take the bisphosphonates?
I am so happy I am on the Zometa.

how are ya doing otherwise, girl friend???


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