My next phase of treatment is to take an aromatase inhibitor (AI) pill daily for 5 years. AI causes bone loss. Since I already have osteoporosis, I will be given an IV infusion of a bisphosphonate called Zometa every 6 months to minimize bone loss. However, side effects of bisphosphonates include atypical femoral fractures (AFF) and osteonecrosis of the jaw.
The risk of AFF is higher for Asian women, and that's what I'm most concerned about. I had a visit with Dr. Deborah Kado at Stanford yesterday. She said I should be more concerned with hip fracture than AFF. She recommended the following. I'll just paste what she entered in the visit notes.
- Agree with recommendation for IV Zometa for 3-5 years, particularly if she is to start an AI. Given patient's body size and Asian heritage (that is associated with increased AFF risk per Kaiser Southern California data as well as Canadian data), may consider a slightly decreased dose of 3mg every 6 months instead of 4 mg (though there are no trial data to support this recommendation). Asian treating MD's from Taiwan, Toronto and Japan have recommended decreased bisphosphonate doses in Asian females because of the elevated AFF risk.
- Vitamin D3 supplementation, 1,000-2,000 IU daily; may recheck level in about February (target is 30-50ng/mL of Vitamin D 25-hydroxy level
- Calcium intake up to 1200 mg daily, preferable through dietary sources (see sources below)
- Diet full of daily fresh fruits and vegetables
- Work on balance daily, mindful of posture 3 times daily (see handout below)
- Visit the dentist regularly, and floss daily
- When move to Kaiser (possible plan), recommend Dr. Joan Lo to follow-up on osteoporosis clinical care.
I will probably take a break from Zometa after 5 years. My Vitamin D level last January was 32. The balance recommendation is probably so that I don't fall and break my hip. The dentist is for avoiding osteonecrosis of the jaw. #7 mentions Kaiser because I will have to switch insurance soon. More on that later.
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