update 2 Oct 2010: a practitioner asks what to do for a white female 58years:
1998 ductal cell. lumpectomy, radiation, 15 nodes removed. Tamoxifen 5 yrs.
2009 lobular cell. double mastectomy, nodes removed. Aromasin for next 5 yrs.
Osteopenia -2.3 found inside 1 yr . on Boniva ibandronate 4 yrs, stopped recently. Doesn’t want to take IV drug for osteoporosis. 24 hr urine calcium normal. High vitamin d levels.
takes a lot of calcium, vit d, vit c, vit b complex sups. Takes Prilosec omeprazole for reflux and hiatal hernia. chronic insomnia. The questioner does not reveal her bodymass index or resting morning cortisol level or insulin resistance- all of which may well be raised; nor give her crucial vitamin D and C intake or vitamin D blood level. It is a question of evidence, not opinion – dogma- or laboratory average population ranges , as to what are optimal intakes and blood levels.
This column has regularly reviewed the conflicting views and evidence on osteoporosis; BNP and breast cancer; and the safe multisystemic efficacy of using the score of natural supplements- including appropriate combined hormone replacement therapy – that safely oppose both osteoporosis – bone and muscle frailty- and the associated chronic major involutionary diseases of aging especially vascular disease, dementia and cancer. .
The antireflux proton pump inhibitors PPI drugs notoriously aggravate osteoporosis; and for average reflux are not necessary with use of slippery elm, apple cider vinegar, simple calmag and sensible diet and lifestyle. It has been known for years that PPIs more than double risk of osteoporosis, so why take them?.
On the other hand, the pluripotential hormones of darkness and light – vitamin D3 and Melatonin – combined with the other mulibeneficial natural supplements that synergistically relieve/ reduce insomnia, reflux pain, cancer, depression, memory loss and all other significant major chronic degenerative diseases of aging.
As this column regularly updates, Metformin too is a natural supplement (plant) co-hormone- a veritable panacea- that reduces all major chronic disease and mortality by about a third- including cancer; and dementia perhaps via reducing serum amyloid levels.let alone tissue oxidation, glycation, vasculopathy. BPN has none of these extraosseous benefits, only deadly risks.
So middleaged patients are at terrible risk of anxiety depression hypercortisolemia, frailty fractures, vascular disease , cancer and dementia after cancer, especially with sex hormone suppression or blockade. They do not need the myriad risky designer drugs touted for prevention of more cancer etc, all they need urgently and permanently is the scores of appropriate natural balanced supplements as this column regularly reviews- most of which supplements can simply be mixed in a tub of customized powder blend to be drunk twice daily. .
:Feb 13, 2009 In response to Death-knell-for-bisphosphonates-for-osteoporosis-breast-cancer-time-for-class-action-against-bisphosphonate-damage last week, a world-renown emeritus professor of radio-oncology comments:
“the action of the bisphosponates BPN is to inhibit osteoclastic action and thus reduces bone resorption; the patients tell the story- they get immediate and sustained relief from bone pain; if they are on opiates the need is much reduced. Of course palliative RT is valuable, but often if pain recurs after RT the BPN give welcome relief, at least in my experience.
The IV BPNs are also very useful in the oft-times encountered hypercalcemia often threatening myeloma- and other cancer patients. I am not however, too conversant with D3 in this setting!” But the first reference links are the latest in the clinical field of BPN and cancer.
Other than in terminal cancer cases- when it doesn’t matter what convenient pain relief is used- the problem with bone pain in cancer always is, what is the cause? either bone resorption from the catabolic effect of cancer (via eg high parathyroid hormone PTH); OR cancer eating away at bone itself, OR something else common OP unrelated to the cancer.?
But FOR CANCER-RELATED bone pain lesions – whether directly from cancer there, or from remote metabolic effect – where are the trials comparing BPN with other antiresorptive antineoplastic ANTIINFLAMMATORY ANALGESIC ANABOLICS ie testosterone (or occasionally estrogen/ other antiandrogen) and vitamin D3?
Obviously bone metastases are attacked with appropriate chemo-/ xray XRT, cortisone, testosterone AND if deficient, vitamin D3.
To put it the other way round: where is the evidence that BPN – at cumulative cost and risk- adds benefit to the multiple attack? where the evidence that- unlike testosterone and vitamin D3- BPN has any benefit except on bone pain? Hypotheses based on in vitro and animal and human cell culture studies have not translated into even good observational comparative evidence favouring BPN as good benefit:cost ratio for osteoporosis or cancer.
The oncologist answers in the traditional mode, by experience that BPN works. But evidence-based medicine EBM asks where is the comparative evidence for BPN to challenge the evidence that we have better multi-attack without BPN – when these supplements are not equally commercially promoted and tested in controlled trials for the usual commercial reason ?
The dream of drug manufacturers is eternal, that their raincheque designer drug- statin or BPN or antihypertensive- will prove to be a safe multisystem panacea as is metformin and many other supplements like vitamin D3 or testosterone. But after more than 30 years of BPN and statins, no trial in humans has yet shown this for BPN or statin or any other original designer drug.