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Done with X-rays of finger, back and upper spine. Bones are looking light. Diagnosed with bladder cancer and taking femara. Advise?

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I've been told by 3 or 4 different doctors within the past several months after taking x-rays for different reasons, finger, back, upper spine, that my bones look very light and asked if I was on any treatment. My endo who also follows me for thyroid cancer wants me to stop my biophosphates at least for a time because he feels I have been over treated with them after diagnosed with BC and taking Femara even though he performed a blood test to check how the bone was being turned over and it was fine. I had a bone density scan which showed I'm now in the osteopenia range vs. osteoporosis which is an improvement but the number is only by .1 differential. He strongly feels the bone scan is the indicator and not putting any credence on the remarks from the other specialists, orthopedic doctors among them, that my bones look very light on x-ray and therefore thin. Could you comment? Also, a recent chiropractor who does specialized treatment commented that he would be leary having me treated with conventional methods, cracking, hand manipulation etc. due to what the x-ray shows.
Posted Sat, 14 Sep 2013 in General Health
Answered by Dr. K. Naga Ravi Prasad 1 hour later
Brief Answer:
You need some supplementation for your bones.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

If 3 or 4 doctors have commented the same thing by looking at your xrays, then it can never be a wrong diagnosis (with regard to your low bone mass).

It doesn't make much difference in the management aspect of osteopenia or osteoporosis (with the differential being .1 only).

Bone density scanning (in the form of DEXA -Dual energy xray absorptiometry) is the most commonly used diagnostic technique for osteoporosis.

You need some form of daily supplementation to keep your bones strong and healthy. Apart from Bisphosphonates, there are many other medical treatments available for treating osteoporosis. A few of them are -

* selective estrogen response modulators, RALOXIFENE
* Calcitonin
* Teriparatide (parathyroid hormone) etc

So, I suggest you to discuss with your treating doctor about the various modalities of treatments for osteoporosis as mentioned above and he will pickup the one which suits better for you.

A few life style modifications may also help in keeping your bones in good shape.
* Regular walking can provide benefits to the frail osteoporotic bones beyond positive changes in BMD
* Discontinue smoking & alcohol as both are detrimental to your bone health (applies only if you are a smoker or alcoholic)

Hope I have justified your query. I welcome any clarification

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