• Results of dexa scan...When our oncologist ordered a dexa scan....again we went and did our research. We found ...

    Asked by Alyce on Sunday, October 21, 2012

    Results of dexa scan...When our oncologist ordered a dexa scan....again we went and did our research. We found ...

    that generally scans are ordered prior to starting chemo to get a base line on levels of calcium in your bones, then another scan following chemo completion due to the chemo leaching out the calcium on your bones, hence giving you osteoprosis (sp), (my pre-scan was never done, my first scan ever was after the completion of my chemo) our oncologist, who ordered the dexa scan, said the calcium in the bones in NOT effected by chemo (so why did he order the scan if the scan/cancer does not effect my bones....now, as an oncologist, he is now treating me for osteoprosis.....which he said the scan had nothing to do with my chemo....so I am totally confused.....which you can probably tell by what I just wrote....any thoughts?

    6 Answers from the Community

    6 answers
    • lynn1950's Avatar

      Here is some information about chemotherapy and the need for a dexascan....lack of estrogen is the culprit in the onset of osteoporosis.

      This is from About.com:

      "...Chemo that includes cyclophosphamide, methotrexate, and fluorouracil (CMF) is the combination which is most likely to cause estrogen suppression. Post-chemo medications, such as Tamoxifen and Raloxifene also help to lower estrogen levels, and are important as follow-up for patients who had estrogen-receptor positive (ER+) tumors.

      Estrogen levels drop naturally during menopause, and during chemotherapy, many pre-menopausal women experience "chemo-pause" (monthly periods cease or become irregular). Regardless of whether your estrogen levels drop due to natural or chemical menopause, bone health becomes an important thing to discuss with your health care team..."

      PS. Arimidex also affects estrogen levels.

      Hopes this helps.

      about 4 years ago
    • nancyjac's Avatar

      I think you either got some bad information or you are misinterpreting your research results. A DEXA scan measures bone density, not calcium. Calcium levels are measured with a blood test. Chemo does not leach calcium from your bones. If anything it is the opposite. Metastatic bone cancer can rob bones of calcium, so systemic chemotherapy which kills cancer cells in the bone can inhibit the calcium lost. We all lose bone density as we age, whether we have had cancer and chemotherapy or not. This is especially true for women because the major hormone that sustains bone density is estrogen. As we produce less estrogen due to age and menopause, we have bone loss. 50% of women over 50 have osteopenia or osteoporosis.

      Even if your chemotherapy could have caused bone loss, what would be the point of before and after DEXA scans? It's not like you could take back the chemotherapy you have already had. The reason you are having one now is because you are over 50, and possibly because you are on medication to block estrogen if you cancer was estrogen receptive.

      The is no medical specialty for osteoporosis. Generally, your oncologist becomes your primary care physician during treatment for cancer, so it is quite logical that he would treat you for osteoporosis.

      Independent research is a wonderful thing. I do it all the time. But if it is confusing you or causing you to lose confidence in your oncologist, then it may be more of a hindrance than benefit to you.

      about 4 years ago
    • karen1956's Avatar

      I had my first dexa scan after finishing chemo...then annually while I was on AI's....osteopenia on first one...a year later borderline osteoporosis...starated on Actonel and another year later back up to osteopenia...I stayed on the Actonel till I quit the AI's and 2 1/2 years later spine is osteoporosis.....Since I'm not on AI's I only have dexa scan every 2 years....I'm on high dose of Vit D, calcium and magnesium....my pcp doesn't want me on biophosphonates as she feels that you should only be on them 10 years total (because of risk of femar breaking) and I've been on them 3 and she would rather me wait till I'm in my 70's then in my late 50's....BUT my pcp said that the chemo does harm the bones.....I had TAC.....and then the AI's......so as long as I stay stable now, I keep up what I'm doing...next dexa scan in 1 1/2 years...

      about 4 years ago
    • Alyce's Avatar

      and other sites, indicate that due to breast cancer treatment, it can cause you to lose density in your bones....I am triple positive with my bc. So they are inhibiting my estrogen. How do they measure the amount of estrogen that you body is producing? In all the tests they have run in the last several months, they keep saying they need to lower my estrogen....but they have never said what level my estrogen has ever been.....it's is sort of like, saying you need to add oil to your car motor...but you have never pulled the dip stick to check the actual level.....

      about 4 years ago
    • nancyjac's Avatar

      Breast cancer hormonal treatment (not the same as chemotherapy treatment) is to lower estrogen in those with estrogen positive breast cancer. Less estrogen can result in less bone density. That is what the sites you cited are saying and what we have said in our previous posts. Estrogen can be measured in the saliva, urine, or blood. Odds are you oncologist has "pulled the dip stick" with one or more of the testing methods several times during your treatment. Simply ask for a copy of your test results if you want to see actual numbers.

      about 4 years ago
    • carm's Avatar

      Hello, I am an oncology/ end of life nurse and I specialize in gyne cancers but perhaps I can help you to understand the DEXA scan tool. But before I do, let me first say that as a nurse, it is wonderful to hear a patient doing the research and educating themselves on their disease and the various therapies and tools used to combat that disease. You empower yourself and this makes you a worthy opponent in the battle you fight. Knowledge is so powerful a tool and I commend you on taking the initiative to understanding and questioning the therapies you are instructed to follow. A Dual Energy X-ray Absorptiometry or DEXA scan uses very low levels of radiation to uncover the weak points in your skeletal system that are more prone to break or fracture as your mineral density decreases, or bone loss or osteoporosis develops with advancing age. As we get older, we all lose bone density. I am older than you, so trust me when I say that I am not stating you are "Old," but this test is done by comparing you on two levels and results in two scores. So lets look at those scores. The first is a T-score. This score measures your bones by comparing to them of a young, healthy woman. A score above a -1 is considered normal. A score between -1 and -2.5 labels you osteopenic, or a greater risk of osteoporosis. Any score below a -2.5 means that you do indeed have osteoporosis.
      The next score is the Z-score. This score results from comparing the condition of your bone density to women who are of the same age and race as you. So this score is the one that will tell you a more realistic view of your bones. Some of the drugs used for breast cancer are called Aromatase Inhibitors (AI). These drugs slow the progression of estrogen produced by your body but these AI's increase the risk of osteopenia and osteoporosis. Some common AI's are Femara, Arimidex, and Aromasin. There are other types of drugs used, and one is an estrogen antagonist called Tamoxifen. This drug does not slow the production of estrogen in the body, instead it blocks the receptors on the breast from getting estrogen thus starving the tumor of estrogen, which in turn inhibits the growth of the tumor. Tamoxifen does not cause osteopenia or ostoporosis. It is quite possible that your oncologist is considering the use of AI's but must first know the condition of your bones before he begins that type of therapy. Regular chemotherapy does not normally remove the calcium from the bones, rather it affects the factory within, the bone marrow production where your immune cells are born, cells like neutroblasts. This is not to say that chemotherapy does no damage, it does quite a bit over time, but when you take a chemotherapy its kind of an understanding between your doctor and the pharmaceutical company that produces the drug that in the short term, that chemo is going to show a benefit to you in killing off those cancer cells and bringing you to a point of remission or stable disease you can live with. However, in the long run, the chemo does carry the risk to do more harm than good with too much use. Then again, what drug doesn't carry that risk?
      The main important fact in your post is that you are questioning the process and by doing so, you are learning of all the tools in your arsenal. You are to be commended for that. Let me end by giving you a website that is a great source of information to all my patients and I always recommend it to many here. It is chemotherapyadvisor.com and it is a great place to learn about your treatments and their associated side effects. It is a free site to join and it contains a ton of useful information for you. If there are times when you find yourself questioning your oncologists decision, just ask your oncologist for the names and contact information of two other patients with similar diagnoses that he has recommended the same treatment he recommends to you. Talk to his other patients and ask them about their experiences. It is quite common for an oncologist to treat osteoporosis as a side effect of any drug they prescribe much like they give you antiemetics to head off any nausea that might also develop. I wish you the best of luck and my hats off to you, your thirst for knowledge and your curiousity will go a long way in this battle and help to insure the promise of a victory in your battle. My best to you and I am here if you need me, Carm.

      about 4 years ago

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