What would you say re:bisphosphonates and known bone lesion(s)? I am on ADT3, second round.
Would you rx Zometa or start with fosomax? I am aware of the jaw necrosis side effect possibilty. My bone density has always been good, even with the first round of ADT3….lowest was a T score of +0.95, usually T=+ 1.2-1.4.


As the many side effects of Zometa have been revealed, I find myself using it less and less. Fosamax is much safer. However, of late I have become most impressed with low dose estrogen as a way to protect bone. I use Vivelle dot 0.025 mg/day patch. This often results in a significant increase in bone density and not just prevention of bone loss. Additionally, it lessens hot flashes and will often eliminate them altogether. Alterations in brain function seem also less of a problem when the patch is used.

Some physicians use Zometa because they think it aids in controlling bone. There is some evidence to support this contention, but it is not very strong. However, the one place where I still recommend Zometa is in men with very extensive bone disease and evidence of cancer that is unusually aggressive. Out of the close to 1,000 patients in our clinic, I would guess that fewer than 30 are on Zometa. In contrast, quite a few are on Fosamax or Actonel combined with Vivelle dot. However, most are on Vivelle dot alone.