Osteoporosis in the oncology setting.

Betty is a 67-year-old woman originally diagnosed in 1992 with a tumor 1C, node 0, metastasis 0 infi ltrating ductal carcinoma that was estrogen and progesterone receptor positive. She was treated with a right modifi ed radical mastectomy followed by fi ve years of tamoxifen. In October 2001, she had a local recurrence that required an excision of a 0.5 cm diameter lesion followed by radiation, chemotherapy with cyclophosphamide and doxorubicin, and hormonal therapy with letrozole (Femara, Novartis Pharmaceuticals, East Hanover, NJ). Betty’s personal medical history includes two pregnancies, menopause at the age of 55, and hormone replacement therapy with estrogen for one year following menopause. Betty also has a history of hyperlipidemia and nephrolithiasis. She denies any alcohol, tobacco, or illicit drug use. Signifi cant family history includes her mother having an unidentifi ed gynecologic cancer. Betty had a routine screening bone densitometry test done in November 2004. At that point, she had been on letrozole for 37 months. The left hip T score was –2.47 with a corresponding –0.39 Z score. She was diagnosed with severe osteopenia of the left hip, which has a medium risk for fracture. The lumbar spine scores were normal. Betty was placed on alendronate (Fosamax, Merck & Co., Inc., Whitehouse Station, NJ) 35 mg by mouth weekly in adOsteoporosis in the Oncology Setting