"Osteopenia" - apparently it's Xgeva time...

I'm on 6-month Prolia shots for the same thing. The possible side effects are a bit scary. My uro had me get a sign-off from my dentist that I had no evident need for dental work before it was administered the first time.

Since, I've had a situation where I really need a crown (tooth shattered), but the dentist won't do it. He literally built a tooth from the facings they often use. Lost the word ... - Dental insurance freaked out, paid virtually nothing, oncologist said he did the right thing, unlike some who would put the patient at risk.

On a related note, does anyone know how much a monthly Xgeva shot costs? We're doing our annual benefits enrollment, and I'm trying to model my projected health care costs.

Jerry,

Xgeva (denosumab - 120 mg every 4 weeks) is only FDA-approved in men with diagnosed bone mets. It prevents skeletal events like pain, fractures and spinal compression. I think you'll have a hard time getting insurance to pay for it when you don't have diagnosed bone mets and only osteopenia.

Prolia (denosumab- 60 mg every 6 months) is the version that's approved for men with non-metastatic (to bone) PC who are at high risk for fracture because of ADT-induced bone loss. You may have an easier time getting it than Xgeva.

- Allen

Hey Allen, thanks for that info. I'll be asking about that right up front. Seems the med onc would know that. If insurance won't cover it, it ain't happenin'!

Ok, I found a pretty good link about Prolia:
www.cancer.gov/cancertopics/druginfo/fda-denosumab#Anchor-BM

Apparently, a 24 month trial with 60mg/6 mo injections showed about a 5.6% increase of Bone Mass Density vs. -1% for a placebo.

I dunno.... for all of the side effects, risk of osteonecrosis of the jaw (to the extent of requiring a dentist's sign off before treatment), that seems (to this engineer) a pretty small benefit.

How much change in bone mass density (BMD) represents an issue, I wonder? Is 7% enough to make the difference between fracturing or not? Man, that seems unlikely.

So, let's I'm at 58% of target BMD now (my worst reading). With Prolia, it could go up to about 64%. Without it, might drop to 57%. How much change of fracture risk might that represent?

The T score is used to show how many standard deviations an area is from a max BMD for a 30 year old. T score of -1 to -2.5 is osteopenia, less than -2.5 is osteoporosis.

My T score dropped from baseline -1 average to -1.7,-2.3, and -3.1 in some areas now, so that's pretty significant and diagnosed as osteopenia. Playing with Excel a bit, increasing the BMD% from 58 to 64 (absolute 6 point increase) takes the T score from -3.1 to -2.6, still at concern level. Decreasing by 1% to 57% takes it from -3.1 to -3.2, a negligible change for the worse.

So far, I guess I'm not really seeing the benefit of it in the simple numbers. This should be an interesting conversation with the med onc.

Well that is interesting. Thanks, as always. More to ponder!