Bisphosphonates and Afib : Due to breast... - AF Association

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Bisphosphonates and Afib


Due to breast cancer 20 months ago which was estrogen positive I have to take Anastrozole which is a AI (aromatase inhibitor). This can deplete bone density quickly hence I had to have a dexa scan which found I had osteoporosis. Due to this I was prescribed Alendronic Acid which had awful side effects. I went onto Risedronate which wasn’t so bad but over a few months made my acid reflux a lot worse. I have now been referred to a rheumatologist with the view of having a bisphosphonate intravenously or subcutaneously. This would take care of the Acid reflux but I am concerned about Afib. I am aware some bisphosphonates can trigger Afib, albeit in only a few cases. The infusion or injection is every 3 or 6 months so if it does happen I’m scuppered unlike like the weekly oral route.

Does anyone have any insight to this or had a bisphosphonate. Stopping anastrazole which depletes bone density is not an option as it’s keeping the cancer at bay.

Many thanks

Frances xxx

14 Replies

hi there, I'm on Exemastane as my cancer was also hormone receptive positive and that was diagnosed in 2015. Off course I have some debilitating side effects but am never sure which of my meds may be causing them. I'm having regular episodes of my AF this past while and my gp is now considering taking me off one of my meds. It'll be interesting to see what difference that makes to my 'flutters'. I've often thought of chucking the whole lot in the bin, but like you say, the AI medication is hopefully keeping the cancer away. Good luck with it all.

stay well

Blue x

Frances123 in reply to nikonBlue

Thanks Blue. Likewise I’m not sure which medication is causing what and some maybe age? All I know is that for the 13/14 years I’ve had acid reflux and Lone Parox Axfib I was fairly ok until the breast Cancer. Even then I was fine and sailed through surgery and radiotherapy. It’s only this past year I’ve felt yuk, acid awful and ectopics really taken off these last few months. They’ve e quietened a bit and mainly late afternoon and evening. The last thing I want is another drug to muck things up. Will see what rheumatologist says but in meantime gathering as much information as possible.


Frances xxx

Long story but I was put on Evista years ago by a gynecologist here in the Us. As I recall he recommended because my sister had breast cancer at a young age and at the time the drug was being used to prevent me from getting it. This was probably twenty years ago so please excuse me for not remembering how long I was on it and why I took myself off it. My reason for telling you this is, after being off the drug for years I was reading a magazine and found an ad for the drug so I read through it and alas there it was was, may cause AFib! I was flabagasted and angry that I wasn’t made aware of the side effects before going on it, I’m not positive this is why I developed lone AFib but with no other health issues this is a great possibility’! Like you I now also am dealing with Osteoporosis and am so fearful of the drugs! I’m for now taking supplements and doing my best to live a healthy lifestyle. I’ve learned a very big lesson over the years and that is to do my research and trust my gut,

Over the last few years this group of people on this forum have given me so much useful information that I had an ablation back in November and am doing well despite two episodes. I truly believe we can all help each other on our path to find the answers! Good luck and keep us posted!

Frances123 in reply to Gracey23

Thanks Gracey. I at least had Afib for 11 years before breast cancer so can’t blame the anastrazole for Afib. I actually find my local pharmacist is a good person to talk to for drug information, interactions and side effects. The rest of the time I have to find out for myself. I was quite astounded a few months back when I saw the doctor for tinnitus. Couldn’t see my regular doctor and saw a locum. He looked at my records and asked why I was on Flecainide. I said for Afib. He replied “you know that can cause tinnitus”. I couldn’t say anything else except “ well that’s news to me”. I left with information on tinnitus and disbelief.


Frances xxx

Gracey23 in reply to Frances123

I take Flecanaide and have tinnitus also, live and learn!

nikonBlue in reply to Frances123

yep, tinnitus for me too and didn't know the flec could cause that. :-(

Hi Frances - I am on Anastrazole but I have not had any of your problems, so cannot help with them. I have had two Dexa scans (I have arthritis so they thought it best to keep an eye on me!), one a year ago and two years before that and all clear. My AF came before breast cancer, so cannot blame Anastrazole for that. I was first on Letrazole, but it did cause some vaginal bleeding, very slight. Medics were unsure if it was the Letrazole or the anticoagulant so I stopped Letrazole for 3 months, this was after takine it for 3 years. No bleeding and I did notice that the joint pain I get from being on Letrazole lessened. I say joint pain, it is not like arthritis it seems to be more the nerves that are affected.

I was put back on meds but given Anastrazole . I still have a little bleeding not as much but the joint pain is back. I am not on the same AF meds as you, I have permanent AF and HF and I am on Nebivolol, Diltazem, Ramipril and Rivaroxaban.

How long have you to stay on Anastrazole, I had breast cancer op in 2014, luckily only a lumpectomy and radiotherapy which all went well, I was 67 at the time. The main guideline seems to be 5 years, so I am nearly there! I have asked various medics in my breast caner team why 5 years, the main response I get is that it is what is recommended. I will be glad to come off them but also feel a bit scared as well. Hope you sort your problems soon.


Frances123 in reply to cassie46

Thanks Cassie. I was diagnosed September 2017 and like you only had lumpectomy and radiotherapy. Sentinel nodes were clear. I’ve been told anastrazole for 5 years so I’ve 3 and a bit to go. I am aware that anastrazole can have delayed side effects so this may be what is happening and it’s kicking off other things. Just seems very strange that I’ve only had tinnitus (that I’m aware of) for about 10-12 months, even though GP said Flecainide can cause it. It is getting worse but that might be because I’m getting wound up with yet something else happening. The same can be said for the PACs.

I’m also aware that PPIs cause no amount of side effects like these and my one was changed 18 months ago so it might be that. I have, with BobD encouragement reduced it to 1 a day for 2 weeks and now every other day.

All I know is that everything was fine until about a year ago and when I had been on Breast Cancer and osteoporosis medication.


Frances xxx

Hi Frances,

I'm in a similar position to you, having gradually suffered bone loss after taking anastrozole for hormone positive breast cancer.

Like you I did not get on with the bisophonates, so was prescribed 6 monthly denosumab injections for the remainer of my five years of anastrozole.

I tolerated the denosumab reasonably wel but have now been told it may be unsafe to stop the injections because of a newly discovered risk of rebound fractures. I was on the cusp of agreeing to a yearly zolendronic acid intravenous infusion when the consultant mentioned a possible link to afib..........I'm seeing my EP in a few weeks and will ask his advice. Like you, the last thing I want is to top up my system with a drug that may set off AFib.

I'll let you know what he says. In the meatime I reluctantly maintained the status quo by accepting another Denosumab injection.

Good luck!


Frances123 in reply to ijan

Hi ijan

I had a zolendronic infusion about 9 weeks ago after looking into it and asking questions. The rheumatologist said it would be fine as did the specialist nurses at osteoporosis society. Apparently the few who had Afib during trial could well have been predisposed to Afib anyway and it couldn’t be said it was the zolendronic acid. I did ask my EP as well as I was seeing him and he said it wouldn’t be a problem too. Having 3 specialists all agreeing the same thing I went ahead with it. All fine and no side effects. Not even the flu like symptoms for a few days I was warned might happen by the nurse who administered it.

I have since had an ablation, 4 weeks ago tomorrow.

Denosumab is not a bisophophonate but a monoclonal agent which is a bone modifying agent and has good results. I didn’t know about the the new rebound risk and will look it up.

Hope you get the answers from your EP.


Frances xxx

Thanks Frances,

I think the risk of rebound fractures when coming off denisumab is something that has recently come to light. Proscribed wisdom suggests that the risk of rebound fractures can be avoided by administering a long acting drug like zolendraic acid which leaves the body very slowly over 18 months.

I got the impression that they are feeling around for an appropriate enable patients to stop taking denosumab

It’s heartening to hear that your zolendraic acid infusion didn’t trigger AFib.

Best wishes


My name is also Frances. I am on anastrozole. The doctor said to take vitamin D with calcium for the bones. I've read that just calcium isn't enough. Magnesium and many other things are found in bones. But the insurance doesn't pay for the expensive supplements. Do you know much about this ??

Frances123 in reply to fdale

Hi Frances. As soon as I was prescribed Anastrazole I was also prescribed Adcal-D3 which is calcium and vitamin D because of the damage Anastrazole does to the bones. I’ve also been taking Magnesium Taurate for around 4 years which I buy myself. I took this for ectopic heartbeats and before I was diagnosed with breast cancer.

I am in the U.K and being over 60 I don’t pay for prescribed medicine. Only for supplements. It costs me around £30/$40 us. for a 3 month supply of Magnesium Taurate.

If you look on YouTube for Sanjay Gupta a cardiologist in York U.K. he has made a video on magnesium and the heart. Think that will explain it a lot better than I ever can.


Frances xxx

fdale in reply to Frances123

Thanks, Frances, for your response. I hope you are well.

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