bisphosphonates -- ?

I saw my doctor yesterday and the big question on the table was about bisphosphonates. I had wanted to be in a clinical trial about them, but missed it because of the extra chemo I took. (I had to start them within a certain timeframe after having stopped chemo and had surgery -- but the extra chemo didn't count, and since I had to wait til it was done, it was past the timeframe.)
HOwever, I had a bone scan which found "osteopenia" in my spine, which is bone loss. It's not wonderful, but it's not osteoporosis, and should qualify me for a bisphosphonate through my insurance. This is a good thing, because bisphosphonates seem to play a role in prevening bone metastases in breast cancer. However, there is a catch.

There is some small risk of jaw cell death associated with bisphosphonates. I wasn't worried at first, and my periodontist said I should go ahead. BUt then Alan started reading more about it, and I realized that I already have bone loss in my jaw; that is somehow part of the periodonal problem I have. (This is the one problem I have that is actually predictable because of family history -- as opposed to the glaucoma and the breast cancer, which were surprises.) My concern is that perhaps having a preexisting condition which predispose me to bone loss in my jaw -- or perhaps the fact that it's already happening to some extent -- means that I fit the profile of the person more likely to have this reaction to the use of bisphosphonates.

SO my oncologist recommended I see an endodontist for a workup. The last thing I want is more doctor's appointments, but I have to agree that if this guy has tests he can do which will tell us more about whether it makes sense for me to take bisphosphonates or not, before I take them, that would be smart -- even if we have to pay out of pocket for it. (Won't know that til after we pay and submit the request to the insurance company, which is how it goes for the endodontist.)

I've never seen an endodontist, BTW. All my problems have been perio, and dental. I did find a 2nd cavity..... The periodontist found one at my first cleaning (a week after I finished chemo) and I don't know how he missed this one, but I found it, so I'm getting that filled soon as I get back from MA, where I am off to tomorrow, with EMily. THen I see the endodontist a couple of days after that. I left room for bike rides on Wed and Fri. No time for jobs though -- we're back to that again! BUt maybe just for a week......

Anyway -- my oncologist said that it's possible the endodontist will say that under no circumstances should I use bisphosphonates at all. In that case, he said, he would recommend denosumab. He spelled it out and told me to have ALan google it. (But why stop at Alan? Anyone else wants to check it out for me, feel free -- I looked already, but the more eyes and brains, the better, especially when some of them are mine.) Apparently it has no jaw cell death side effect and MAY be the next great drug for preventing bone metastases..... but it's new, and they don't know, and it may have other issues, and in any case insurance probably won't pay unless bisphosphonates are counterindicated.....