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Should I take Alendronic Acid

Posted , 14 users are following.

gladioli30
gladioli30

Hi, My doctor and rheumatologist wants me to take Alendronic Acid. But I am very reluctant, mostly because of the side effects which may affect my stomach, which honestly is delicate enough. The rheumy suggested a yearly injection. Although I have the tablets, I have not as yet taken them. Besides my tummy probs, I don't fancy a full glass of water and standing up for half an hour. Would value any of your comments please.  

2 likes, 35 replies

35 Replies

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  • pat38625
    pat38625 gladioli30

    Posted

    Hi, I am a newbie on the site and someone with a lot more experience will get in touch with you.  They are a great bunch on here so you are more than welcome.  Good luck.

    Pat

  • EileenH
    EileenH gladioli30

    Posted

    You don't have to stand! Just sitting upright, as on a dining chair is enough - you just mustn't lie down or bend over.

    However: Have you had a dexascan? That is the scan to see what your bone density is like. The consideration as to what bone protection you need (or don't need) should only be made after a scan that shows what state your bones are in. I had my first a few months after starting pred and it was fine. I had another after well over 3 years of taking pred - it was to all intents and purposes the same (done on a different machine but it was still acceptable). All I have taken in the meantime is calcium and vit D supplements. That is the starting level of "bone protection" recommended by the British Association of Rheumatologists. Other stuff should be used only when shown to be needed.

    Only about 40% of people on pred develop osteoporosis and I personally want to know whether I really need to take something like AA. It isn't just the gastric aspect - many dentists won't do some procedures on patients who are taking or who have taken AA - but they only find out when it becomes necessary. It should not be taken for more than 5 years (latest recommendations from the FDA) and I would prefer to keep it as an option when I need it - I may never do so.

    If the single annual injection version is zolendronic acid then the gastric side effects are minimal - it may cause nausea but there isn't the risk of the reflux and damage to the gullet that is a reason for not using it in patients with pre-existing problems.

    However - first of all: a dexascan to see if you need it at all yet.

  • tavidu
    tavidu gladioli30

    Posted

    Hi gladioli

    Have had PMR for 8 months and have been on 70 mg Alendronic Acid tablets taking 1 a week. I have found them to be no problem what so ever at the moment. I was advised against the injection which I believe is much stronger and can cause more damage in the long term.

    Others who have more experience than I on this forum may advise otherwise but this is my personal experience of them. Hope it helps.

  • tina-uk_cwall
    tina-uk_cwall gladioli30

    Posted

    Hello gladioli, yes the good old alendronic acid Drs like to dish out like sweets if any of their patients are taking steriods for any given length of time, regardless of wether any bone density tests have been carried out. Steriods are not good for bones and we all want healthy bones so that the risk of fractures is reduced. But I believe that as soon as we're prescribed prednisone we should also have a bone density scan followed by periodic bone density cheks. Surely that makes much more sense? 

    Your stomach is the last of your worries when taking alendronic acid. It also can damage your top and bottom jaw bones, and once they are damaged should you ever require a tooth extraction, you could be confronted with complex problems re your jaw bones. 

    I stupidly took alendronic acid for a year before finding out about the jaw bone problems, needlessly to say I don't take it any more but according to all research the 

    Effects of the drug are in your bones forever. 😥

    if I were you I'd ask your Dr for a bone density test and see what that reveals. I also take vit d, and calcium supplements along with others. Good luck, christina 

    • allie42357
      allie42357 tina-uk_cwall

      Posted

      Thank you for your advise, I've been so worried to take the tablets, I've taken them on and off for about 6 months I guess.  I've Oesteopena and have had a dexta scan showing Z score -1.8 and T score -2.4. 

      ​I'd rather look after myself in natural ways but scared to go against the advise of my Dr.

    • tina-uk_cwall
      tina-uk_cwall allie42357

      Posted

      Hello allie, not being medically trained I have no experience re your dexa scan readings, but the topic of bone damage seems to be the topic of the day. 

      Keep taking your vit d, calcium and magnesium daily, RDA amounts. Keep up with a daily gentle exercise programme which can consist of nothing more than walking, the best weight bearing exercise for helping to increase bone density.

      regards, tina

    • EileenH
      EileenH allie42357

      Posted

      The Z score is pretty meaningless really but your T-score is pretty borderline - -2.5 is where the diagnosis changes to osteoporosis. When did you have the first dexascan done? You will need another after about 2 years to see if things have got any worse. Are you OK when taking the alendronic acid?

      I really would suggest contacting the National Osteoporosis Society if you are in the UK and discuss it with their helpline. 

    • allie42357
      allie42357 EileenH

      Posted

      Thank you Eileen, I'll contact the NOS and have a chat.  My dexa scan was March this year, the dr said 5 years before my next, I'll push for one sooner than that though.
    • allie42357
      allie42357 tina-uk_cwall

      Posted

      Thank you Tina, I'll check the max doses of the vits and be a bit more organised to take them.   
    • EileenH
      EileenH allie42357

      Posted

      Under normal circumstances 5 years would be fine - the changes are normally slow and more often than that probably isn't worth it if you have good bone density now. Pred MAY change that - hence the recommendation to have it done after 2 years maximum. Though presumably it is assumed you are taking alendronic acid so it won't get worse. Did they check your calcium and vit D levels before putting you on the bone tablets?
    • allie42357
      allie42357 EileenH

      Posted

      Yes calcuim was fine but Vit D low, it was back in March time.
    • EileenH
      EileenH allie42357

      Posted

      Then before you take the "bone protection" pills you need to have that vit D got up to where it should be - it says it quite clearly in the data sheet for the pills. That means highish dose vit D and checking the blood level. Only when both are in the recommended range should you start the alendonic acid or risendronate, which ever they give you.
  • Dave-California
    Dave-California gladioli30

    Posted

    Hi Gladioli - I have been taking 70 mg Sodium Alendronate tablets (Fosamax) once a week for 11 months and do not appear to have had any reaction - although I was initially concerned due to comments by others.

    As EileenH mentioned, you don't have to stand up - I usually just sit and do my emails before eating breakfast - and drink 6 oz of water with the pil on an empty stomach.

    Dave

  • Diana112
    Diana112 gladioli30

    Posted

    Hi, like you I have been prescribed Alendronic Acid and queried this with my doctor as I had no wish to add any more problems apart from dealing with the PMR.  Apparently the standard advice is that if you are over a certain age, 60 or 65 I think, 'the book says - DEXA scan not required' - so they just prescribe the drug as at that age you are cosidered to be automatically at risk of osteoporosis !   I guess you can arrange to have a scan carried out privately, I don't think it is a prohibitive cost.
    • tina-uk_cwall
      tina-uk_cwall Diana112

      Posted

      Hi Diana, I have no idea what the cost is, hopefully it won't be too high, however, before you go down that route, talk to your gp first, you never know they may be willing to send you for a scan, and you will have saved yourself some expense!  After all if you don't ask you don't get! Christina
    • EileenH
      EileenH tina-uk_cwall

      Posted

      There is this assumption that older people are automatically going to have osteoporosis - but it is based on our mothers' generation. If you have been on HRT it is less likely for one thing. I know two ladies who are just under and just over 80, who have been on pred for 5 years or longer and whose bone density is perfectly OK. It ain't necessarily so. The age is over 65 I think but I would hold out for a dexascan.
    • EileenH
      EileenH

      Posted

      PS Gladioli - where do you live?
    • gladioli30
      gladioli30 EileenH

      Posted

      Hi Eileen, I live in the Huddersfield area. And to answer your other query, I have had a Dexa scan, it showed thinning of the bones, but not full blooded osteoporosis. Why do you need to know where I live?  Having read all the replies, nothing I have read will convince me to take AA.
    • EileenH
      EileenH gladioli30

      Posted

      I asked because many of the people who post on here are from all over the world - makes a big difference in terms of what system of health care they are under.  I also believe that Southhampton (for example) offers very reasonably priced dexascans to anyone - it was in the event you hadn't had a dexascan and if you lived south of London the going to S'hampton might have been worth it. 

      There is an outstanding PMR/GCA consultant at Leeds - just in case your rheumy gets particularly shirty when you refuse AA.

      No, I wouldn't take AA unless they proved to me I had osteoporosis - or at the very least osteopenia that was bordering very closely on osteoporosis. It is something that should be kept for need. Unfortunately the company that developed it marketed it as the best thing since sliced bread to prevent hip fractures and there is a generation of doctors which was brought up on the wonders of AA. Things that they learn at a particular stage of their career tend to remain in their minds and it is very difficult to persuade them otherwise. In the meantime the thoughts have changed a bit - they then lag behind.

    • Dave-California
      Dave-California EileenH

      Posted

      Hi Eileen - you mention the info from around the world and indeed I agree that the systems are very different.

      FYI - United States Preventive Services Task Force (2011) that provides standards for many of the 'masive' US medical insurance companies states the following -

      " the risk for osteoporosis increases steadily and substantially with age. Relative to women aged 50-54, the odds of having osteoporosis were 5.9-fold higher in women aged 65-69 and 14.3-fold higher in women aged 75-79, in a study of over 200,000 postmenopausal women. Low body weight or body-mass index (BMI) and not using estrogen replacement were also consistently associated with osteoporosis but to a lesser degree than age. Other risk factors for fracture or low bone density found in some, but not all, studies include white or Asian ethnicity, history of fracture, family history of osteoporotic fracture, history of falls, low levels of physical activity, smoking, excessive alcohol or caffeine use, low calcium or vitamin D intake, and the use of various medications. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.

      Bone mass measurement (BMM) is considered medically necessary if ANY of the following criteria are met:

      ·  A woman determined to be estrogen-deficient and at clinical risk for osteoporosis based on medical history, age and other findings; OR,

      ·  An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture; OR,

          An individual receiving (or expecting to receive) glucocorticoid therapy equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months; OR,

      ·   An individual with primary hyperparathyroidism; OR,

      ·   An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy

      DEXA/DXA is considered medically necessary for those on Corticosteroid use with hip or rib pain; OR, Low impact / vertebral fracture.

      The Frequency Standards - BMM screening is considered medically necessary once every 2 years (given at least 23 months have passed since the month the last covered BMM was performed).

      More frequent BMM is considered medically necessary for, but not limited to, the following indications:

      ·   Monitoring members on long-term glucocorticoid therapy of more than three months

      ·   Confirming baseline BMMs to permit monitoring of members in the future......."

      It seems that in the US, regular wellness care for the elderly is saving insurance companies a great deal and many of the osteo issues are being financially covered and put into action - hopefully based on professional evaluation by qualified specialists.

      Dave

       

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