Alendronic acid and teeth

Mrs.O Very best of luck with your dentist tomorrow. It does sound as though it could be the drilling that has caused your pain. Have you taken any painkillers? If so, which and did they help?

I do feel very lucky to have met my new one. He was recommended by our builder and also a long-term and very selective ( and well off!! ) friend so was fearful of the cost. It was less than £300 and he had every chance to sell me treatment that would have cost much more but did not; rather, pointed out that it would have been unnecessary expense to have complete new dentures.

Wonderful day in every way here today. Weather A1. ALSO after lots of extra walking woke up with almost no leg pain. Did ring our dispensary before dentist to see if ok to take cocodamol if necessary and told it was fine with Pred. Took 2 at bedtime as anaesthetic wore off and told not to let pain build up and slept all through. Is this the magic combination?? Will certainly ask GP if it's ok to use cocodamol rather than up the Pred. at times of stress to keep pain at bay. I feel so very much better when I get below 7 and hope not to have to go up.

Boosted my Vit D in the garden and got quite a lot done.

Hope you enjoyed your Tai-Chi.

No Betty I haven't taken any painkillers yet (I'm pill phobic! :roll: ) but may resort to a paracetamol. Thanks for those good wishes for tomorrow.

That's very interesting that the cocodamol seems to have relieved your leg pain - isn't it such a wonderful relief when a long standing niggling pain improves - I bet it tempts you to take another cocodamol tonight even it it just gives you another good night's sleep! :wink:

Hello Mrs O

Hope all goes well at the dentist tomorrow Im almost looking forward to my next Dental check up just so I can ask her opinion of AA !!

It has been the most wonderful day here today Nordic walking in the forest this morning 3 miles !!! I had a nice sleep for an hour this afternoon in the garden ( topping up my Vit D !!) then all my horsey work It is taking me about 20 mins just to groom them at present as they are moulting like mad probably nearly a month early !!

Im hoping Easter wont ruin it all as I can remember awful Easters !!

Best wishes

Mrs G

Hi Betty,

Glad all has gone well with you, I'm still waiting for the hospital to get in touch with what is now going to be two extractions. Hate the thought!

When I first started on steroids the GP went all through the not having ibuprofen etc and said take paracetamol. I told him it had absoutely no effect on me, and he has been prescribing co-codamol ever since which certainly works well for any pain I have. But I tend to avoid it during the day as it makes me so sleepy! :roll:

Hope all goes well with you Mrs O. too.

What a gorgeous day we've had here :D Green granny

Hello all really good to be able to talk about this alendronic acid matter.

Have been on steroids for 6 months had a DEXA scan with above average bone density for my age but Dr put me on alendronic acid ('I should be on it'). Took 2 courses of 4, 8 in total and all nerves in all teeth hurt. Decided to stop having read info and this forum posts re jaw necrosis and the pain and the fact that it remains in the body for so long. Just seen new GP who is strongly advising me to take it not considering the teeth pain significant and 'if it gives you more problems we can use something similar'. My overall feeling is no especially as I have it seems bone 'in reserve'. Would be most grateful for comments. Thank you all. Nicknocks

Hi nicknocks! Now that's a different name!

If you have had a dexa scan with above average bone density for your age there is no reason whatsoever to be taking alendronic acid. You do need to continue with the calcium and vit D supplements you should also have been given as steroids make you get rid of calcium through the kidneys so you need more available to get into the bones.

If you go to the PMR and GCA Northeast support site (google it if you haven't seen the links on other threads here) you will find the Guidelines for the diagnosis and treatment of PMR issued by the British Associaton of Rheumatologists. In that they give guidance for "bone protection medications". You have the dexa scan results - so all you need are calcium and vit D. They should have checked both calcium and vit D levels BEFORE prescribing the AA as, unless your vit D levels are high enough, the AA is useless as it cannot be absorbed anyway.

AA only works to increase bone density AS LONG AS IT IS BEING TAKEN. It is absorbed into your bones and then attracts calcium to it to form new and denser bone. Once you stop replacing the layer of AA every week it becomes covered in calcium and no longer works inthe same way. Because of the now emerging downsides of AA, the FDA in the USA has recommended it should only be taken for a maximum of 5 years - so it seems to me it is logical to keep it for when it is needed, not use when it is not.

Many doctors have been convinced by the marketing done by the company that developed Fosamax, the original drug, that "prevention is better than cure". The company provided the non-dexa scan equipment for measuring bone density using the heel and did massive studies. The measurements with this piece of equipment are, in the opinion of many experts, dubious and were shown to be so in a study by a British medical physics group. However, be that as it may, if someone is taught something at a crucial time in their education it is very difficult to dissuade them of its truth and many doctors still believe AA to be wonderful.

There are other drugs that encourage replacement of lost bone calcium, your doc is quite right there. However, if you have problems with AA you are likely to have problems with any other bisphosphonate (this is the group of drugs AA belongs to) and in some cases if you have certain reactions your notes should have a big red sticker saying "no bisphosphonates ever again". The other drugs are, almost without exception, extremely expensive and at present require special permission to have them. Most PCTs would turn down a request.

Maybe your doc thinks the other drugs are better in terms of side-effects but the reason alendronic acid has the most reports of nasty events is because it has been on the market longest and is most used. However, few bad side-effects are established during the clinical trials before any drug is brought onto the market. They are found once it is in common use in the general population and many thousands of "guinea pigs" are being given it. The newer a drug, the fewer real side-effects have been identified and the fewer long term side-effects have been found. That is the reason that new drugs are hailed as miracles - but 10 years down the line the story has often changed. Remember HRT? And the COX2 antiinflammatories that were so wonderful for arthritis but gave you a heart attack?

I was given AA too - but another GP at the practice agreed with me that the evidence was shaky and I stopped taking it after a few weeks. I now live in northern Italy and here you get steroids for PMR - not the list of medications that seems to be handed out as standard in the UK. Pred only comes as ordinary white, non-coated tablets. But we don't get omeprazole (which interferes with calcium absorption too) or AA or anything else unless it is needed. It seems to work OK.

Hope this adds to your fount of knowledge - download the guidelines and ask the GP to justify you taking it. I will consider taking it when I'm shown evidence I need it. Then, and only then.

Eileen

Another whinge for the day Moderators: I was notified of this post by email and it then took me nearly 10 minutes to get to it in a form in which I could reply to it sensibly. I still have no idea where on the 23 pages or so of PMR threads it appears but I scrolled through several looking for it before giving up and trying search discussions - nothing! If you can't see the post you can't reply so coming direct from email is fine to read it but not do anything about it.

For goodness sake hurry up and do something - had I not spent that time nicknocks might have thought we'd all gone home in a huff ;-) If there had been a couple of new posts a long way back I would have given up - I don't have unlimited time, I do work for a living as well.

Eileen

Hi Eileen Thank you for your extremely informative and comprehensive reply. I now feel sure that my resistance to taking AA is justified. Also this having been my first post to any forum having been diagnosed with PMR (having become seriously ill following fall from horse and the 'missed' diagnosis of 2 vertebral and sternal fractures in June 2012, CRP of 200) last October it was a relief to find some support and guidance.

Kind Regards

Nicknocks by the way a childish name for horses of which I have 3 and cannot ride at the present. However weather is fab and am nowgoing out to see to them and dogs.

Nicknocks - come over to the other forum and have a look! Lots of us with PMR with interesting histories of diagnosis and we have loads of horse and dog and cat people over there! With photos! We seemed to be having a "how high can your CRP go" discussion the other day - you'd be in the top few! Quite impressive that! We are always open to hear a whinge or a moan (here too but there's more of us to sympathise over there. pmrandgca dot forumup dot co dot uk

Eileen

Hi Eileen Thank you for your kind reply and I do hope to engage with the other forum soon. ( I say hope as I think I am going a bit batty on the memory with the steroids!!!) I looked it up and registered but will make a further attempt soon. I am so keen to hear other stories and yes I created some consternation with my CRP yet the PMR was not diagnosed then but on my becoming ill later i.e October after the June injuries. Will get onto the other site soon and thank you again.Such a relief to hear of others with weird histories!! No doubt most like me thought, 'No I am not the sort of person to get one of those strange, disabling auto-immune diseases. More education is needed yeah.Interestingly mostly women.

Nicknocks

Hi Eileen, Nicknocks etc

I would appreciate it if you could help me about AdCal tablets.

I have stopped taking them for a couple of weeks on a trial to see if it helps my bladder problems, as you probably remember, Eileen.

A nutritionist told me a few months ago that GPs shouldn't be in charge of giving out dietary supplements because they don't understand them and that AdCal is only given out because it's cheap. He said that lots of the calcium from it gets deposited in undesireable places around the organs rather than getting into your bones. He said there were other things to take that would be better.

I take 1000iu D3 anyway.

Opinions please??

Thanks

Beev

"Nutritionists" often come up with a load of not entirely founded stuff - mainly I suspect so you will buy their very expensive versions. It is true that supplemental calcium isn't as well dealt with by the body as dietary calcium - the urinary problems don't happen with a high intake of dietary calcium for example. There are other calcium supplements which are different salts that are meant to be better - and some are available on prescription I think (don't quote me). Ask a pharmacist, they will know.

You note I put nutritionist in quotes - it isn't a recognised and controlled medical field, anyone can set themselves up and say that is what they are. I have a personal allergy to many chiropractors who flog vastly expensive dietary supplements claiming they will cure your bad back along with a twice weekly session for the next year at megabucks a time. Then there is what's-her-name from Perth who did the programme "You are what you eat" with her fixation with poo :-) Her "doctorate" is said to have been purchased ...

You need a good source of calcium - and it goes into the blood and it does end up in the bones. The reason you need extra is that the pred makes you excrete more and having more available means there is a better chance of it getting into the bones. In the US milk and orange juice are fortified - but that is still a supplement. I don't know how much of what you need to get the same amount from diet - I'm sure you can find out or work it out though.

But if your urinary problems are better without the adcal or whatever - ask for a different version. I think the alternatives are citrate based - so the stone formation can be avoided. I'd have to look it up though. You could try to up the dietary intake of calcium and reduce the adcal to one - might that be an answer?

Eileen

Thanks Eileen.

I have stopped them for a couple of weeks to see what happens but 1 could well be the answer or I will ask GP about citrate based ones.

I googled stuff about dietary calcium and it seems a post-menopausal woman really needs 1300mg a day. That is quite hard to achieve I think - you would need about a pint of milk a day, a couple of yoghurts and then some more, maybe from green leafy veg etc..

My dexascan after a couple of months of Pred showed ok in hip and osteopoenic in lumbar spine so I do have to be careful, especially as I also take Omeprazole and now (though maybe not for long) Amitriptyline.

I have cancelled my gynae physio app for this week as I am also wondering if the "stim" thing for pelvic floor might be irritating my bladder - 2 days after it I seem to get a day of an irritated feeling and having to go to the loo a lot (which is different from the normal pangs of discomfort I get). I don't know if it's the stim or the fact that I've applied the oestrogen cream the night before. I can't see how the cream could cause irritation but it does seem to be a regular problem the day after. Any thoughts??

Beev

Hi All Would be grateful if any who have suffered tooth pain after having taken Alendronic Acid could tell me of their experiences. Just to repeat mine after taking 2 courses of 4 I had pain in all of my teeth specifally nerve pain like hypersensitivity. It took 3 weeks for this to go after stopping the tabs and some sensitivity persists. especially the lower incisors.

I have decided not to risk any more especially as my bone scan inidcated higher than average density for my age.

Kind regards

Nicknocks

Nicknocks - I assume you have read all this thread, but if you go to the top right hand corner of this page you will see a green box "search by keyword or term". Type "alendronic acid and teeth" into it and it should come up with a new page with all the places those words appear. This thread comes up as well as another much longer one which will probably answer some of your questions.

Lots of us have had tooth hypersensitivity and generally it's been put down to the pred as it can also happen with it. However - yours sounds pretty likely to have been the AA if it has gone away again - you must be really relieved.

Beev - I had a single vertebra that was osteopeneic 2 1/2 years ago when I had my first dexa scan - such patches are very common. I've got a referral to have another but here it is over an hour to Bolzano where the machine is - need to coordinate the appt with OH and his timetable ;-) And I probably need him with me as I'm on crutches because of an achilles problem: the wrong antibiotic plus pred = inflamed achilles. Pain! In all senses ;-) Re the oestrogen cream - it isn't all oestrogen, what are the carriers? You may be reacting to an ingredient in it.

Eileen