Does anyone have an opinion on on zoledronic acid?

Eileenh, if my bones are more denser now than when I first had a scan, why would I have another intravenous drip? I guess I don't understand how dense is normal?

Thanks Eileen for your help.But what do you mean when you say people with osterporosis often don't have fractures, but people with normal bones might. That sounds contradictory.

I did get a dexascan last April, and it was -2.6. I asked for another one now, but he said, every two years.

Bone starts to lose density as we age - it is at a peak at about age 25-30. In some people the density remains high, equated as being "normal", in others the new bone which is constantly being formed is less dense if there is less calcium being incorporated. Bone isn't a static substance, it is constantly recycled, old bone being broken down, new bone being built.

The received wisdom is that denser bone is also stronger bone - so that is the justification for giving patients bisphosphonates which encourages the uptake of calcium into bone. It stops the breakdown of bone while bone is still formed - so it becomes denser. But as the bisphosphonate is covered up by new bone it stops attracting the calcium and the effect slows down again. If denosumab (not strictly a bisphosphonate) is used, they have discovered that if you stop giving it, there is a rebound loss of bone density. And if bisphosphonates are given for too long the bone formed may have fine cracks in it which, in the long term, make it weaker, despite being denser.

http://www.iofbonehealth.org/introduction-bone-biology-all-about-our-bones

explain the way bone is structured and formed simply.

It means that bone density is not the only factor involved - muscle fitness, balance, good diet, medication, hydration (drinking plenty of water) are all important in avoiding falls. Someone with normal bone density might fall for any of those or other reasons and break a bone, someone with low bone density might never have a broken bone. Just because you have low bone density doesn't mean you will have a fracture.

But your bone density was quite low - so it was reasonable of them to suggest something.

Your t-score is -2.6 which puts it just on the osteoporosis side of the rather arbitrary line drawn by the WHO which is -2.5. I think this is only a guideline and it cannot tell you how strong and flexible your bones are. That can at the present time only be determined through an invasive biopsy which no one would do, nor want. So the t-score gives us only an idea of what may be going on. If you get numbers like -3.something, well that's another story. Even so I do know of people on the forum who have at least one of the bones reading in the -3.something range who have gone the so-called natural route and managed to both avoid fractures and to increase their bone density.

Do you think stopping bisphosphonates, after it is covered in new bone, then starting again when it looses it's denseness, on some kind of schedule, would be something to talk to the doc about?

Or maybe that is why they prescribe it once weekly, or monthly, or the yearly infusion.

As you can see, I am so in the dark as to what to do.

I don't think that is how it works. It is a decision you have to come to yourself and it really isn't our place as other patients to say do/don't do. I know that sounds unkind but a forum is to talk about such things, not answer other people's problems. It was clear for me - my t-scores were iRO -1.1 so there was no question in my mind: at that point I didn't need it. Had they been -2.6 I might well have decided differently.

Thank you, EileenH

🙂

Thanks Anhaga , place to research.🙂