Does anyone have an opinion on on zoledronic acid?
Posted , 11 users are following.
Good evening my friends,
I went to the reumey yesterday for a check up, that I was suppose to have last November, but didn't mind waiting on, because of all the good information I've gotten here. In fact, I was rehearsing what I would say to him, and trying not to let on I knew more than he would like me to. He was happy with my taper, now at 5, but he did not like the fact that I stopped taking alendronate acid, he thought I was taking it all along, but I stopped in December, ( I took it for six months). After he realized I won't take it, he pressed on about zoledronic acid, another bisphosphonate. It's given intravenously once yearly, that way it bypasses the stomach, which can cause alot of the side effects we talk about here. But, I guess my question is, more along the long term effects of this drug on the bones; does it really build bones that are going to serve us and keep us from fracturing our hips and ending it all there. Or is it all pharm/doc talk, if you know what I mean.
Thank you all for being there.
0 likes, 11 replies
EileenH patricia43291
Posted
It DOES build denser bone - but denser bone isn't necessarily stronger bone since people with osteoporosis often don't have fractures, people with normal bones might. Since you haven't taken it for more than 3 years it is probably OK but why not ask for a dexascan? Did you have a dexascan originally?
Michdonn EileenH
Posted
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?
patricia43291 EileenH
Posted
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.
EileenH Michdonn
Posted
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.
EileenH patricia43291
Posted
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.
Anhaga patricia43291
Posted
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.
patricia43291 EileenH
Posted
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.
EileenH patricia43291
Posted
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.
Michdonn patricia43291
Posted
Thank you, EileenH
🙂
Michdonn Anhaga
Posted
Thanks Anhaga , place to research.🙂
Anhaga patricia43291
Posted
Bisphosphonates work by preventing the bone remodelling cells, called osteoclasts, from doing their job. Which is to remove old bone. The bone building cells, called osteoblasts, can carry on making new bone. The idea is that by doing this your bones become more dense because old bone is not being removed. Because old bone is not being removed eventually the new bone is being laid over an aging and increasingly brittle matrix, risking "atypical" and spontaneous fractures. This is why it is now recommended that people only take this type of medication for a couple of years, although many are still prescribed it for years. Many of us are avoiding taking drugs altogether and successfully maintaining and even increasing bone density solely through diet, a few supplements (take Vitamin K2) and appropriate exercise. Even while taking drugs, doing these other things can do no harm and is almost certain to help.
The biggest fracture risk is falling - so improving one's sense of balance, maintaining strength, and removing tripping hazards from the home are probably going to help just as much as pharmaceuticals.