Prolia Vs. Aclasta

I could not understand your last sentence. Can you make it simple for me to understand.

Because of the very real risk of serious rebound osteoporosis after stopping Prolia people have to take another medication for a certain length of time (I do not have any idea how long) and one which is sometimes used is teriparatide (Forteo).  But that particular medication is only approved for use for two years because one of its possible results may be a form of bone cancer, and for once the regulators do not want to take a chance.  

Teriparatide failed to increase the bone density in the hips and so the risk of hip fracture is still there after completion of 2 years course.  It works magically to increase bone density in AP spine but not the hips. It does not add/increase any bone density in the femur neck left and femur neck right of the hips. So I want to know what is the best cure to add some bone density in the hips so that it does not easily break after fall.

From my purely layperson perspective I'd say weight bearing exercise (even walking will help) and a healthy diet with lots of leafy greens, not too much liquid milk but dairy like yoghurt, some cheeses and kefir, plus a few supplements, like Vitamin D3, Vitamin K2 (not K1, you'll be getting that from leafy greens) adequate magnesium from diet or an occasional supplement.  A ll balanced diet heavy on vegetables and a few fruits like prunes (for boron) will give your bones the materials they need to work with.  Weight bearing exercise stimulates the bone-building cells (osteoclasts) to work harder to make more bone.  

a well balanced diet - oh for an edit button!

And the bone building cells are osteoblasts!

Has your mother fallen? Has she broken any bones? Is she able to research online?

 

She had a fall. But her hip bone is not broken, it has slight cracks. Teriparatide failed to increase the bone density in her hips and so the risk of hip fracture is still there after completion of 2 years course.  It works magically well to increase bone density in AP spine but not the hips. It does not add/increase any bone density in the femur neck left and femur neck right of the hips. So I want to know what is the best cure or first line medication to add some bone density/mass in the hips so that it does not easily break after fall.

There is no cure as such for osteoporosis.  What we are trying to say to you is that none of your mother's current readings indicate that she has osteoporosis. She has normal bone thinning which occurs with age, and this is most safely dealt with through appropriate exercise and nutrition, including a few supplements. All of the osteoporosis medications have the potential for very serious side effects so they really should never be used unless completely necessary.  The aim should be to prevent further bone loss through exercise and nutrition, and this will in all likelihood also increase her bone density.  

Most fractures, whether in the aged or the general population, occur from falls, so if she is able to do some exercises which improve the sense of balance, like tai chi for example, but I am sure there are other less complicated techniques, then the chances of a fall are reduced, and therefore the chances of a fracture.  

I agree with Anhaga. Just follow her suggestions to help your mother.

How is your mothers health overall?

My mother Sobha Ghoshal (77 years) has Type 2 Diabetes, Pressure,  Osteopenia (T-Score -2.2) and asthma. She also suffers from constipation and leg swelling esp.in ankle and feet. Her haemoglobin level is always in the lower side.

Her recent Test Results are as follows:

1.     Haemoglobin:                                9.4g/dl

2.     PCV:                                             31.6%

3.     MCV:                                            87.5 fl

4.     MCH:                                            27.4 pg

5.     MCHC:                                        31.3 g/dl

6.     Platelet count                             1,70,000 /cu.mm

7.     Total Leucocyte Count:              6800 /cu.mm

8.     Neutrophil:                                 76%

9.     Lymphocyte:                              20%

10.  Monocyte:                                  02%

11.  Eosinophil:                                 02%

12.  RBC Morphology:                      Normocytic, Normochromic

13.  ESR(westgren)1st hr.:               32 mm

14.  C-Reactive Protein:                   2.4mg

15.  Sugar (Fasting):                        70 mg/dl

16.  Sugar (PP):                              137 mg/dl

17.  Urea:                                         26 mg/dl

18.  Creatinine:                                0.9 mg/dl

19.  Blood Pressure:                        130/70

20.  TSH:                                          1.92

21.  Cholesterol:                               156 mg/dl

22.  HDL Cholesterol:                       53 mg/dl

23.  LDL Cholesterol:                       86 mg/dl

24.  VLDL Cholesterol:                    17 mg/dl

25.  Triglyceride:                              96 mg/dl

26.  Total Cholesterol: HDL:             2.9

27.  25-(OH) Vitamin D3:                 50.3 ng/ml

28. Little increased renal parenchymal echogenicity.

She takes the following medicines on daily basis:

 

1.       Pan D in empty stomach early in the morning.

2.        Frumil to get rid of extra fluid through urination.

 

After breakfast (usually taken in between  9.00 am to 9.30 a.m.)

3.    Zoryl M1 for Diabetes

4.    Telsar 40

5.    Shelcal HD 12

6.    Nervmax

5.    Mega Free Flex

6.    Evion LC

 

After Lunch  (usually taken in between 1.00 p.m. to 1.30 p.m.)

 

7.    Myosone Plus for muscle relaxation, removes painful spasm of skeletal muscles.

 

   

After Dinner (usually taken after 9.30 p.m.)

1.    Tenglyn 20 for Diabetes

2.    Ecosprin AV 75/20

3. Softeron Capsule

4. Shelcal HD12

6.    Nervmax

7.    Mega Free Flex

8.    Evion LC

 

 

Extra Medicines

10. Budamate (200 transhaler        

12. Salbair I transhaler        

13. Upress D3 60K tablet fortnightly.

14. Livoluk Syrup for constipation.

15. Gelucil for acidity

 

Her cells are damaging faster and her red blood cells are diminishing (blood strength weakened). As she eats less now-a-days (takes less calories) her sugar and pressure levels are now normal.

My mother Sobha Ghoshal (77 years) has Type 2 Diabetes, Pressure,  Osteopenia (T-Score -2.2) and asthma. She also suffers from constipation and leg swelling especially in ankle and feet. Her haemoglobin level is always low.

 

Her recent Test Results are as follows:

 Sl.  No.

Test

Result

1.      

Haemoglobin:

9.4 g/dl

2.      

PCV:

31.6%

3.      

MCV:

87.5 fl

4.      

MCH:

27.4 pg

5.      

MCHC:

31.3 g/dl

6.      

Platelet count

1,70,000/ cu.mm

7.      

Total Leucocyte Count:

6800 /cu.mm

8.      

Neutrophil:

76%

9.      

Lymphocyte:

20%

10.   

Monocyte:

02%

11.   

Eosinophil:

02%

12.   

RBC Morphology:

Normocytic, Normochromic

13.   

ESR(westgren)1st hr.:

32 mm

14.   

C-Reactive Protein:

2.4 mg/L (method – Turbilatex)

15.   

Sugar (Fasting):

70 mg/dl

16.   

Sugar (PP):

137 mg/dl

17.   

Urea:

26 mg/dl

18.   

Creatinine:

0.9 mg/dl

19.   

Blood Pressure:

130/70

20.   

TSH:

1.92 µIU/ml

21.   

Cholesterol:

156 mg/dl

22.   

HDL Cholesterol:

53 mg/dl

23.   

LDL Cholesterol

86 mg/dl

24.   

VLDL Cholesterol

17 mg/dl

25.   

Triglyceride:

96 mg/dl

26.   

Total Cholesterol:

2.9

27.   

25-(OH) Vitamin D3

50.3 ng/ml

28.   

Little increased renal parenchymal echogenicity.

 

She takes the following medicines on daily basis:

 

1.       Pan D in empty stomach early in the morning.

2.        Frumil to get rid of extra fluid through urination.

 

After breakfast (usually taken in between  9.00 am to 9.30 a.m.)

3.    Zoryl M1 for Diabetes

4.    Telsar 40

5.    Shelcal HD 12

6.    Nervmax

5.    Mega Free Flex

6.    Evion LC

 

After Lunch (usually taken in between 1.00 p.m. to 1.30 p.m.)

 

7.    Myosone Plus for muscle relaxation, removes painful spasm of skeletal muscles.

 

   

After Dinner (usually taken after 9.30 p.m.)

8.    Tenglyn 20 for Diabetes

9.    Ecosprin AV 75/20

3. Softeron Capsule

10. Shelcal HD12

11.    Nervmax

12.    Mega Free Flex

13.    Evion LC

 

 

Extra Medicines

14. Budamate (200 transhaler        

15. Salbair I transhaler        

16. Upress D3 60K tablet fortnightly.

17. Livoluk Syrup for constipation.

18. Gelucil for acidity

 

Her immunity cells are damaging faster and her red blood cells are diminishing (blood strength weakened). As she eats less now-a-days (takes less calories) her sugar and pressure levels are now normal.

 

You are requested to kindly make a daily diet chart for her keeping in mind her age, osteopenia and renal parenchymal disease (early stage).

Her recent T- Score chart  for osteoporosis is given below:

BMD Test Done on 18.09.2017

Region

T-Score

Femur Neck Left

-2.2

Femur Left Right

-1.8

AP Spine L1-L4 is 0.920  g/cm2

-1.4

 

 

 

 

 

 

 

 

 

Thanking you,

 

Sumit Ghoshal (son)

How to delete a message? How to add attachments to the message here?