Thoughts on Alendronate?

Good evening The Raven

It's your lucky day. I was diagnosed today I was diagnosed today January 2nd with osteopenia. I'm a 56 year old female. I was diagnosed with PMR in October 2017 and have been on prednisone ranging from 17.5 mg to my current 9 mg due for the next step down. I am on my second rheumatologist at this point and expect to be looking for a new one I am on my second rheumatologist at this point and expect to be looking for a new one as we do not we do not agree on we do not agree on treatment. She wants to throw on Methotrexate or Plaquenil. No thank you. I have other health conditions that require my taper to be slower than the average. I've always been active. I have other health conditions that require my taper to be slower than the average. I've always been active. I have other health conditions that require my taper to be slower than the average. I've always been active exercising walking. I have other health conditions that require my taper to be slower than the average. I've always been active exercising, walking, hiking and weightlifting though my fibromyalgia as required made to cut out the weight lifting. I still. I still Dabble with some light hand weights I keep in the living room while watching TV.

The message of the osteopenia from my dexa scan on New Year's Eve was delivered to me on the phone today by the receptionist. She told me the rheumy wanted to start me Fosamax right away. We are our own best advocates. I have been reading everything I can find since I got home from work. So a lot of this is fresh in my mind. Your comment about having another scan. It states that you don't need another scan for at a minimum 5 years because it doesn't change very quickly sometimes just keeping Pace rather than adding bone density. Fosamax according to the literature should be taken no longer than 5 years with a drug break. Each patient's risk factors should to be looked at individually based on risk factors health and other points The options to treat are not that great medication wise. I have a friend who took the Prolia and ended up with lifelong atrial fib requiring a pacemaker. Today is diagnosis comes on the heels of my emergency eye surgery November 20th for a torn and detached retina and macular hole just a spontaneous thing no cause other than age. So as of Thursday I learned that the damage was too extensive to too extensive to be repaired. Legally blind in my left eye with waving and bent bow tie looking figures. So today's news was truly an unwelcome addition to the long list of issues. Best of luck to you. Hope I've helped you with some of your questions. Janet

You are certainly not making something out of nothing.

My doctor says that, after a while on fosamax-type drugs, you cease getting further benefit. When I went on prednisone, he did have me get some reclast infusions, but only because I'd had full osteoporosis for decades.

I assume you know about the downsides of these drugs, especially the potential for necrosis of the jaw since you mention future dental work. I have also read that, though the bones become denser, they may also become brittle. If a break occurs, it can be a far more serious injury and can be hard to heal.

These are issues you may want to raise with your doctor. Is your GP unwilling to manage this? You might also get your dentist's comments before going to the GP or rheumatologist.

On the other hand, osteoporosis has really terrible effects- not just bones breaking (for example in a fall), but vertebrae collapsing. So don't take this decision lightly.

Like so many issues in PMR, this is a decision that requires balancing pros and cons based on your individual case. It seems that most doctors err on the side of "protecting your bones," while people on this forum would avoid these drugs unless successive bone scans indicate that prednisone is like.y to be causing measurable bone loss.

If you return to rheumy #3 and he or she is affronted by your successful reduction in pred, it may be time to look for rheumy #4. The doctor has a responsibility to discuss consequences of the options, but you have a right to make informed choices, especially when there is no single right answer.

The most recent thoughts have been that bisphosphonates shouldn't be used for more than 2-3 years maximum without a holiday to try to reduce the longer term risks of atypical fractures and the other bone problems they have now been found to cause. Previously the drug holidays were recommended after 3 to 5 years depending on the drug.

Researchers at Imperial College London found that use of bisphosphonates changed the structure of the bone formed and this led to the building of bone which was LESS strong.

https://www.researchgate.net/publication/314272972_Long-term_effects_of_bisphosphonate_therapy_Perforations_microcracks_and_mechanical_properties

As for the dental work - I doubt stopping alendronate now would make much difference as it remains in the body for at least 10-15 years and those are figures based on the 15 years they have been in common use. Once they have been in common use for 20 years I'm sure the figure will rise. But your dentist is the person to discuss this with.

Of course my opinion, held by a lot of doctors too, is that if you have an osteopenia result for the dexascan, bisphosphonates are not appropriate as prevention. I have no objection to their use if the osteopenia has worsened significantly after 2 years of pred use. However, I and a lot of others have never had a significant fall in bone density while taking calcium/vit D and a few were OK even without calcium supplementation.

Having read Janet's post - 5 years is a figure I have never heard for dexascans. There is little point doing them more than 2-yearly in normal patients as the BMD doesn't change quickly under normal condition. However, the change in patients on pred or with other problems leading to osteopenia can be quite quick and the greatest change in BMD is said to be in the first 3 months of pred management - which is why they say the first dexascan should be in the first 3 months to get a baseline, then again after 2-3 years to see if there has been an effect. At my last dexascan, mine had changed by less than 0.1 points over a period of 7 years of taking pred - it isn't inevitable.

I reacted badly to AA ( wheezing and breathlessness in someone who has never had a cough in her life! ) and got on fine with just calceos As often reported on here the surgeon who did my wonderful hip replacement told me I had "amazing" bone density for my age ( 83 at the time ) I was taking Pred. for eight years.

Having read about necrosis of the jaw being connected to AA I warned my sister, who has had PMR for a year, to check with her dentist as she has several dental implants but he didn't seem to think they would be affected. I certainly hope not; it would be a jolly expensive unwanted side effect.