Alendronic acid quandary

[Redtime]

After a recent DEXA scan I have found that I have osteopenia of the hips and some osteoporosis at L3 and L4. My doctor has put me on Alendronic acid tablets and 1200 mg calcium supplements(Adcal D3).

After the first six days I had constipation and consequent haemorrhoids. I took the alendronic acid and a day later that resulted in headaches, muscle tightness in the legs and arms and fatigue. It took all week for that to ease off. I also decided to check how much calcium I was getting in my diet and found that with the supplements it was exceeding 2200mg! I tried phoning the prescribing pharmacist but they didn’t phone back. I then decided to cut the calcium supplement and check that I was getting the 1200mg by diet (I was already taking a vitamin D3 and K2 supplement). My symptoms eased off.

I then took the alendronic acid the next week and lo and behold the muscle pains, headache and fatigue started again the next day. So another week of symptoms to put up with. Does anybody know how long these symptoms might last, as it’s very hard going?

Also, how much calcium does one need? There are conflicting recommendations: NHS 19-64 700mg, Royal Osteoporosis Society 1000mg, American sources 1200mg. And then there are the varying amounts that they say are too much. Some experts say supplements are harmful and you should get it from diet.Then there’s the calcium carbonate/ citrate/ seaweed argument.

So I’m wondering - can you attempt to get it all from diet and vitamin d3 and k2 alone and thus stop getting all those nasty symptoms? Dr Kate Rhéaume-bleue’s book The Calcium Paradox says that it’s the D3 and K2 that gets the calcium into the bones. Pumping calcium into the body without those vitamins risks deposit of the calcium in the soft tissue and consequently raises one’s chances of a heart attack. She doesn’t mention the effect of bisohosphonates though - might be too old a book (2012 I believe).

Has anybody in the community got any advice/ observations? Anybody medical out there any comments?

It’s such a minefield!

Thanks.

[Met00]

The ROS website says that you need a minimum of 700mg calcium a day, though may need 1000mg if taking an osteoporosis medication, and that this should be through diet if at all possible: theros.org.uk/information-a.... If you haven't been advised to take a calcium supplement for a different health condition, you shouldn't need one now, unless you can't get enough through diet, in which case you should only take enough to make up the dietary shortfall. From what you've calculated, you don't need a supplement. However, your prescribed supplement also contains D3, which you do need. Your GP should have given you a blood test to check for underlying causes of your osteoporosis (including blood D, calcium and parathyroid levels, full blood count, thyroid, and coeliac disease). If this hasn't been done, then you can ask for it. Once it's been done, get a copy of your results and check your blood D level. It should be at least 75nmol/litre (some say 100nmol/litre or even higher), but the normal lab range is usually 50-150 and GPs usually say 50 is adequate! You need to take sufficient supplement to maintain this blood level. As a general guide, on average each 1000iu of D3 supplement raises blood level by around 25nmol/litre in about 3 months.

[Pte82]

Redtime, calcium needs to be balanced on a 2 to 1 or 1 to one ratio with magnesium. If your using 700 mg of calcium 350 mg of elemental magnesium is needed as an example. Generally speaking calcium without magnesium is toxic because it will go to soft tissue. The first link below is about geranylgeraniol's benefit when using alendronic acid. Geranylgeraniol is available as a supplement. The second is about reading supplement labels which can be confusing especially those containing magnesium. Always consult your health care provider before using any supplement.

pnas.org/doi/abs/10.1073/pn...

blog.evertrain.fit/suppleme...

[Met00 in reply to Pte82]

It's better to get calcium from diet, but if you are supplementing calcium it's essential to take vitamin K2, which helps direct it to the bones. Unfortunately many doctors haven't even heard of K2!

[Redtime in reply to Met00]

Thank you. Interesting comments on calcium levels though the question whether to aim for 1000mg or 1200mg calcium remains.

I am taking Purolabs Vitamin D3 and K2 so that should take care of that side. Yes there seems to be no reference within GP circles to K2 but Rhéaume Bleue’s book seems to confirm that it is necessary but usually deficient!

[Met00 in reply to Redtime]

The World Health Organisation says that 500mg calcium is sufficient, so I think 1200mg might be a little excessive!

[Redtime in reply to Pte82]

Thank you.

My chiropractor mentioned the importance of magnesium. Just need to calculate how much (and how much I’m getting from diet!).

Geranylgeraniol! That’s a new one. It gets ever more complex. I’ll read the article and see what it says.

[Pte82 in reply to Redtime]

Redtime, the krispin link offers a magnesium calculation formula. The newhope link expands magnesium's importance in addition to balancing calcium. One other bone building mineral to check out is the fifth element boron. Search on "nothing boring about boron" for an introduction.

newhope.com/blog/time-ditch...

krispin.com/magnes.html

[Cappuccinobaby]

Get your parathyroid checked as per Met00 also look up horlicks a mug a day made with 250mls skimmed milk or oat milk gives 800mg calcium.......

[Redtime in reply to Cappuccinobaby]

Wow! That’s a whopping amount. Must admit I’m not so keen on the sugar but it’s certainly one to bear in mind.

[Cappuccinobaby in reply to Redtime]

Shows we can get it from our diet. But please get your calcium pth and vit d checked to rule out that primary hyperparathyroidism isn't responsible for your osteoporosis. It can be reversed somewhat if it is by surgery to remove a faulty gland x

[Redtime in reply to Cappuccinobaby]

Good idea.

Also, has anybody out there had a success story with improving bone density via diet and vitamin/ mineral supplements alone (I.e. not using bisphosphonates and other medication)?

[AnnieW55 in reply to Cappuccinobaby]

Redtime I get my calcium from diet after originally being prescribed AdCal with no check on how much I was getting from diet. The perceived wisdom (in all that I have read) is that no more than 500mg of calcium should be taken at one time as this is the highest amount that can be utilised at one time (body size/composition doesn’t appear to be taken into account for some reason). The link below has lots of info.

my.clevelandclinic.org/heal...

[Sweetwillia]

I started taking allendronic acid 4 weeks ago. The day after my first dose I had terrible back pain which lasted about 24 hours but I have had no problems with subsequent doses. Hopefully your symptoms will ease off in time. I was also prescribed Adcal by my GP although my consultant had not said it was necessary. I think it was the cause of an upset stomach which I had after taking it for a few days. It has a coating of iron which had caused me similar problems in the past. I have stopped taking it , hoping that I will get enough calcium from my diet anyway. Hope this helps.

[Redtime in reply to Sweetwillia]

That’s reassuring. I am managing to get the calcium from my diet too, and I certainly hope the side effects of the alendronic acid die down soon!

[Hidden]

You could speak to an Osteoporosis specialist nurse on the ROS free helpline for medical information about this. 0808 800 0035

[Februarysnow]

I've been on alendronic acid for six months, and my legs have hurt for five of them. My doctor said that wasn't a regular side effect, but to try coming off them for a month and then going back on to check. I came off them for two weeks rather than a month, and my legs seemed OK, but then had two more doses. The day after the second, I had to stand for 90 mins on a train journey and then walk around 10K - the pain by the end of the day and for five days in my back and legs was truly crippling. I felt like my thigh was burning and so so tight, it felt like it would burst. It has felt like this previously with the pills, but this was intense. I am going to have to see if I can take an alternative. Yours, Redtime, was the first post I'd read about muscle tightness in the leg. It seems crazy as I wouldn't have known I had osteoporosis before I started taking the pills but since being on them, I've felt I've aged 15 years and felt bad!

[Redtime]

Well that’s interesting. After several weeks of leg tightness and pain and then cheek bone pain (yes!) and also discussion with a GP specialising in HRT, I decided to come off the alendronic acid. I am now on a slow introduction to HRT- starting with a low dose of testosterone to be followed by oestrogen (I hope). The GP said that alendronic acid can lay down rather brittle bone, but that HRT could form better bone. So I’m giving it a go as the alendronic acid felt like neat poison. I also ensure that my diet gives me between 1000 and 1200 mg of calcium a day as well as over 300 mg of magnesium to counterbalance the effects of the former. It’s a plan and am reviewing it all with the GP in 3 months. Good luck Februarysnow!