New treatment guidelines

[Mo51]

Hi. Just been reading the new US guidelines for osteoporosis/osteopenia. I am in the Uk so probably different here. But what struck me was this extract

"For postmenopausal women with osteoporosis, you should use a bisphosphonate as first line treatment to reduce the risk for future fractures. This is given a strong recommendation based on a high certainty of evidence. Bisphosphonates vs placebo over 3 years leads to one fewer hip fracture per 150 patients treated and one fewer vertebral fracture per 50 people treated."

I was surprised that the the level of improvement for hip and vertebral fracture numbers sounds quite low to me. Or am I reading it wrong? AA is a properly brutal treatment for many and if the reduction of fractures after 3 years is so small why would we want to subject ourselves to a drug with so many side effects? I opted for the non meds treatment (exercise and diet) as I could not tolerate the AA.

Here's the whole thing if you are interested.

medscape.com/viewarticle/99...

[HeronNS]

Actually I was surprised the result is as positive as they say!

First line treatment should be PREVENTION.

Most people will benefit from following a bone healthy diet and exercise regimen all their lives, but certainly from their mid-30s. But we aren't told this. We learn the signs of stroke, we learn what to eat for a healthy heart and to avoid type 2 diabetes, we are warned not to smoke, but there is no information about how to keep healthy our skeletons, on which everything else is built.

It's never too late to start, even if you've reached the stage where medication is advisable or necessary as well.

[wellness1 in reply to HeronNS]

Yes, I also read this and some of the comments included more comprehensive guidance for investigating causes and non-pharmaceutical approaches. It's very drug-treatment oriented and, as you say, so many early detection and prevention opportunities are missed.

They also pointed out that Asian women are 5 x more likely to experience atypical femur fractures on bisphosphonates. I wonder if that's widely known.

[Met00]

I agree with you, that seems a lot of people to treat to prevent just one fracture! It's largely because most people taking bisphosphonates wouldn't have fractured anyway, even without the meds (for example if your fracture risk is, say, 16%, that means only 16 in 100 people would fracture without taking meds, 84 wouldn't fracture). Bisphosphonates only prevent 50% of fractures, so if the same 100 people with a 16% fracture risk take a bisphosphonate, only 8 fractures would be prevented.

[Raleigh59]

what were your side effects from AA ? I have a total of 7 10 mgs that I am getting through slowly by breaking them up and then I am not getting this again. Actually this medicine is free with my insurance and I still don’t like it bc of stomach aches. You know why we get stomach aches from it - think about it, it’s alendronate ACID

[jimister in reply to Raleigh59]

I had the infusion 7 months ago, and I have had stomach/abdominal pain every day since. I thought you only got this with the tablets but it is down as a side effect for the infusion as well. It's really putting me off having another one.

[Houseelf in reply to jimister]

I'm so sorry to hear that, it sounds very uncomfortable!

[Mo51]

Hi Raleigh59. I had tummy upsets, constipation, acid reflux and just general unwellness. But the worst effect was ocular migraines which I was getting daily. I understand that some people tolerate it well - but not me. I am also a bit doubtful about the long term benefits and as HeronNS comments above prevention should always be the first goal. My docs didn't even consider education about how to deal with it and sop it progressing - just meds. If I was severely affected by osteoporosis I might think differently but for now I will avoid meds

[Raleigh59 in reply to Mo51]

I just take 5 mgs at a time and every time I get a stomach ache, I guess it’s gas pain within 15 minutes. The pain passes but I also think it gives me anxiety or depression or something. I don’t like taking it at all but I am making myself get through this bottle of 7 ten mg tablets bc I think maybe it’s good for my bones and I need it. After that I might try actonel.

[Mo51 in reply to Raleigh59]

Can't remember the doseage I took. But it was only once a week. I took mine on a Sunday and the tummy issues etc lasted for the rest of the week. 😒

[Cappuccinobaby]

I say this to everyone......have you had hyperparathyroidism ruled out as a cause of your osteoporosis? It caused mine and 2 years after surgery, my osteoporosis has reversed to osteopenia with my spine improving by 25 %

[Mo51 in reply to Cappuccinobaby]

I had blood tests for thyroid issues but none detected.

[Raleigh59 in reply to Cappuccinobaby]

mine was ruled out

But you are lucky

[Cappuccinobaby in reply to Raleigh59]

Check your blood test results because if they show both parathyroid and calcium are " normal " bit both high normal then there is an inappropriate relationship that needs investigating, because they work like a see saw, when one is high the other should be low. Worth a try x

[Cappuccinobaby]

Not thyroid, parathyroid they are 4 glands either side of your thyroid. They control calcium in the blood. If one of more are faulty it caused the body to constantly leak calcium from the boned. Overtime it leads to osteoporosis kidney stones, muscle pain, brain fog, anxiety and a whole host of other symptoms. Ask your GP to do a bone profile blood test along with parathyroid and vitamin d

[Mo51]

I will certainly do that. Thank you

[Uglow]

I’m not using AA too much more to put in mix with pred painkillers etc. all we end up doing is rattling. 🤣

[BrancepethCastle]

I read it the other day. To begin with, it continues to support AA, dammit, but further down, it modifies it, and I couldn't really understand why. It didn't seem to fit with the earliest paragraph. Does anyone know why?