considering treatment

[Chunkymonkey2]

I was diagnosed with osteoarthritis osteopenia after many years of hip pain and both my hips have now been replaced. My back pain continued to worsen and they finally gave me a dexa scan confirming osteopenia and I have been prescribed alendronate acid a weekly tablet of 70mg with a follow up in 3 months. I had a very scary chat with my gp going over all the side effects but never a single benefit mentioned they seemed to be trying to put me off rather than encourage me to take it. Do people thing the benefits outweigh the side effects. I’m 66 years old female. Thanks

[Chunkymonkey2]

alendronic acid

[Met00]

It isn't usual practice to prescribe medication for osteopenia, so do you know why they did? The decision is supposed to be based on your FRAX fracture risk score (eg 10% risk of fracture in the next 10 years) which should be included in your DEXA report. At 66 I would be really surprised if you didn't have osteopenia, as we all lose bone as we age, starting around age 40. Also, bone loss itself doesn't cause pain unless you've fractured. As you're in a lot of pain, have they checked for fractures (x-ray and, if that doesn't show anything, MRI scan)? If you do have a high fracture risk, have they run blood tests to check for underlying causes? You need to have tests for Vitamin D, calcium and parathyroid (all three from the same blood draw), thyroid, coeliac and a full blood count. Some underlying causes of bone loss can cause pain, for example low Vitamin D and hyperparathyroidism. I would ask for a copy of your full DEXA report and for all of this to be done before you even consider medication. You might also find this decision aid helpful: nice.org.uk/guidance/ta464/...

[Chunkymonkey2 in reply to Met00]

My FRAX score is 36% from my dexa report. I’m to take extra vitamin d and calcium as well. They did find a healed fracture in my spine but I have no idea when it happened

[Met00 in reply to Chunkymonkey2]

That's an incredible high fracture risk, given that you only have osteopenia. A previous fracture would raise your fracture risk, but I'm surprised it's raised it by that much. Perhaps you have other risk factors too. Have you had the blood tests I mentioned? If not, I would definitely request them, particularly given that you've had a fracture.

[Freshair24 in reply to Chunkymonkey2]

Hi am sure I cant add much,but just to say did you mean Osteoporosis not osteoarthritis as you have had a spinal fracture,that would put you into high risk on the fracture score ,then as others have said you should be referred to a fracture prevention clinic or other for a plan of treatment. My GP also read the riot act about alendronic acid,I was fine on it . But 7yrs on I have needed other bone strengthening drugs ,I am 66yrs and run my own gardening business, I am glad to continue what I enjoy. You need good advice to work out the best plan for You. All the best.

[Ludovic4]

I would be very wary starting medication as once you do you are tied into them in one form or another. Have you considered HRT ?

[Aquadulce]

No-one mentioned any side effects when I was prescribed alendrotnic acid....

[strongmouse]

If you have a high risk (of fracture) then I would suggest the benefit of taking alendronic acid outweighs the side effects (depending on any other illnesses you have). I tried it but had gastric side effects and I am now on a yearly infusion of zolendronic acid instead, which works in a similar way.

The Royal Osteoporosis Society has information about it theros.org.uk/information-a...

[narajito]

Hello Chunkymonkey 2

I was diagnosed with osteopenia December 23 and put on the same medication as you. I did at that stage have a couple of compact vertebrae fractures. My dexa scan scores were in the normal range for hip and -1.8 for spine ie in osteopenia range. I was v worried about medication but have taken it for a year with no side effects at all and no problem swallowing. You will see that others do have problems but just want to reassure you that not everybody does. I decided to take it on the basis that I wanted to max my chances of avoiding further bone loss. I have back issues too and find that the best possible management strategy for me is exercise - gym and walking ie meds don't fix back pain. Re gp's - I guess different people have different experiences but I find mine is way behind the curve on current research and management strategies. My dentist is far more up to date and ROS is a truly excellent resource especially the specialist nurses that you can speak to on the phone. good luck

[Errp82]

hello Chunkymonkey2,

I was prescribed Alendronic Acid after I incurred 4 spinal fractures in 2022.

I have suffered with a hiatus hernia and acid reflux for many years, yet no real discussions came about either from the doctors.

I personally looked up all the potential side effects and was very scared, however I agreed.

Within 3 months I experienced a constant tickling in my throat which then became a wretched cough. So I stopped taking the pill, discussed things with my doctor and was moved on to zoledronic acid - totally different as this is infused straight into your stsyem, bypassing your throat.

I will have this infusion annually, for a minimum of 3 years and, then, hopefully longer.

please bear in mind that I’m sure my reaction was very largely caused by my hiatus hernia etc.

I had a very rewarding conversation with a nurse from the Osteoarthritis society. Perhaps you could try this.

Wishing you good luck X

[ChickenDopiaza]

Speak to one of the specialists nurses at Royal Osteoporosis Society they are very good. Telephone number 0808 800 0035. The nurse spent 45 mins on phone. I ended up ending the conversation because Tesco delivery turned up!

My BUPA specialist said take it but prefers the yearly infusion because it’s hard to take.

My GP is sceptical about it because I’m 45 and male. He said he’s only comfortable prescribing it to older people due to side effects. My GP did discover there is an effervescent version available now.

My Dentist nearly scared me to death saying I’d have to have any extractions done prior to starting it. As they won’t do anything other than inspection after because you might not heal properly.

I’m waiting to see an NHS specialist see what they think. I’ve decided not to - I think? Just improved lifestyle, diet, Vit D supplements and eat 1000mg calcium a day.

Hope that helps.

[ROSModerator Partner]

Hi Chunkymonkey2 ,

Just dropping in to wish you a warm welcome to our community It can feel very overwhelming when we receive a diagnosis and bring up lots of concerns for us, especially in the way you mention.

As some of our valued members have mentioned, we have lots of information about osteoporosis medicine on our website: theros.org.uk/information-a...

We hope this may feel helpful at this time

Wishing you the very best on the next steps of your health journey,

Lulu

ROS Moderator