Risendronate

[maria40]

|At third attempt saw GP who seemed to understand PMR/GCA. He's referring me to rheumatology and neurology to determine whether what was diagnosed as GCA by first GP is in fact that. In the meantime I continue on 30mg Prednisolone with slow reduction after six weeks. My symptoms have lessened considerably but both GP 3 and I are aware of the feel good factor a raised dose can give initially, though I'm making the most of it and enjoying increased mobility. He also ran through all my medications and saw that I had not taken any bone protection apart from ADCAL since I stopped Fosimax after an oesophegal reaction some years ago. I am prescribed Risendronate and wonder if anyone has had any experience, good or bad, to pass on

[PMRpro Ambassador]

Have you had a dexascan to see if you even need bone protection medication? After over 3 years on pred my bone density was essentially unchanged despite only taking calcium and vit D and no bisphosphonate.

Risendronate is also a biphosphonate, just like Fosomax. You should not take it if you have EVER had any difficulty swallowing (say the manufacturers). The MHRA urges caution in any patient who has or has recently had any oesophageal problems. Was your GP aware of that when he decided to give you risendronate?

Other, non-bisphosphonate bone-building drugs are available - given if indicated by a dexascan first.

[maria40 in reply to PMRpro]

I did mention the oesophagal reaction to but he said that Risedronate was gentler on the throat. I did have a scan which showed borderline danger density levels 2 years or so ago but I'd rather take the risk than get another reaction. Thanks for the advice.

[PMRpro Ambassador in reply to maria40]

"rather take the risk"? Of what? Loss of bone density?

Personally, I wouldn't take the risondrenate in your case. If it was "borderline danger" only 2 years ago - no way. It isn't necessary: dexascan first and if that shows reduced bone density in a risk area ask him for denosumab which is a totally different mechanism, given as injections every 6 months and approved for patients who can't take bisphosphonates.

Risondrenate may be "better" than alendronic acid (manufacturer's claim and it isn't used as much so there'll be fewer cases) - but that is starting from scratch. You are starting from a very different place.

[maria40]

Thanks for that. The risk I meant was that of doing nothing which is what I'll do for a while. Then ask for a further scan and take it from there.

[polkadotcom]

Entirely agree with PMRpro - I doubt if it is necessary and really shouldn't be taken if any kind of gastric problem has been present even in the past.

[maria40]

Thanks polkadotcom. It will join the list of stuff prescribed which I have not taken!

[honeyadams]

Just to let you know that the biopsy they use for GCA diagnosis is useless after taking steroids. Another diagnosis can then only be made based on symptoms.

[polkadotcom]

honeyadams, it isn't much use when it is done before - or in the early days - of steroid treatment. There is a higher percentage of negative results than postive and while a positive is just that, a negative biopsy doesn't mean you don't have it. The giant cells may be simply not present in the strip biopsied, or GCA could be present in any of the other arteries, rather than the temporal ones.