Alendronic

[ritter]

Hi every one,can I just ask what are the long term effects of alendronic acid please, I have been on them 3years now as I do have osteo and poorly spine,I will be finished my preds in 2 weeks touch wood and was just wondering if I could come off the alendronic, the docs says will have to have scan and that will determine the situation,when i get the scan should i be asking what number it is,and what do the numbers indicate please, thank you people, kind regards Anne

[PMRpro Ambassador]

Your doctor is quite right - if the bone density is OK then there would be no further need to take the AA. It is a bit complicated to explain it all here but if you google dexascan you should find a site that explains it for patients.

This is fairly simple:

weinsteinimaging.com/userfi...

They will tell you what the results mean, not necessarily at the time as the technician shouldn't comment, but the results will be sent to your doctor and the figures will have a comment by them,

[Hidden in reply to PMRpro]

I was on alendronic for years for osteopoenia before PMR/ GCA with limited results. Now my rheumatologist prescribes Forteo (teraparitide) which he claims he has never had a patient not do well on. I'm in Canada so practices might be different here. Is there some kind of protocol regarding bone health and prednisone?

[PMRpro Ambassador in reply to Hidden]

Prednisolone is felt to increase the risk of osteoporosis and the knee jerk reaction by many doctors is to hand out AA like sweeties. However, if it isn't used properly there is no benefit. Before starting the patient on AA their calcium and vit D levels should be checked. It says that very clearly in the data sheet. If either is low, AA will not work as it requires an adequate supply of both to do its work. Vit D is almost always too low - but it is very rarely checked by GPs for a whole range of reasons.

Forteo is a totally different drug - bone is not a static material, it is constantly being broken down and being reformed. AA stops bone being broken down while bone is still being formed so over time, providing the conditions are right, your bone density will improve. Forteo actually causes the formation of new bone.

The BSR guidelines - which you can find here via a link at the left hand side of the page to useful medical information:

pmr-gca-northeast.org.uk

say that bone protection medication is recommended alongside pred, particularly if the patient is on high doses for GCA. Over 65s and people who have had a fragility fracture should be given AA without a dexascan, others should have a dexascan and calcium and vit D supplements prescribed as a matter of course, AA if indicated by the dexascan. There are plenty of ladies I knowwho are over 65 with perfectly acceptable bone density readings who have never taken AA alongside their pred. One didn't even take calcium and vit D due to a mix-up between the rheumy and the GP, each thought the other was prescribing it.

[ritter in reply to PMRpro]

Hi PMRpro,thank you once again for all you intellectual remarks my doc is sick of me reminding him on how to look after me,I keep telling him about our wonderful forum but their is only one docs that is interested and if he is not on when you go,well what can I say,thank you once again,Anne

[ritter in reply to Hidden]

Well preds supposed to take all the goodness from your bones the first 3 months of taking them,if that is the case i must have nothing left as I did not go on AA until a year later,they think I have had crumbling bones since my periods stopped when I was 50ish,as when I was 59 I fell of a ladder and snapped 2 vertebrae but did not have scan at the time, thank you for the info,kind regards Anne, in the north of England,

[PMRpro Ambassador in reply to ritter]

Not only should you have had a scan, you should probably have been put onto an appropriate medication then. THAT is when it is appropriate - not handing it out "just in case".

Tell the doctor you would like a copy of the report - you are entitled to it even in the UK. Here, I get the reports at the same time as the doctor, some of them I get first and have to take to her. That is how it should be if you ask me.

[Celtic PMRGCAuk volunteer]

Ann, if you already had osteoporosis prior to taking steroids, then it seems likely that you will need to continue with treatment of some sort to continue protecting your bones. However, if you have developed osteoporosis as a result of the steroids then it is possible that your bones might improve after coming off them. Although I was lucky to only suffer from a very slight thinning of my bones during my steroid days, having been off them for coming up for 3 years my latest DEXA actually showed an improvement.

Hopefully your scan will show good results. If you do have to continue with Alendronic Acid, you should have a break from it after five years anyway.

With regard to the "numbers", I'm sure your Dr will explain the DEXA results to you but in case not, here they are:

Normal T Score: - -1 or above

Osteopenia: - below -1 to -2.5

Osteoporosis - Lower than -2.5

Good news about nearing the end of the steroid road - fingers crossed for you.

[ritter in reply to Celtic]

Thank you Celtic,that will help me when I go,in the hospital the lady that does the scan just says check with doc,when I asked doc 2 years ago he did not mention numbers just said you got osteoporosis,but got a nice doc now,thank you celtic very much appreciated as usual, Anne.PS I hope you are feeling well with all you trouble you have had with the illness,.