Alendronic acid again

[MaryWR]

I have had PMR since December and been on prednisolone 15mg since January and am now just about on 9. I have had no flares and am almost symptom free except for the odd twinge and some tiredness. When I saw the rheumy she put me on alendronic acid with no discussion. After 5 weeks I started to get discomfort when swallowing so I stopped taking it. When I discussed it with the GP he said I should carry on taking it otherwise I would get osteoporosis. I pressed for a dexascan which he reluctantly agreed to. I now have the result and the GP wrote to me and said I should resume taking it as I had osteopenia. My scores are : spine T-score -1.6 Z-score 0.2 - osteopenic, hip T-score 0.1 Z-score 1.4 normal.

I've read a lot of your information plus other sources and feel that I still don't want to take AA because osteopenia at my age (66) is fairly normal, my readings are not that high and osteopenia doesn't automatically progress to osteoporosis. Also it seems that it might not even be that effective against osteopenia. Am I being foolhardy? Any advice would be so gratefully received.

[Celtic PMRGCAuk volunteer]

My first DEXA scan showed normal bone density, and a repeat two years later showed spine slightly in to the osteopenia range but not needing treatment. My latest scan a couple of years after coming off steroids has actually shown an improvement.

If it was me and I was presented with your scores, I would definitely not consider AA. Try and keep up with daily walking and eat plenty of calcium-rich foods, including oily fish, and hopefully you will be fine.

[MaryWR in reply to Celtic]

Thanks for your help and support. I am definitely not taking the AA especially in the light of other people's experience and comments! Yes I will ask for another decals an in 2 years and hopefully will be off the dreaded steroids by then.

[PMRpro Ambassador]

Those readings are very similar to mine - they are not considered worthy of any intervention here in Italy! They are nowhere near osteoporosis.

I had a dexascan done about 3 months into pred and again about 3 years later - they were essentially the same (done on different machines so can't be compared directly but both were fine). I have taken calcium and vit D - and 4 AA tablets before I decided not to take it. I was lucky, the GP I discussed it with agreed with me about AA not being the wonder-drug with no side effects the manufacturers would have you believe it is!

You do NOT necessarily develop osteoporosis because of taking pred for PMR. You have a dexascan result that gives a baseline and you should tell your GP you will be happy to have a repeat in 2 years or so.

If I were your GP would be more concerned about the gastric discomfort you had when taking the AA rather than insisting you take it when you don't yet really need it.

[MaryWR in reply to PMRpro]

Thank you for your reply - I definitely agree with your thoughts and will tell the GP where to put his AA. Italy sounds a lot more enlightened than the UK!