Alendronate

[Hurtinpat]

My doctors have written to me telling me I need calcium and vit D supplement to go with the Alendronate. This is fine why not tell me earlier when I started Jan 2015?

[PMRpro Ambassador]

I hope he is also ordering blood levels to be checked! At a guess someone's only just read the strict instructions for using bisphosphonates which say quite clearly that calcium and vit D levels should be checked and remedied if necessary so it is ensured they are at adequate levels BEFORE starting the patient on alendronate.

Did he send you for a dexascan to see if you needed more than just calcium and vit D? The rheumatology guidelines say calcium and vit D should be given automatically and bisphosphonates only if shown to necessary when a baseline dexascan is done, preferably in the first few months of pred, or if there is deterioration in the bone density at a repeat scan 2 year later. Except they do make the assumption that if the patient is over 65 they will have osteoporosis - which really doesn't follow these days at all.

[Hurtinpat in reply to PMRpro]

Just had a general letter from the doctors,presume any one at my surgery on same medication got the letter. Scans not happened or blood tests since first visit Jan 2015.

[PMRpro Ambassador in reply to Hurtinpat]

They've probably got a new manager or senior partner who's making sure the holes are being plugged. There'll be more to come no doubt!

[HeronNS]

OMG you are not getting the best care re possible osteoporosis. Please note research that shows people require Vitamin K2 (not K1 which has little help for the bones) in order for Vitamin D3 and calcium supplements to do their work. You want the calcium to go into your bones and not get deposited on the walls of your blood vessels, and this is the job that K2 does! All the fat soluble vitamins (this includes A and E) are necessary in the diet or as supplements. Do let us know how you get on. Certainly the doctors deserve a scolding at least. This borders on negligence.

[Hurtinpat in reply to HeronNS]

My medication will be Adcal - D3 cap lets .hope this is ok.

[HeronNS in reply to Hurtinpat]

The two best forms of calcium are hydroxyapatite and citrate. They are more easily absorbed by the body. What is in the AdCal? Also you need to make sure you are getting Vitamin K2 as this is the vitamin that makes the calcium actually get into your bones and is not deposited on the walls of your blood vessels. This can be hard to get from the modern diet because of the way our animals are raised - should be present in products from grass-fed cattle, and genuinely free-range hens. I've given in and am taking a supplement. Vitamin A and E also important for proper Calcium/D3 metabolism. What advice are you getting re exercise? Load-bearing exercise is very important for making the skeleton get stronger. Depends very much on your physical condition right now, but can include walking, tai chi, Nordic walking, etc., but not swimming which is good for cardiovascular fitness but because the water supports your weight not so good for combatting osteoporosis.

[Hurtinpat]

Am walking but too tired to do much else. I will buy some vitamin k2. Thank you for your help

[PMRpro Ambassador in reply to Hurtinpat]

Don't worry too much - I've only ever been on calcium and vit D during 6 years of pred. Celtic on this forum never had anything due to crossed wires - her GP thought the rheumy was dealing with it and the rheumy assumed the GP was sorting it out. Neither of us had any problems and our bone density was fine, didn't change at all. Only about half of patients on pred have bone density problems and unless they had a dexascan at the beginning to get a baseline it may not have been the pred at all - people develop osteoporosis even without pred.

[Hurtinpat]

Thank you. It's not exactly a straight forward illness I now understand.

[PMRpro Ambassador in reply to Hurtinpat]

PMR you mean? In the sense that they can't say this is what you have, here's a prescription and you'll be cured in a few weeks, no. It is a chronic illness that may or may not go into remission and which is managed using pred which is a lot of possible side effects. Unfortunately, most doctors assume that everyone will develop the worst/riskiest side effects and hand out prescriptions for drugs to avoid some of them instead of measuring the baselines and then adopting a wait and see policy with careful monitoring. But once you get the hang of it it isn't half as bad as you think now.

[Hurtinpat]

mmum. Yes but on a Wednesday I have thyroxine,prednisolone,alendronic acid, then the new Adcal -d3 plus bought vit k 2. Wonder which order to take them in. Ah the Adcal says lunch time and evening.

[HeronNS in reply to Hurtinpat]

I found out after several months that one does not take prednisone and calcium at the same time. The upside is that a bedtime dose of calcium has worked so far unfailingly to give me a good night's sleep.