Should I reduce while I have a Fractured Vertebra.

[Attic]

Hi everyone. I have successfully got down to 7mg on the Dead Slow Method. I have stayed on this for four weeks to make sure and it is now time to start trying to get to 6 1/2. The trouble is, since June last year, I have had 2 Fractured Vertebra due to the Pred and Osteoporosis. They seemed to be healing up well, but then, last Saturday from out of the blue I have got another Fracture.

I am in absolute agony and my question is, should I try a reduction, or stay On 7mg a while longer? As you can appreciate, I really want to get to a low a dose as possible because the Pred isn't doing my Bones any good, but then again I don't want to spoil all the good work of getting successfully down to 7mg.

Thank you Attic x

[Celtic PMRGCAuk volunteer]

Oh dear, Attic, as if the pain of PMR isn't quite enough to cope with. I'm so sorry to hear that your fears of another fracture have been confirmed. If you aren't already, you really do need to be under the guidance of a good rheumy, who will understand your past history with fractures and problems with bisphosphonates. It is my understanding that where a patient has previous fractures together with previous bad reactions to bisphosphonates, a special case can be made for treatment with a drug called Forteo which is given by injection. My aunt suffered a spinal fracture a few years ago in spite of years of treatment with bisphosphonates. Her consultant finally applied for and received approval to prescribe Forteo (it is very expensive). She had this treatment for two years, it has successfully built new bone, and she is back swimming, dancing and attending the gym.......at the age of 90!

As for whether you should continue with your reductions, at this stage perhaps it would be wiser to remain on 7mg whilst you are coping with the obvious stress caused by the pain from the fracture. I do hope it eases soon.

[Attic in reply to Celtic]

Thank you Celtic. I am seeing the Doctor on Thursday. I will see what he says about Forteo.

Attic x

[HeronNS in reply to Attic]

Do your own research on Forteo. It caused bone cancer in the lab rats, but I didn't, with a cursory look at the internet, find recent results for human trials. There probably is something, either for or against, and if your doctor is prepared to prescribe it they should have access to recent research. Hopefully over the past few years it has proven safe for humans.

[Attic in reply to HeronNS]

Thank you a Heron. This really is a bit of a a Minefield. I am so worried about taking these Drugs, I don't know which way to turn.

Attic x

[HeronNS in reply to Attic]

What about these procedures (NOT the spinal fusion):

webmd.com/pain-management/g...

Some people who don't want to use the regular OP drugs have been trying strontium citrate or strontium ranelate (second requires a prescription and not yet approved in US, the first is apparently readily available worldwide and needs no prescription). I don't know what kind of side effects they have, nor if the reduction in short term fracture risk is good enough for your needs. If that were me, and I am ONLY speaking for myself, I would likely opt for something to stabilize my spine, get safe exercises to strengthen the muscles around the spinal column and the core, deal with the pain short term and up my game with regard to caring for my bones long term. But of course I don't know all the details of your situation, and at some point we have to trust the doctors.

If I'd known everything I now know about prednisone, for example, and how even at my relatively low dose it would begin to damage me, I probably would still have opted to take it. Trust your gut instincts.

[DorsetLady PMRGCAuk volunteer]

Hi Attic,

My advice would be not to try reducing at the moment. I appreciate you want to get as low as you can ASAP, don't we all, but not a good idea at the moment. Your body is under extra stress from your fracture, so don't add to it by trying to reduce.

It's very difficult because at the moment you seem to be in a catch 22 situation, but if you can, get over your fracture first before you reduce again. Can you ask your GP for some stronger painkillers to help - you can take co-codamol with Pred whereas you can't take ibruprofen.

Hope you soon feel better.

[Attic in reply to DorsetLady]

Thank you DorsetLady. I have got a Telephone Appointment later on with the GP to try and organise some Painkillers.

You are probably right about the reduction, I think I will wait for a while.

Thank you Attic x

[PMRpro Ambassador]

I agree with the others - you need (probably) an orthopaedic specialist on the job. There are things that can be done to reduce the pain of vertebral fractures - but a GP won't be able to do a lot. My neighbour who had fractured vertebrae was provided with a corset to support the spine which reduces the pain somewhat. And something more than bisphosphonates will probably be needed.

[Attic in reply to PMRpro]

Thank you PMRpro, I am seeing Doc on Thursday. I think I need to ask him to refer me somewhere.

Attic x

[PMRpro Ambassador in reply to Attic]

So do I. xxx