Fissamax or not

[lyndamcw]

What is the option on Alendronic Acid (fossamax)..my dexa scan was normal

I am new to this just been on 15mg pred for two months reducing to 14 now

Thank you Lynda

[lyndamcw]

Sorry I meant OPINION ON FOSSAMAX

[PMRpro Ambassador]

If your dexascan is normal then you don't need AA, certainly not at present - just calcium and vit D supplements and a follow-up dexascan in 2 years.

In over 7 years on pred my t-score has gone from -1.3 to -1.5 - still slap bang in the middle of normal for my age. I was given AA at the start but after 4 weeks decided I wasn't happy with taking it and neither was a different GP at my practice. I haven't taken any since. And as has been proven - I didn't need it. I will have another dexascan in a few years - and in the meantime continue taking calcium and vit D and walking every day.

AA should not be taken for more than 5 years without a holiday to avoid some of the nastier side effects - and some experts are now saying 2 years. There are two ladies on the forum who have developed fractures in under 2 years, one has shin splints, one has femoral fractures. There are several with tooth problems.

It isn't the miracle with no side effects it was marketed as in one of the most successful drug marketing campaigns in recent years - unfortunately, the doctors who were "brought up on it" find it hard to change their minds.

[lyndamcw in reply to PMRpro]

Thank you for this that ess my thinking too.

[paddyfields in reply to PMRpro]

I am sure I read that the rationale behind the use of these drugs is debateable , i.e. that "denser" (my description) bones are less likely to fracture

.

[PMRpro Ambassador in reply to paddyfields]

There are no figures on correlation between density of bone and fracture rate. People with low density don't have fractures, people with normal bone density do have fractures. There is some concern that AA itself CAUSES atypical fractures of the femur and that was part of the reason the FDA warns it should not be given for more than 5 years maximum before a holiday was taken from it. Recently there has been comment saying even 5 years is too long. It also can lead to jaw problems and tooth loss because of bone degradation, even necrosis.

The rate of hip fractures was declining anyway, even before AA was used so widely and there are far better ways of avoiding fractured hips in elderly patients that have no side effects - correcting vit D status, keeping properly hydrated, not over-medicating for various things, especially BP, good lighting, handrails where appropriate, removing trip hazards (even the Queen has given up her large numbers of corgis which were always around her feet).

I don't mind it being suggested where there is proof of need. But far too many patients get AA tablets handed them without having had a dexascan - it shouldn't be given to patients with normal bone density - and without the requisite checks on calcium and vit D status. You can take all the AA you like, but if calcium and vit D status are low it won't do any good.