Steroids and alendronic acid

[Koalajane]

I have been having troubles with my legs being painful and weak enough to collapse. I was diagnosed as having vitamin d deficiency. My doctor has been concerned about my inflammation levels being high and thinks I may have Polymyalgia Rheumatica. She has prescribed prednisolone and alendronic acid. After investigating the alendronic acid I am not sure that I am happy to take it. Does everyone who takes steroids have alendronic acid?

[DorsetLady PMRGCAuk volunteer]

Hi,

It is one of the recommended medications because Pred (steroids) can cause osteoporosis in some people.

What we recommend on here is to check if you actually need it, a DEXA scan with confirm either way. If you don't need it, don't take it, it can cause problems in some people.

I took it for 4 years with no problem, but I needed to, many don't.

You should be prescribed VitD and Calcium tablets - Adcal-D3 chewable is one type. Those will protect your bones as well.

Sure others will be along with further advice.

[Koalajane in reply to DorsetLady]

I have been prescribed vit d but not calcium. With having vit d deficiency as well I am not sure how pain free I will be until the vit d kicks in. The legs are certainly getting stronger but still give me pain

[PMRpro Ambassador in reply to Koalajane]

If you have a low vit D you must not take any alendronic acid until the vit D level is replenished to normal levels - which usually takes a few months so you have time to think about it. Request a dexascan - if your bone density is in normal range then the vit D plus calcium may be enough. I have never taken AA and my bone density has hardly changed in over 7 years of pred.

Had I not questioned the AA I'd have been on it all that time - and it is now recommended you don't take it for more than a few years without having a holiday from it.

[Koalajane in reply to PMRpro]

I have beeb prescribed both vit d supplements and AA. Why should I not take both

[PMRpro Ambassador in reply to Koalajane]

Because it doesn't work if the vit D or calcium level in your blood is low. It does say it clearly in the data sheet from the manufacturers and doctors should KNOW that they must first sort out the vit D and calcium problems BEFORE they prescribe the AA.

You should also get a dental check and any work that may be needed should also be completed before starting AA. There are some dentists who refuse to do extractions and other major items on patients on AA.

[Koalajane in reply to PMRpro]

Just read through the leaflet with the thought I could show it to my doctor and can't find where it says that. Thanks anyway

[PMRpro Ambassador in reply to Koalajane]

Ah - maybe the patient one doesn't.

medicines.org.uk/emc/medici...

Point 4.4, Bone and mineral metabolism mentions it.

I have seen it more emphatically expressed!

It also mentions the dental precautions - including maintaining good dental hygiene.

[Rugger in reply to Koalajane]

I'm on Risedronate, which is a bisphosphonate similar to AA. In the leaflet in the box, under 'Warnings and precautions' it states "Talk to your doctor before you take Risedronate......If you have abnormal bone and mineral metabolism (for example lack of vitamin D......"

Maybe she should have talked to herself!

I was low in vitamin D and have just finished 8 weeks of a very high dose to top up my levels.

My DEXA scan shows osteoporosis, so I felt I had no option but to agree to take the drug while I'm still on steroids, but I wouldn't have agreed to take it without knowing the result of the scan.

I'm also on a calcium (600mg) and vitamin D (400IU) tablet twice a day - not taken at the same meal as my pred.

We need a spreadsheet or something to get all this sorted!

Good luck!

[Tonylynn]

Anyone taking Alendronic Acid (or other bisphosphonate) should make sure they inform their dentist at their next appointment. Some GP's provide a really helpful guide which the patient is advised to hand to their dentist.

The reason dentists need to know is that there is a very very slight risk of complications following surgery or extractions and if these can be avoided , by say root canal treatment instead, then this may be a better option.

[piglette]

Hi Koalajane, I am so sorry you may have PMR. There has been a lot of press about AA recently, basically think twice before taking it and ensure you really need it.

If you are taking vit D you should have it with something fatty to eat eg yogurt to help absorption. Also if you are taking prednisolone you should leave at least two hours if not longer between taking the pred and taking the vit D. With pred you really should have a combination of vit D and calcium because of possible pred side effects.

It does seem that people with auto immune diseases have low Vit D levels, although they reckon over twenty five per cent of the population are deficient in fact! Probably all sitting inside playing with their iPads! What was your vit D reading?

[Koalajane in reply to piglette]

Think it was 22.3