The bisphosphonate question - another study. - PMRGCAuk

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The bisphosphonate question - another study.

PMRpro profile image
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38 Replies

womenshealthnetwork.com/com...?

ncbi.nlm.nih.gov/pmc/articl...

The first link explains the second one in people-speak.

The study was published last year and we did discuss it a bit then I think so I'm not sure why BetterBones has taken so long to identify it. But it IS worth a read. And is from a reputable group in London.

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38 Replies
Rugger profile image
Rugger

Thanks for this. As you say, we heard about it last year. Methinks it's time to discuss with GP a date for a holiday from Risedronate!

Allsgrandso profile image
Allsgrandso

Thanks for this, have rheumy appointment end of month and he will not be happy with me at all....keeps pushing it and I say yes and then I don’t 🙈 I know I don’t want to take it because recent research has shown that it’s not good... technical speak I can’t do.. so can’t really argue with him when I’m there

PMRpro profile image
PMRproAmbassador in reply to Allsgrandso

I have nothing against it for the patient who really has low bone density and is approaching osteoporosis. But for those of us with average sort of t-scores - wait and see.

Berylholley profile image
Berylholley in reply to PMRpro

Not quite sure if I should reply like this but I am now wondering if my lower back problem is the pred affecting my chipped vertebra if so am I in trouble?

PMRpro profile image
PMRproAmbassador in reply to Berylholley

I don't see why pred should have an effect on an existing chipped vertebra - but your orthpod is the person to ask I'd have thought.

Berylholley profile image
Berylholley in reply to PMRpro

I am now thinking my lower back problem is Interspinous Bursitis between lumber vertebrae 3 to 4 it says it is quite common with PMR.

PMRpro profile image
PMRproAmbassador in reply to Berylholley

Except this lot

ncbi.nlm.nih.gov/pmc/articl...

say it doesn't correlate with the symptoms. Not that really means that much as they do seem to have difficulty relating to our pain!

Berylholley profile image
Berylholley in reply to PMRpro

It is very very similar to what I am experiencing and you wouldn't know it was there if there wasn't any pain. Right across my pelvic area and in my spine. I have been having a lot of trouble getting up.

PMRpro profile image
PMRproAmbassador in reply to Berylholley

Mine is the sacroiliac joints - rarely have anything central enough to blame spine. But I know what you mean about getting up at times!

Berylholley profile image
Berylholley in reply to PMRpro

I was wondering how I was going to get up from bed this morning and it took me about 2 hours to figure it out, never had anything like it. It is much better now so I am hoping for improvement tomorrow.

PMRpro profile image
PMRproAmbassador in reply to Berylholley

I had an episode like that and managed to get to the ER! They admitted me - it was entirely due to muscle spasm across the lower back causing the sacroiliac joints to be tight although all of my back muscles were as hard as boards! Their desired approach included i.v. diazepam which triggered severe atrial fibrillation after the second lot - but luckily by then the pain was livable with. Then I was handed over to the Pain Unit where an anaesthetist pain specialist did a lot of manual mobilisation and needling techniques plus steroid injections into the trigger points. It was much slower but worked pretty well. I had a return, not as bad though, a few months ago and my rheumatologist gave me a week of high dose NSAID infusions. I was terrified but it worked without any bad effects. Have to say I preferred the original techniques - but she has left and joined GP-land. Too far away to be my GP though :-(

Berylholley profile image
Berylholley in reply to PMRpro

I wouldn't be up to all that as I am 84. My last 2 mornings getting up have been awful but I am getting better in the day time.

in reply to Berylholley

I use the convenient handles on my mattress to pull me along...if I am in a position to reach them. I need a new mattress but refuse to get a handleless one. The problem with such spasms is you breathe less deeply. Remember to breathe and do the child birth breathing as you try and move. I have been on amitrypiline for years fir back spasms which does seem to help. I hope it improves for you. Remember. Breathe.

Soraya_PMR profile image
Soraya_PMR

That Women’s Health Network is a nice site. I’d just got to reading about chromium, difficult to find in your diet, when.....hang about, red wine is one of the best sources. Right at that moment, son came in with a large glass of Malbec for me. ‘T’would be rude to refuse.

Very tasty this chromium 👍🏼

SheffieldJane profile image
SheffieldJane in reply to Soraya_PMR

🤣

PMRpro profile image
PMRproAmbassador in reply to Soraya_PMR

Wonder how much is in our local quite light reds - a glass of which I have within reach. Not in my hand, would make typing impossible...

Ricketts40 profile image
Ricketts40

Help please - I have had painful upper arms since Jan/Feb and went to GP today. She thinks I have the start of PMG and wants me to go on 5gm of Pen from tomorrow. Im having 2nd thoughts as I really don't feel that bad at all. It's just when I raise my arms high I get sore. did any of you start off with these symptoms or were you worse??

HeronNS profile image
HeronNS in reply to Ricketts40

As this thread is about osteoporosis medication you might do better to make a new post in this forum to ask your question. More people will see it. I will say that 5 mg prednisone is a very low start dose but if your doctor thinks this is the very beginning of PMR and 5 mg will do it for you, take it!

SheffieldJane profile image
SheffieldJane in reply to Ricketts40

I agree with Heron, this needs a post of its own. If it is PMR, I am afraid the inflammation does get worse if untreated.

SheffieldJane profile image
SheffieldJane

Thank you for posting this PMRPro. Sometimes you can trust your intuition and gut instinct. I remember my GP merrily telling me the genius of how they stop the formation of new bone etc etc. I was sitting there thinking,” no way am I ever taking Alendronic Acid “. Thankfully my bone scan showed that I didn’t need to.

PMRpro profile image
PMRproAmbassador in reply to SheffieldJane

Um - think he's got his wires a bit crossed. Hope his knowledge of medicine is better than his pharmacology!

karools16 profile image
karools16

I am having 3-yearly Dexa, 3 May, and dreading it. Not the actual scan, but I have lost 3" in height, since last scan. I also have lost bone in my feet, as my shoes are a size too big. I have Osteoporosis. Also, noticeable curvature of spine. I take Ibandronic Acid Mylan tablet, once a month. I am thinking of asking GP if I can stop taking it, as I really don't think it can do anything for me.

Gate-lodge profile image
Gate-lodge in reply to karools16

Will be very interested in what you do next as I have Osteoporosis severe in spine, had a fracture in the lumber spine just over one year ago, lost a few inches in height and have a very noticeable curvature of the spine plus terrible pain under shoulder blade when doing the smallest household chore but so far have not taken any tablets for it because of what I read so just don't what to do for best. This afternoon I see a physiotherapist to see if they can help as this constant pain is getting me down. Any advice please

karools16 profile image
karools16 in reply to Gate-lodge

I get such backache that I can't stand upright. I bend over to relieve pain, and , when out, I prop myself up against a wall, until I either get some relief/take a co-codamol, extra strength, prescribed. When it's all too much to bear, I have a dose of liquid morphine. I was diagnosed age 11 with curvature of spine. I was so upset when the hospital nurse told me my height was now 5' 4" i.o. 5'7". I saw a Spinologist 3 years ago. He said I was not to use a vacuum, so I got a cleaner. She went AWOL, so I do it myself.When I walked into the Spinologist's rooms, he said I had the worst back he had ever seen! CLOSE TO TEARS, HAVING TRAVELLED AN HOUR TO THE HOSPITAL AND PAYING SOMEBODY TO BRING ME.

I have been for physio, and am supposed to do exercises, but...........!

12 years GCA is the least of my problems. Just take each day as it comes. Hope you find somebody who can help you.

PMRpro profile image
PMRproAmbassador in reply to karools16

They have checked that your calcium and vit D levels are right? And your parathyroid hormone levels? I'd think there is a bit more going on than they have thought of.

Mind you - my change in shoe size is a change in fat - not bone!

karools16 profile image
karools16 in reply to PMRpro

No, I don't think so. I don't know what parathyroid hormone levels are. Maybe something I should ask the Endo, when I see him next month?

No fat in my feet. Only part of body that is slender! Am seeing GP Monday. Will ask him about calcium and vit d.

Sho-Sho profile image
Sho-Sho

Thank you for the link - really interesting. My Dexa scan showed bad Osteoporosis with a fractured vertebrae so saw a back specialist who I have been to a lot on the past few years who was horrified that I was on Ibandronate (can't spell it!) as he said, in his experience, it weakens the bones long term. So I have stopped taking it and now upping green veg, fruit, taking apple cider vinegar to increase alkalinity and just take AdCal. This is all as a result of high steroids because of GCA.

Sandy1947 profile image
Sandy1947 in reply to Sho-Sho

How much cider vinegar do you take?will it remove wrinkles?

Sho-Sho profile image
Sho-Sho

Just one tablespoon mixed with warm water.

No - unfortunately the best thing for wrinkles is the dreaded Pred!!

ConventCassie profile image
ConventCassie in reply to Sho-Sho

The dreaded Pred for wrinkles. How ironic is that?

Pollyanna16 profile image
Pollyanna16

This was a timely post PMRpro, I have a Rheumatologist appointment today & one of the things she is keen on is Bisphophonate injection. I couldn’t tolerate Alendronic Acid & stopped Adcal. Am on HRT which she wants me to come off as now 67 & been on it over 10 years. Take Vit D& K2. My dexa scan 2 years ago said I was Osteopeanic- just. She would also like me to try Methotrexate or something similar to get me odd Pred. But I am now down to 3.5 most days and coping. I am very concerned about yet more drugs 😝

I really feel all at sea. My GP seemed to support the injection idea yesterday but now having read the article am very concerned.

BonnyQuine profile image
BonnyQuine in reply to Pollyanna16

Hope yr rheumatologist appointment has gone ok, Pollyanna16. PMRpro's article confirms what I've read before, and I'd avoid bisphosphonates under most circumstances.

We seem to have a fair bit in common. My rheumy was also keen on a bisphosphonate - zoledronic acid - and I turned it down. I also refused methotrexate - keen to avoid unnecessary side-effects. Stopped Adcal because it was hard on my stomach. I too am osteopenic (just), and think there are better ways to improve my chances. Like you, I take vit D3 and K2, and am also on HRT - since menopause. Stopped it when diagnosed w GCA in Nov '16, but started again when began losing my hair some months later [I'm 71] on the basis that it should also help the state of my bones, and I don't have any particular factors against. I wouldn't stop unless there are good reasons to. I eat a calcium-rich, low carb highish protein diet and aim to do a lot more gentle exercise than I do at the moment.

3.5mg pred daily is a very low dose, and probably not much to worry about - no need to do anything drastic to get off it, especially at that stage. Take your time.

Hugs and best wishes, and hope it all works out for the best.

PMRpro profile image
PMRproAmbassador in reply to Pollyanna16

I would be looking for a different rheumy since I doubt you can educate her. At 3.5mg/day and a decent dexascan result AND being on HRT - a bisphosphonate would be going backwards IMHO. It is accepted that there is little effect of such a low dose on bone density. And at 3.5mg - why on EARTH add another drug that doesn't replace pred and isn't guaranteed to reduce how much you need? That is already way below the physiological level. Your body is making more corticosteroid than you are taking!!!!

PS - I'm just osteopeneic too, worst t-score -1.3. Nothing would induce me to take AA or anything else.

Jackoh profile image
Jackoh

Thank you for this.

Pollyanna16 profile image
Pollyanna16

Thank you PMRpro. I was very anxious about seeing her today but I assume, having seen me for the 1st time in February she was able to be more flexible in her approach especially as I was able to demonstrate how I had reduced from 5/4.5 to 3.5/4 since then & using the dead slow method aim to be in 3/2.5 by mid June. Apparently my dexa score 2 years ago was -1.5 & she demonstrated how little a bisophonate injection would help. So quite a turnaround. Thankfully. There is quite a high possibility that there is psoriatic arthritis going on & it is hoped the picture will be clearer in 6 months. When I will have another dexa scan, fingers crossed there will be no need for any bisophonates ..... so, feeling calmer now & hoping the reduction continues to go fairly smoothly 😬. Thank you for your sound advice.

Reeceregan profile image
Reeceregan

Great article once again PMRPro. Wonder if its the same for Denusabs...I see my rheumy tomorrow for the first checkup since starting Prolia early February. (T score -4 so I needed something :(...)

PMRpro profile image
PMRproAmbassador in reply to Reeceregan

Different problem there - there appears to be a rebound effect after they stop the denosumab so they shouldn't stop it after the 2 years they currently use it for. But yes - questions would be appropriate I think!

gtate1914 profile image
gtate1914

I was prescribed Fosamax and actually took it twice..... then I said naww, no good evidence it did anything good. Rheumy not happy with me. Plus I feel I am taking a big chance with my GERD......Taking all the right supplements, walking, and do stair climbing as much as I can.

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