At what dose of Prednisolone can I stop Alendronic Acid

[HamishPMR]

Obviously I do not want to be on AA so please do not advise me that I should not take it at all. I have tapered my Prednisolone dosage over the last 15 months from 20mg daily down to 4mg daily. At this level of Pred, can I discontinue AA?

[Hidden]

The NHS website says...

"You'll usually take alendronic acid for a long time. Exactly how long depends on why your doctor has prescribed it.

If you're having long-term treatment with steroids, you'll usually take alendronic acid until your steroid treatment stops - maybe longer.

For other health problems, your doctor will usually assess your risk of broken bones every 3 to 5 years. This may include tests to check the strength (density) of your bones.

Depending on the results, you'll either keep taking alendronic acid, take a break from it or stop taking it completely."

I suppose the problem is that you may be at 4mg but (🤞fingers crossed it doesn't happen) you may have a flare and end up at a higher dose again. In the end it's up to you and your decision may be based on continued steroid treatment, even at a low dose or whether your dexa scan shows a worsening of bone density. I think if a dexa scan has shown osteoporosis and you have committed 15mths to AA to protect your bones it seems like it would be sensible to continue it based on NHS advice. Perhaps the osteoporosis forum/and website might offer more fulsome advice. I am sure others will be along soon to advise you, especially those who took it /take AA.

[SheffieldJane in reply to Hidden]

Good morning Poopadoop - do you never sleep?

As ever you’ve said it all. X

[Hidden in reply to SheffieldJane]

Sometimes I do...but if you know that then you are awake too. 😮🤔

And I hope I haven't said it all....

[PMRpro Ambassador]

There is no answer to that - there is a study that says that pred still can have an effect at 3mg. I, on the other hand, had been on pred for over 7 years and had almost no change in the t-scores from a dexascan done within 2 months of starting pred.

Of more interest is how long you have been on AA. It is recommended that a drug holiday should be taken after 5 years, more up-to-date recommendations say 3 years - and after recent study results that is reduced by some experts to 2 years. This is to reduce the risk of the long term effects of AA that have been identified which weaken the bone structure and can even lead to spontaneous femoral fractures.

[Charlie1boy]

For what it is worth, GP was happy for me to come off AA when I got down to 7mg, but I have no problems with bone density etc.

As always on this forum, there is good advice from PMRpro.

Good luck

Paddy

[HeronNS]

The reasons for you taking AA in the first place should have included an initial DXA scan to get a baseline measurement, and if your subsequent scans show improvement then at least a drug holiday is likely the best thing to do anyway. As AA stays in your bones for the rest of your life it won't stop working the day you stop taking it. Unlike pred you would not have to taper it. Do you happen to know your t-score?

Pred can continue having an effect as low as 2 mg dose as far as we know, but there are so many things we can do to improve bone health besides the medication I personally don't think there would be any harm discontinuing it at the dose where you currently are, provided you are able to get the nutrition and exercise required to stimulate formation of bone building cells, and that is quite straightforward really.

[DorsetLady PMRGCAuk volunteer]

Also from nhs advice pages -

“How long will I take it for?

You'll usually take alendronic acid for a long time. Exactly how long depends on why your doctor has prescribed it.

If you're having long-term treatment with steroids, you'll usually take alendronic acid until your steroid treatment stops - maybe longer.

For other health problems, your doctor will usually assess your risk of broken bones every 3 to 5 years. This may include tests to check the strength (density) of your bones.

Depending on the results, you'll either keep taking alendronic acid, take a break from it or stop taking it completely.

How long do the effects last after I stop taking it?

Once you stop taking alendronic acid, the effects of the medicine will gradually wear off. Your bones may continue to benefit for up to 5 years afterwards.

The longer you take the medicine, the longer the effects will last.”