Adcal-D3 and Alendronic Acid

[Bncc]

When pred was first prescribed I was also prescribed Adcal-D3 and Alendronic Acid. Why? Are these reduced as the pred is reduced, now on 8 down from 20?

[DorsetLady PMRGCAuk volunteer]

As Pred can still be affecting bones, even at lower doses.

Adcal -D3 is still find to take, unless you are one if the few that it causes issues especially, and if it were, you’d already know.

In fact I’m still on it, 4 years after finishing Pred, as we age many of us need a bit of help, bones-wise....and I was advised to continue following DEXA 18months ago.

As for AA, discuss with prescriber, they may feel you’ve been on it long enough, if so then stop. However it might be considered advisable to continue a bit longer - depending on YOUR bone situation - but you shouldn’t be on it longer than 5 years without a pause.

[Bncc in reply to DorsetLady]

Thank you. I only started this June, when the pred overnight removed my stiffness, so really am a beginner.

[DorsetLady PMRGCAuk volunteer in reply to Bncc]

Then this might help - and yes ask for a DEXA scan - healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

You are given them because one of the adverse effects of pred is to lose more calcium through the kidneys and in the longer term in some people this can lead to loss of bone density and even to the development of osteoporosis. Often just extra calcium and vit D is enough to prevent that but AA reduces the breakdown of old bone and encourages building of new bone so that the bone density remains the same or gets better (bone is a living material which is continuously broken down and replaced, if breakdown exceeds building, bone density falls).

I believe the AA should only be given after a dexascan to see what the baseline is - but you probably do need the AdCal. I have never taken AA, my bone density has barely changed in 11 years of taking pred. They aren't reduced as the pred is reduced until you get to really low doses, you may be able to think about it below 5mg, but a dexascan is a sensible precaution first. I had to stop AdCal because of bladder problems but I replaced it with 4000 IU vit D and more dietary calcium.

[Bncc in reply to PMRpro]

Thank you for this information. I started pred in June, when it overnight cleared by debilitating stiffness, so a long way to go. Maybe when Covid is no longer priority I can get the bone tests.

[Joanbill13 in reply to PMRpro]

I have had bladder problems for years but worse since taking AdCal. I did have a small bladder tumour removed 5 weeks ago but still suffering pain passing urine. What problems did AdCal cause you

[Bncc in reply to Joanbill13]

No problem. Just asking for information.

[PMRpro Ambassador in reply to Joanbill13]

Cystitis - grit can form in the urine and irritate the lining of the bladder and the urethra, especially if the urine becomes concentrated because you don't drink enough. I changed to a different calcium product which helped but eventually it got worse again and I gave up calcium. Take plenty of vit D and indulge myself on cheese to up the calcium intake.

[Joanbill13 in reply to PMRpro]

Thank you