Alendronic Acid

[Gardenbay]

I have reduced my Prednisolone to 3 ml a day, I was thinking of stopping my weekly intake of Alendronic acid, but I first of all contacted my GP. She has responded by saying that I should stay on it for five years. I have been on it for 15 months. What are your thoughts on stopping Alendronic Acid.

[piglette]

Five years is a maximum not a minimum. There have been some papers suggesting less than that. Have you got osteoporosis? What were your Dexascan results?

[Gardenbay in reply to piglette]

I do not have any other health problems, I suggested a X-ray to my GP, but nothing was suggested.

[piglette in reply to Gardenbay]

If you have have not had a Dexascan you may be taking Alendronic Acid and you don’t need it. The trouble is there is a long wait to get one on the NHS. I should say there is no way I would take Alendronic Acid if someone had not proved to me I needed it. Some doctors do tend to give it anyway assuming all older people will have reduced bone density.

[PMRpro Ambassador]

Oh dear - how is it they get half a story? And all too often the wrong half ...

Five years is the MAXIMUM time you should stay on AA without a drug holiday. Some recommend THREE years as the max.

An x-ray will show nothing useful - as piglette asks, have you had a dexascan at any point?

[Gardenbay in reply to PMRpro]

No dexascan, my GP not in until sometime next week, so I will ask her then.

[Wallydb in reply to PMRpro]

I have been on Alendronic Acid as well as Accrete D3 tablets now for nearly six years so should I stop both now for a holiday. And how long a holiday should I have?

[piglette in reply to Wallydb]

Your doctor should have reviewed you at 5 years.

[PMRpro Ambassador in reply to Wallydb]

I wouldn't stop the supplements - they are the first line of protection even if you don't take bisphosphonates. Unless you develop problems due o calcium which some do, then you need good dietary calcium. And vit D is probably the most important factor in protecting BMD.

[Exflex]

Given bone depletion is caused by Corticosteroids, is it proportional to dosage. That’s what I’d like to know. For example if we start on 15mg but successfully taper to 3mg is bone depletion reduced to one fifth of what it was at the higher dose? Until recently I was tapering from 2.5mg to 2mg but stopped this to follow sick day rules. Although my GP advised taking bisphosphonates until I finish steroids, I decided to take the bone saving meds (in my case risedronate) once a fortnight until I’m off steroids. 2mg and below is a very low dose and I think I’ll be ok following the once a fortnight dosage rather than once a week. Of course I’d like to see/read research papers to be better informed.

[PMRpro Ambassador in reply to Exflex]

The simple answer is no. And loss of bone density with pred is by no means inevitable. I have been on pred for over 13 years now, all bar about 3 years at above 10mg/day. I had a baseline dexascan after about 2-3 months with t-scores IRO -1.3 that meant no-one suggested AA was needed, just calcium and vit D. At my 4th dexascan after 11 years my t-scores were very little worse - the worst is -1.6 if I remember rightly.

Some people do lose BMD (bone mineral density) with pred and it can be quite quickly at all sorts of doses. Others no problem at all: I had PMR so never above 15mg, jinasc had GCA so much higher doses, 60mg to start I think, and her BMD was also fine.

[Exflex in reply to PMRpro]

I think we need to assess this on a much larger scale. The experiences of a few are interesting, but difficult to extrapolate to population level (the population meaning those on Pred, obviously). Interesting that for some BMD due to steroids can possibly result at low doses. Probably why I was advised to stick with it until the bitter end. Damn!

[tangocharlie in reply to Exflex]

I've been on steroids for 10 years, the last 2 years at a high dose (40-22), but my bones are fine as shown by DEXA scans, so bone loss is not inevitable. It's high time we knew more about this

[Wallydb]

How long should the holiday be for. I have been on it for nearly six years. I think I ought to stop now.

[PMRpro Ambassador in reply to Wallydb]

Something to discuss with your doctor:

mayoclinic.org/diseases-con...

is the Mayo Clinic's take on it. Of course - there is no consensus!

[Wallydb in reply to PMRpro]

Thank you for your help and advice. This site is a godsend.

[Logic]

I am planning to ask my PCP if I can go off alendronate in December, after 3 years if my bone scan looks good. I have read that is a good idea. I think it depends on that. Five years is the max that's safe I have heard. I am very nervous about taking it but scan showed osteoporosis.

[AyJayBass]

My DEXA scan showed good results and my GP allowed me to cease AA when I got down to 5mg of Pred.

[PMRrunner]

My dexa scan showed osteopenia but I was told I could stop taking alendronic acid at 5mg prednisolone. I still take calcium and vitamin D

[autumnlass in reply to PMRrunner]

When I fractured my ankle 20 years ago on two occasions they put me on AA and kept me on it for 10 years! I rang the Royal Osteoporosis Society and they were horrified! Maximum time on AA in those days was 7 years. I remember speaking to my GP then and they insisted I continued taking it! About 6 months later they said I could stop it (sigh). I started taking Risendronate last year, but had a DXA scan first which showed Osteopenia. I had to have that done privately.

[Gardenbay]

Thank you to everyone for your advice.

[Koalajane]

I think also we should remember it is our body not the doctors,You should be allowed a bone density scan before taking bisphosphonates.

I started on them and my doctor rang me to say do not take any more until you have been for a check at the dentists. This led me to not take any more and at a doctor appointment I was referred for a bone density scan. No need for bisphosphonates, just take d3/calcium. A year later my bone density was normal. I continue to take d3/calcium along with k2 which sends the calcium to the bones. I also walk over 10,000 steps each day