Opinions needed ref Aledronic Acid

[marionofnorwich]

Having recently been diagnosed with bone marrow oedema and a subchondral insufficiency fracture in my knee, I am wondering whether or not I should consider taking the Alendronic Acid I was prescribed as a precaution at the start of taking steroids. I did take it to start with, once a week and a couple of times experienced extreme stomach bloating (have now got a very sticky out belly button) so after abiut a year I stopped taking it, and asked for a Dexa scan. The Dexa scan confirmed that I didn't need it so I haven't taken it since. I am coming up three years since diagnosis and therefore steroid use. This time last year I had reduced to 4mg, just dropped from 5mg when I experienced extreme pain in my knee. I put it down to Covid and a flare, increased the pred and have been tapering down again now at 4.5mg.

About to have a cortisol test to see how my adrenals are doing but curious to know what people think about the Alendronic Acid or would it just be shutting the stable door after the horse has bolted?

Any thoughts?

[piglette]

Why do you want to consider Alendronic Acid when your Dexascan was fine? If you have not had one for three years, you could ask for another to make sure things are still OK.

[Bcol]

I would agree with Piglette and ask for another DEXA scan and wait and see what the results tell you.

[Kendrew]

Hi marionofnorwich,

Alendronic Acid...like steroids....can have some unpleasant and unwanted side effects and is not, in my own personal opinion, a medication that should be taken unless there is reliable evidence to support the need for it.....some of that evidence being sought from a DEXA scan.

You said your last DEXA scan showed no requirement for AA but as Bcol suggested, maybe request another one to ensure you're maintaining the satisfactory bone health you previously had.

[PMRpro Ambassador]

Time for another dexascan before taking it.

But I'm not quite clear why you suddenly are thinking about taking AA? Have the orthopods suggested it? Is there evidence that the fracture is due to OP? It isn't usually and it is a common fracture in older adults,

"Subchondral insufficiency fractures are slowly healing fractures of the bone situated immediately below the cartilage of a joint.1 The prognosis may range from full recovery to rapidly escalating joint destruction.2 A case series of 32 patients (mean age 70 years, 5 patients osteoporotic) with knee insufficiency fractures concluded that osteoporosis is not the underlying cause of subchondral insufficiency fractures in the majority of patients."

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

where you will notice that all the subjects were 70-ish and only 5 out of 32 were osteoporitic.

This is also a good read

sportdoctorlondon.com/bone-...

[marionofnorwich]

Yes it wasnt that long ago, mid 2022 that i had a DEXA. I just wondered if not taking it, or enough calcium and vitD was responsible for the bone oedema and fracture. I am not sure which came first. The MRI (February) didnt show up osteoporosis on the knee but this oedema and fracture is often caused by steroid use apparently. As i was given it originally as a preventative i wondered if not taking it had let problems occur. But mainly whether now it would help strengthen the bone. But it sounds as though AA is specifically for osteoporosis which i am pretty sure is not the problem so it can stay on my shelf in that case

[PMRpro Ambassador in reply to marionofnorwich]

Quite!!

[marionofnorwich]

I have a phone conversation tomorrow with an osteo/ortho triage so I guess will get an idea of next steps then

[sennetta]

Read Pizzorno's book entitled "Your Bones