How long do the effect of AA persist after stopping?

[Exflex]

I stopped the weekly AA (actually Risedronate in my case, but basically the same) about 10 or so months ago when I had reduced to 2.5mg Pred. (I’m now on 0.75mg having reduced by 0.25mg when appropriate). How long does AA (or risedronate) persist after cessation in terms of laying down new bone mass on top of old bone that should have been recycled, potentially leading to fragile bones?

Edit: My GP practice has ordered a DEXA, but the waiting list is as long as your arm. The original DEXA performed 3.5 years ago was ‘normal’.

[PMRpro Ambassador]

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

probably answers your question

[Exflex in reply to PMRpro]

Thank you for that Pro!

As I was on Risedronate, the binding affinity with Hydroxyapatite is low compared to Alendronate, so empirically a 12 month holiday would seem to be appropriate. But since I’m on 0.75mg of Pred and, fingers crossed, 0mg in two months time I don’t intend to start taking Risedronate again, unless a DEXA scan shows it’s necessary - I’m not getting younger. (I seem to have waited ages but I’m told by my GP that I have been referred.)

Edit: interestingly, there’s no mention of taking calcium / D supplements to offset the kidneys flushing it out due to glucocorticoid use, or the use of K2 that’s often mentioned here.

[PMR2011]

not sure why you were prescribed AA when the Dexa scan was normal. It seems the general practice is to prescribe it if you’re on Pred whether or not it’s really needed. My Dexa showed osteopenia. I elected to manage it with supplements and weight bearing exercise. After over 7 years of Pred and no AA my Dexa scan has stayed the same.

[Exflex in reply to PMR2011]

I can’t think of an appropriate analogy off the top of my head, but I look at it this way. If your bones are normal before Pred but the effect of the steroid is to cause the kidneys to dump calcium, you’d be advised to compensate. Doctors probably predict not everyone will stick strictly to CalChew D3 so they opt for AA to put a protective shield around your bones. (The technical stuff is in the link PMRPro provided.)

When I was prescribed AA I had no idea about the downsides, until I joined this forum. Now I would advise others to think carefully.

[DorsetLady PMRGCAuk volunteer in reply to Exflex]

This is para 6 from guidelines re bone protection -

BSR guidelines para 6 -

We recommend the use of bone protection when initiating steroids for PMR to prevent the complications of osteoporosis

A. Individuals with high fracture risk, e.g. aged greater than 65 years or prior fragility fracture

Bisphosphonate with calcium and vitamin D supplementation

DEXA not required

B. Other individualsCalcium and vitamin D supplementation when starting steroid therapy.

DEXA scan recommended

A bone-sparing agent may be indicated if T-score is -1.5 or lower.

C. Individuals requiring higher initial steroid doses

Bisphosphonate with calcium and vitamin D supplementation (because higher cumulative steroid dose is likely)

[darkred in reply to PMR2011]

I took NOW calcium hydroxyapatite caps 500 mg daily until about a year ago. After going through the bottle containing 120 capsules, I started on Solaray calcium magnesium 2:1 ratio (containing calcium amino acid chelate complex, calcium carbonate, calcium hydroxide/ magnesium amino acid chelate complex, magnesium oxide plus glutamic acid HCL 100 mg). (I also take other supplements.)

My question: Does anyone else take calcium hydroxyapatite??? I would like opinions on the pros and cons of this supplement. For example, has anyone's rheumy mentioned this supplement? Is it better than other kinds of calcium?

[PMRpro Ambassador in reply to darkred]

Few people will see this - if you want replies, start a new thread. AA is not a supplement, it is a drug so questions about supplements don't fit here.