Is it really necessary to take Alendronic Acid with these results?

[NowandAgain]

I am 72 years old and have been diagnosed with osteoporosis/osteoporotic (Iam not sure which as the report refers to both). The results of my tests are as follows:-

Indication: PTH

Risk Factor: Excess alcohol, fractured

wrist age 64, maternal hip fracture,

Secondary Osteoporosis (PTH)

Medication: OTC Vit D just started

Falls in the last 12 Months: 0

Weight: 58.8kg

Height: 159.5cm

Ethnicity: white

Age: 72

..

Bone mineral densitometry hip Lt :

Scanned Region:

..

AP Spine (L2, L3, L4)

BMD(g/cm2) = 0.676

T-score = -3.7

Z-score = -1.3

Classification = osteoporosis

..

Femoral Neck

BMD(g/cm2) = 0.467

T-score = -3.4

Z-score = -1.5

Classification = osteoporosis

..

Total Hip

BMD(g/cm2) = 0.531

T-score = -3.4

Z-score = -1.7

Classification = osteoporosis

..

WHO Fracture Risk Assessment Tool

10 - Year fracture Risk:

Major Osteoporotic Fracture =60%

Hip Fracture = 46%

..

Reported Risk Factors: previous

fracture, parental fracture, Secondary

Osteoporosis, alcohol use

UK, Neck BMD = 0.467, BMI = 23.1

..

FRAX Version 3.08. Fracture probability

calculated for an untreated patient.

Fracture probability may be lower if the

patient has received treatment.

..

Interpretation:

No technical difficulties reported with

the hip or spine scans. On analysis no

artefacts seen.

L1 has been excluded due to being > 1 SD

different to adjacent vertebrae

appearing small and bright on the AP.

The non dominant forearm could not be

scanned due to previous fracture.

At present due to BMD and risk factors

for osteoporosis, the patient has a high

risk of fracture in the next 10 years.

Possible dental issues have been

recorded and must be fully resolved

before starting any bisphosphonate

treatment.

..

The patient has not lost any height but

as L1 has been excluded due to appearing

small and bright a VFA scan was

performed today. No fracture identified.

Chronic degenerative changes noted but

grossly unchanged to CT 07/09/2021.

..

Recommendation:

The patient is osteoporotic.

Based on the referral information and

DEXA results, treatment is indicated

with Alendronate, Risedronate or Binosto

for 5 years provided there are no

contraindications, and it can be

tolerated. If the patient is unable to

take an oral bisphosphonate or they are

not tolerated, the current recommended

second line agent is Denosumab 60mg

subcutaneous injection, every 6 months

for 5 years. (NICE T161 \T\ 204)

Denosumab can be prescribed and

administered in the primary care

following this recommendation, but prior

to doing so, please consult the drug

prescribing information/summary of

product characteristics, patient

information leaflets and risk materials

(available online at the Electronic

Medicines Compendium)

medicines.org.uk/emc/

In particular, the similar cautions

regarding dental treatment / risk of

osteonecrosis of the jaw and atypical

femur fractures exist for Denosumab as

oral (or IV) bisphosphonates. Denosumab

should be used with caution in patients

at risk of recurrent or severe

respiratory / urinary or skin or other

infections and in this situation (or if

it is not tolerated), IV bisphosphonates

may be an alternative or Strontium

Ranelate could be considered (please see

BNF for risk factors)

If treating with Denosumab for up to 5

years do not just stop as there have

been cases of an increased rebound

fracture risk shortly after stopping.

Discuss with Rheumatology in all cases

after a repeat DEXA scan to assess bone

density before stopping Denosumab.

..

If the patient fractures after 1 year of

treatment with a T-score -3 aged 65 or

a T-score of -4 refer to rheumatology to

consider future treatment options in the

osteoporotic clinic HUTDG/OST.

..

The patient has been given lifestyle

advice on bone health. They have been

advised to reduce their alcohol

consumption to within the daily

recommended limits.

If vitamin D deficient and treating with

a Bisphosphonate recommended treatment

regimen is based on:

A fixed loading regimen to provide a

total of \R\300 000 IU vitamin D, given

either as separate weekly or daily doses

over 6 - 10 weeks.

Followed by maintenance therapy

comprising vitamin D in doses equivalent

to 800 - 2,000 IU daily (occasionally up

to 4,000 IU daily), given either daily

or intermittently at higher doses.

Adjusted serum calcium should be checked

one month after completing the loading

regimen or after starting vitamin D

supplementation in case primary

hyperparathyroidism has been unmasked.

Calcium Supplementation: Under normal

circumstances calcium supplementation is

given alongside vitamin D

supplementation, however, if the patient

has a dietary intake of calcium that is

equivalent to the proposed calcium

supplementation; vitamin D

supplementation is available without a

calcium component. There may be rare

circumstances where there is a

contraindication to calcium and or

vitamin D supplementation. Always check

with the treating specialist if there

are any concerns.

..Follow-up:

Refer back for reassessment of fracture

risk in 5 years.

I am at present taking prescribed Vitamin D Adcal calcium carbonate and have also been prescribed Alendronic Acid 70mg to be taken once a week, but to date I am not taking this since I am loathe to take more medication than is absolutely necessary since my husband seems to take so many to counter-effect others.

My fractured wrist over 10 years ago was due to me being silly failing to leap over something of height!

I am active in the garden carrying heavy barrel loads of garden material and laying heavy garden slabs, etc. and this seems never ending.

I have recently had a masectomy to one breast and have hyperthyrodism due to a small biateral goitre but as I have no symtons to date I am refusing to take the 5mg carbimazole prescribed for this.

The only other medication I am taking at present is10mg rivaroxaban for the thrombosis of the leg (this may have been caused by the Astra Zeneca vaccine)

I believe I may have arthritus in one knee.

I am sorry if I have given more of my health details than may be necessary but maybe it will assist and any comments as to whether it is considered the Alendronic Acid prescribed is necessary will be greatly appreciated.

[DorsetLady PMRGCAuk volunteer]

Hi,

Doesn't look as if you have GCA or PMR which is what this forum is for, nor that you are on steroids which can affect bones. So perhaps you would be better asking on the bone health forum-

healthunlocked.com/bonehealth

..or maybe looking at the ROS site - and speaking to a nurse specialist -

theros.org.uk/

However this link is in the FAQs on this site, so maybe have a look through that -

healthunlocked.com/pmrgcauk...

[NowandAgain in reply to DorsetLady]

Many thanks for your reply and will follow the links you have kindly supplied. Finding my way around Health Unlocked. Sorry for bothering you

[DorsetLady PMRGCAuk volunteer in reply to NowandAgain]

No it’s no bother at all…. Please don’t think that. Just thought there might be more info on the bone forum than on here… being on steroids [which we know about] can make a big difference to advice given on AA.

[piglette]

As DorsetLady says the Royal Osteoporosis Society site is probably the best for you. theros.org.uk Looking at your results it does look like you are pretty osteoporotic.

[NowandAgain in reply to piglette]

Thank you piglette for the link. I have a lot of research to do.

[PMRpro Ambassador]

You do have very low t-scores which indicate quite severe osteoporosis. A score of -1.0 is normal. -2,5 is the borderline between osteopenia and osteoporosis and you are well the other side of that. As a result you are at risk of an osteoporitic fracture - in the spine if nowhere else.

But I notice they have said osteoporosis secondary to PTH - is your PTH (parathyroid hormone) level high? If so, that is what is causing the calcium to be leached from your bones. It is often due to a benign tumour on the parathyroid glands so that should be investigated too. If that is corrected then the loss of calcium from bone will stop and bone density will slowly recover - and probably faster with the AA.

You need to talk about it to an expert - such as at the ROS. It would be interesting to know what transpires! Good luck

[NowandAgain in reply to PMRpro]

Thank you PMRpro. Other people have suggested hyperparathyroidism too, so I am looking into this. Thank you.

[DrRon]

I am 81. Four yrs ago, with a hyperthyroid issue, high calcium level, there was concern about my bones. I was prescribed Alendronate. Then I came down with Polymyalgia Rheumatica, so a corticosteroid (Prednisone) was prescribed. It's a medication that can cause osteoporosis. Alendronate has worked for me. Calcium level normal. We believe Alendronate has prevented bone breakdown and has increased bone density (thickness). -- I have read your entire report. My own condition is different from yours. Yet, from my experience, I would recommend a no fear approach.

[NowandAgain in reply to DrRon]

Thank you DrRon. From the information I have gained from here and on the Bones Forum I have a lot of reading and research to do.