Alcasta (zeolodronic acid)

[Monkey321]

Hi, anyone have any experience with the oral tablets? (Good or bad) My DR wants me to start this and I opted for tablets rather than infusion. He said I'd have to take it for next 5 yrs for osteoporosis. As my DEXA scan revealed under -2.5 I'm eligible for this to be government funded here in NZ. However, having read many articles and MedSafe info on this, I'm really not keen to take it. It seems to have many negative side effects. Thanks.

[PMRpro Ambassador]

I think you are confusing what you are intending taking. Aclasta is zolendronic acid but it is an annual infusion - the tablets will be a different substance, either alendronic acid or risendronate.

I took 4 AA tablets when I first started pred 15+ years ago before discussing it with a different GO and we agreed to wait for the dexascan result. It was good, so have all the others since then and I never took another tablet. A couple of months ago, a spinal x-ray showed a probably spinal compression fracture and it was agreed I would start a bisphosphonate, this time a zolendronic acid infusion. I will have 2 more, in a year and in 2 years and that will be it.

Before starting whichever you choose, you need a thorough dental check-up including a panoramic x-ray to rule out any inflammatory problems and a thorough hygienist appointment. After that, you need to maintain good oral hygiene. This will reduce any of the dental risks associated with bisphosphonates. They are not usually a problem with the doses used in osteoporosis prevention, it is in oncology patients that they arise where much higher doses are used (infusions every month in some cases) and there is also an underlying potential bone pathology with the cancer.

The infusion itself wasn't a problem. My rheumy had warned me that 1 in 5 patients feel flu-ey for a few days. I was unlucky - as described in the NZ patient info sheet, my adverse effects took 3 or 4 days to appear and lasted 2 weeks!! It wasn't too bad though. I still think it was preferable to messing about to take the tablets once a week!!

[Purplegloss in reply to PMRpro]

You may remember that I have now been diagnosed with osteoporosis following my latest Dexa scan, and I now have managed to get a F2F appointment with my GP 3rd April to discuss my starting Prolia. Just wondering if I should have a zolendronic acid infusion instead. I believe if I have Prolia it would be for life every six months, whereas from what you say it is just 4 infusions and then stop if I understand correctly with zolendronic acid.

[Viveka in reply to Purplegloss]

Prolia has to be taken on an ongoing basis because if you stop the bone growth goes into reverse, unless you then go on to take AA or ZA. NHS likes to push prolia because it can be done by a nurse so far cheaper. Not all GPs know the issues with prolia. Mine didn't. I think it depends on your age and level of osteo. Prolia grows bone but is ongoing, ZA maintains what you have. Both prolia and ZA infusion seem well tolerated.

[PMRpro Ambassador in reply to Purplegloss]

I will get the 3 annual infusions and stop - is the plan as I understand it. Prolia will be ongoing - or switch to zolendronic acid if you decide to stop the Prolia as that also works. Prolia will increase the bone density faster which may be an advantage but you will lose it if you stop it.

[Timelost in reply to Purplegloss]

I was diagnosed with osteoporosis about 6 months ago. I opted for 3 annual ZA infusions and had the first one just before Christmas. I had a bit of a reaction but fine after a week or so. Decided it was much better than taking a tablet every week.

[Purplegloss in reply to Timelost]

Thanks for your reply, not sure what to go for yet!

[Jbobby in reply to PMRpro]

I’m interested you went 15 years on Pred without any need for more AA until now. Like you I did 4 weeks of oral AA just over a year ago when I started Pred but I couldn’t bare it so one rheumy said to stop for a while. Havnt taken any since but have been on vit d/calcium K2 etc. I’m already on osteoporosis border ( some areas) and due another dexa next week. However I’ve had some slight back pain for last 6-8 weeks ( worse when tired) and other rheumatoid now sending me for MRI in case of spinal fracture.. I’m on 10 mg pred at moment. Is it ok to have MRI on that dose? I dread returning to AA or the infusion but suppose I might have to.

[PMRpro Ambassador in reply to Jbobby]

Unusual to do an MRI for spinal fractures - except to decide if it is an old or new fracture. I dont think pred will affect it if that is why. Have they not done a good old-fashioned plain x-ray.

[Jbobby in reply to PMRpro]

Thank you. Well I think my rheumy said mri is to establish if it’s old or new fracture. Or fracture at all. I agree good old fashioned xray might be best but think I had one of those recently ( brain fog so can’t remember when exactly) so maybe mri essential. In your experience is spinal fracture vv painful? . I seem to have intermittent slight pain up and down spine in different areas…

[PMRpro Ambassador in reply to Jbobby]

My probable spinal compression fracture that showed on a plain x-ray doesn't hurt at all! It's other low back things that hurt and mainly due to sacroiliac inflammation and muscle spasm. OTOH, my husband had one as the result of a fall and it was excruciatingly painful.

[Jbobby in reply to PMRpro]

Ah ok. I’m sorry for your husband. Well I’ll have to wait and see what cause of mine is …. Thank you for info.

[Sophiestree]

I, like Pro had the annual infusion which I much preferred and unlike AA where I had terrible side effects, was ok after. I only got 2 instead of 3 though as I requested a referral to a different hospital and so they revoked no 3 🙅‍♀️

[MrsNails]

Hi, l took Zolendronic Acid for three years but it was every six months as l was taking it as an adjuvant treatment following Chemotherapy. I had previously been taking Alendronic Acid.

It was totally unremarkable so much so l wondered if they’d actually added it to the infusion but they were all the same!

[PMRrunner]

I took Alendronic acid but had flu-like symptoms for 2-3 days each week. I stopped taking it when down to 5mg prednisolone but will reassess if I ever have another dexa scan, my first one was over 5 years ago and showed I had osteopenia in my spine and both hips.

[Rubha]

As I already had osteoporosis before having to take Pred due to PMR diagnosis, I take a bisphosphonate. There is AA and Risedronate which are oral tabs , the infusion is annual (I believe) . I have no problems with AA. I had a 4 year « holiday » from it after another Dexa. Please do not panic about the need for AA (or alternatives) if you need them . There’s more negative info than positive. …..that’s the nature of negative thinking. Good Luck 😁