Prescribed Alendronic Acid and Lansaprozal at start of treatment. Are they necessary?

[Scaredofpred]

greetings! Now on Day 7 of 15mg Pred. Stiffness and general pain considerably reduced, but persistent pain from frozen shoulder.

Sleeping much better, feel tired but have pulled back on activity and allowing plenty of rest time.

Started a low carb diet, take Pred after breakfast of eggs ( veg omlette) and full fat Greek yoghurt.

saw locumGP last week, started Adcal D3.

Do I need AA and Lansaprozal please? I feel very light headed which I assume is my body adapting to Prem, so reluctant to add more to the mix.

So grateful for this forum.

[Koalajane]

I was prescribed Alendronic Acid and took 4 tablets which gave me heartburn. I then had a call from my GP who said don’t take any more until you have had a dental check up and any treatment completed. I did a bit of research and decided against taking it. Later that year I was offered a bone density scan which showed I had very mild osteopenia and the report said carry on with the d3/calcium and with walking, no need for AA. The next scan showed my bone density to be normal. I think you should ask for a bone density scan before taking it.

I was never offered a stomach protector and always take my prednisolone with breakfast. After 7 years I have had no problems at all.

[Scaredofpred in reply to Koalajane]

Thank you! Reassuring

[Thelmarina in reply to Koalajane]

I was fine with yoghurt for 5 years but finally took Lanzaprozole after diagnosis of diverticulosis and starting a blood thinner and statin. (I know. Held together by modern medicine!). I also take an excellent pro-biotic. Others will be along to advise. Take your time before adding to the mix 😀

[DorsetLady PMRGCAuk volunteer]

Depends.. do you actually need AA - have you had a DEXA scan or know you have osteoporosis - if not, then request scan before you consider AA.

Do you have gastric issues, if not or aren't on any other medicines that might need a PPI [many manage with yogurt] then put them on hold initially.

[Scaredofpred in reply to DorsetLady]

Thanks a lot,feel more in control now

[DorsetLady PMRGCAuk volunteer in reply to Scaredofpred]

Good.. another box ticked then… 🤣😂 Makes a change for patients to do that rather than doctors…

[Dinahmite in reply to DorsetLady]

Hello. I am having problems with Omeprazole. Do you know if steroids plus blood thinners mean a PPI is essential? I've read that they aren't really necessary for steroids alone but I've been on the blood thinner for years and never needed a PPI. Also I am on Alendronic Acid. Seeing GP next week so would like to get clear in my mind before that.

[DorsetLady PMRGCAuk volunteer in reply to Dinahmite]

I think you need to be taking some sort of stomach protection with your combination of drugs - they all can have adverse effect on gastrointestinal tract.. But that’s something you need to discuss with GP - there are different “prazoles” -another type may be better for you.

[Dinahmite in reply to DorsetLady]

Thank you.

[PMRpro Ambassador]

My personal view is that AA can be considered AFTER you have had a dexascan to assess your bone density status and whether you need it. No dexa - no AA.

Like Koalajane, I took 4 tablets until I had done my homework. Then a different GP agreed we should wait for the dexascan result - it was fine, I took calcium and vit D religiously and had further scans over the years with little change in bone density. I recently had a spinal x-ray that shows a possible compression fracture so I have had the first zolendronic acid infusion to stabilise the bone. Whether I will have another remains to be seen - wasn't too keen on some of the effects! However - it potentially saved me 15 years of a medication that wasn't necessary.

I have only taken a PPI (lansoprazole) when other things have required it, never solely because of pred.

I too would postpone either until proven to be required. And certainly until you have settled down a bit on what you are already taking.

[Scaredofpred in reply to PMRpro]

Thank you. Really helps to have affirmation

[LindyMc in reply to PMRpro]

My late partner had 2 osteoporotic vertebral fractures was put on AdCal and a back brace and they stabilised fine after 6 weeks.

[PMRpro Ambassador in reply to LindyMc]

They healed - that isn't quite the same. Using the bisphosphonate stabilises the structure of your bones and reduces the risk of further fractures.

[KASHMIRI1]

Good morning my rheumy said at the outset of my treatment for GCA that he didnt care what stomach protection drug I took as long as I took one. Which I have with no problems.

[neas999]

all i would suggest is you slowly reduce and stop your stomach protection if you are ok great if not you have answered your own question. i take omeprezole with no side effects but high doses of pred can effect some but not all people good luck

[Hulotsholiday]

I was prescribed both and took neither. I wasn’t thrilled with the warnings and discussed further with dr, dentist and pharmacist after doing some research. I’ve been waiting 3 years for a Dexa scan, but haven’t had one. There was no baseline. It’s personal choice. All I can say is I haven’t had any gastric issues and unaware of bone problems. I’m over 7 years on pred and currently at 10mg. I take with yoghourt but I’ve also taken without food on a few occasions without apparent issue. Good luck.

[Scaredofpred in reply to Hulotsholiday]

Thanks for this. No sign of gastric probs. Taking Pred with yoghurt and breakfast. Early days for me but advice on here helps a lot!

[Gimme]

I was prescribed AA and omeprazole. I took AA for 3 weeks and was fed up of spending a day a week camped out in the bathroom with a massively upset stomach, so I stopped. Since then I did my homework and decided against bisphosphonates until I have a DEXA scan, but I am under pressure to start on Densosumab instead, which I am even less keen on. I insisted on a DEXA scan first and waiting for the results, but the radiologist did comment that I don't need to worry about the state of my bones, which was encouraging. Since I am not taking AA, I have not felt the need for omeprazole, although the locum doc that I saw a few weeks ago "urged" me to take it to protect my stomach. I'm not keen, because PPIs are also calcium scavengers, i.e. reduce absorption, so I would expect that to potentiate the effect of the pred on my bones. So, looking after my bones consists of Vit D and calcium supplementation, using the weight machines in the gym to encourage the bone density, and swimming to keep the bearing surfaces and muscles mobile. Though, if I am honest, exercise has been the last thing on my mind for the last few weeks as I have felt so unwell and devoid of energy.

[Steal]

Have been taking pred for about 2 years (now at 4mg) and in the course of that I became very unwilling to take anything that was not absolutely necessary. I don't take lasaprazole or other stomach protector now but manage any gut issues with diet and timing and don't get any indigestion. I was prescribed AA and took it for a while. Have stopped taking it but getting a bit of pressure from rheumatologist so asked for a DEXA scan which I have had today. I'll take AA if scan suggests I need it, but otherwise I won't. Support from this forum has made me feel more in control of and more informed about my GCA and PMR . I changed my GP and I'm pleased that I now have a GP and a rheumatologist who listen andare willing to have a sensible conversation.

Great that you too feel more in control now - we really don't need the stress and anxiety of wondering what's the best way forward.