Advice on alendronic acid please

[Hedgehogfriend]

Hi all, I was diagnosed with PMR a year ago and have tapered down to 4.5mg of Pred. Going very slowly! The DEXA scan I had last year showed I was one point into the range for osteoporosis and so the GP put me on weekly alendronic acid. I don't like taking it, even though I don't get any obvious side effects. But a recent routine visit to the dentist threw up the possibility of me needing dental work - and the mindboggling problems if I need an extraction.

I am 70 and my teeth are not getting any younger so I am in two minds about continuing the AA. The GP said it was personal choice and I could risk an osteoporotic fracture without it.

To take or not to take? Any views or advice please?

[PMRpro Ambassador]

I fear it is a bit late to worry about it now as the (really very small) risk persists once you have been on it a while. Prof Sarah Mackie addressed the risk in her talk last week for PMRGCA week.

The risk is there but it is something usually seen in oncology patients who are on far far higher doses than are used for bone protection. In some forms of cancer the dose used for us once a year may be given every 3-4 weeks - so something like 17x as much. We know that quite a few patients meet resistance to doing dental work on patients on bisphisphonates but Prof Mackie says she gets a very different view if SHE speaks to dentists.

[Hedgehogfriend in reply to PMRpro]

Thank you. I watched the Sarah Mackie presentation last week. It was excellent but I wish she'd said more about alendronic acid. I fear I am stuck with for now, but still mulling it over. The dentist said the effects lasted for a year after you stop taking it. Sigh!Another thing we have to put up with

[PMRpro Ambassador in reply to Hedgehogfriend]

I think it can last a lot longer than a year - though if that's what he thinks then all the better for you! Your GP was remiss in not insisting you got a checkup before starting the AA in case there was anything that MIGHT need doing and then being done preemptively.

[Hedgehogfriend in reply to PMRpro]

Thank you x

[Rubha in reply to Hedgehogfriend]

I was on Risedronate (another bisphosphonate) similar to AA) 12 years ago for 5 years following 2 fractures and a diagnosis of osteoporosis. Subsequent Dexas showed no further deterioration . Now on Pred for GCA and PMR , I’m back on it. My dentist has no worries and similar to what PMR Pro and others have said , it is people on chemo taking it daily who are most at risk. My dentist said in all his years of practice he had only ever had one problem extracting from a patient on AA. …..I feel better taking it than compression fractures if your Dexa shows you need it. Good Luck

[Hedgehogfriend in reply to Rubha]

Thank you x

[Indigo2417]

I was put on Alendronic Acid in 2021, before the arrival of PMR. My GP said I must check with the dentist before starting to take it, but when I spoke to the dentist they were fairly relaxed about it. She did do an X-ray of my teeth before I started the AA. I’ve since changed dentist and they have been ok with the AA as well. I do try and be careful looking after my teeth, so hopefully ( fingers well crossed) to try and avoid having work done.

[Hedgehogfriend in reply to Indigo2417]

Thank you x

[ncfaaeos]

I wasn't happy taking AA either and have instead had an Aclasta infusion (about 3 months ago), which is given once yearly for three years. I shall have a new DEXA scan after a year. I have had no side effects.

[Hedgehogfriend in reply to ncfaaeos]

Thank you x

[Numptybrain]

I’ve been taking it for 2 years and only had a rib fracture in that time but previously I had bilateral spinal fractures so I’d say definitely keep taking it. I also take calcium, vitamin D and a load of other stuff doctors prescribed to help my bones too. It’s definitely worth it and rheumatologist pointed out also that it’s important that I don’t miss a dose whilst on prednisone.

Good luck

Wendy xx

[Hedgehogfriend in reply to Numptybrain]

Thank you x

[Dance62]

I wish my Rheumatologist had told me about the risks and suggested a check up before I started taking it. I'm in a similar boat, except I've never had a DEXA scan. I "might" need to have a tooth out, so I'm a bit on tenterhooks. I've been taking AA since September 2023 and am now down to 5mg pred so hoping that at my next rheumatology appointment I might be able to either stop taking it, or at least get a scan to see how my bones are.The info from PMRPro was reassuring.

Good luck!

[Hedgehogfriend in reply to Dance62]

Definitely get a scan, then you know where you are x

[Orange_2022]

My dentist seems quite relaxed and says risk is mostly for surgery - this can be negated by scrupulous dental hygiene so I go for a check up 3 times a year and the hygenist 3 times as well (spaced apart) plus the flossing etc! Regular spaced visits to dentist and hygenist should pick up any issues early. Of course it costs but I feel it's a worthwhile investment while I'm on AA... (my bones are at high end of osteopenia).

[Hedgehogfriend in reply to Orange_2022]

Thank you, more regular check up are very good idea x