Why is osteoporosis looked after within rheumatology? Is that the case in every hospital?
Rheumatology: Why is osteoporosis... - Bone Health and O...
Rheumatology
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Nanaedake
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I was seeing a doctor in the Endocrinology department regarding my OP diagnosis. I had to ask to see someone. It was not automatic at all but I could see that my GP knew very little about OP. I have been discharged from there, this year.
OK, so it wasn't rheumatology then? What treatment did you get?
I had bloods taken twice a year, DEXA scan and was prescribed Protelos which I asked for as I was not interested in any of the other OP drugs. (I had tried AA and Risedronate prescribed by my GP but they did not suit me.) I had to wear a 24 hour BP monitor before allowed to have Strontium Ranelate. Then unfortunately it was withdrawn. I had another scan which showed I no longer had osteoporosis in my hips etc but the DEXA result could not be used regarding my spine due to me having scoliosis as the result would not be accurate. I was discharged. I have it in writing from this doctor to have another DEXA next year, so I shall see what the result is then. It is possible the result in my hips was good because I had only stopped the SR 6 months before the DEXA.
I thought strontium relelate had been reintroduced? Although I still think there must be a good reason why it was never approved in the US. It can, apparently, cause increased incidence of heart attacks and blood clots. (Although terrible side effects don't seem to have slowed down the approval of other bone meds.)
Yes, it's available in Europe and is considered safe for those who don't have existing heart or kidney problems. I don't know why different countries approve different drugs - there's a new one in the US, Evenity (romosozumab) that's unavailable in Europe on safety grounds!
As Evenity is brought to you by the people who gifted us Prolia I would wait at least five years to see what unexpected and unpleasant effects crawl out of the woodwork before even thinking about trying it. It was approved with a warning. It can cause death.
SR has been re introduced in the UK. It can only be prescribed by a consultant and I was told that the hospital I attended for my appointments regarding OP before I was discharged, would not be prescribing SR to patients. I totally agree with you regarding the terrible side effects don't seem to have slowed down the approval of other bone meds.
Osteoporosis seems to come under rheumatology at my hospital, to the extent that the rheumatologist at my first consultation for GCA prescribed Alendronic Acid and adcal D. Only after my GP arranged for a DEXA at another hospital after I had fractured 2 vertebrae and got a diagnosis of osteoporosis did the first one arrange for an infusion of zolendronic acid.
At my last rheumatology appointment the consultant, who was standing in for the usual one, said I should remind them when a year was nearly up to arrange another infusion in case they forgot. After three infusions, i.e. 3 years I should have another DEXA, however although they had now got an in house DEXA machine, I should have it done by the first machine so that the results would be comparable.
So its back to the GP, who seems to know more about most things than the hospital!
That seems to be the case and where they try to persuade you to take bisphosphonates. If your own GP has been savvy enough to order calcium and pth tests (the latter I very much doubt so you have to push for that yourself) and both seem to be higher than the normal range, then a rheumatologist, who will have access to your records, or if not you tell him/her, as in my case, will refer you to an endocrinologist to check on this and whether in fact the osteoporosis has been caused by primary hyperparathryoidism.
Taken from bones.nih.gov
Medical specialists who treat osteoporosis
After an initial assessment, it may be necessary to see an endocrinologist, a rheumatologist, or another specialist to rule out the possibility of an underlying disease that may contribute to osteoporosis:
Endocrinologists treat the endocrine system, which comprises the glands and hormones that help control the body’s metabolic activity. In addition to osteoporosis, endocrinologists treat diabetes and diseases of the thyroid and pituitary glands.
Rheumatologists diagnose and treat diseases of the bones, joints, muscles and tendons, including arthritis and collagen diseases.
As I have RD, Vasculitis and Sjogren's Syndrome, I am under a rheumatologist anyway. So she took over from my GP for OP treatment. I'm glad she did. Treatment with high dose steroids for Vasculitis and occasionally RD caused my OP so she understood my health problems.
I attend the Endocrinology/Bone clinic at MRI ... I pushed my GP for this because I have hypothyroidism and on diagnosis of OP I researched secondary causes .. sure enough my PTH was high and I was being over treated with thyroid medications. My bone turnover was really fast, thyroid meds radically reduced and DEXA scans every two years. I do however only attend the endocrinology clinic once a year, unless there are urgent issues. I was diagnosed 91/2 yr ago and managed to keep OP meds at bay, with diet, exercise and supplements, until this year when I suffered fractures in a car accident. I have been lucky because I have felt supported at the endocrinology clinic and by specialist OP nurses in the clinic, who like ROS are available on the telephone if I have any issues to discuss.
I was never referred to any hospital department. Just sent for x ray which showed fracture, then dexa and MRI. After that nothing. Gp issued medication.
It is in my area & after a really sever reaction to Infusion I seemed to have been 'dropped' by them, no one from the Dept has assisted me in what next, even the Osteoporosis Nurse (via phone call) from my Area didn't think that the Infusion hadn't given me such a reaction. GP more understanding. So at present I don't receive any support for my OP, I see a Physio for problems with balance & Gastro problems who really does help me.
What sort of reaction did you have and what type of drug was used for the infusion?
It was Zoledronic Acid for Osteoporosis... Ended up in hospital via A&E very much the symptoms they mention on the info they give you but worse, got infection & just had an awful time, have been left with IBS on top of my Gut problem which was under control prior to this & was told the infusion wouldn't cause any problems with my gut....
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