Acute Phase Reaction

July 26, 2014 @ 6:12 am
posted by Dr Ginther

An Acute Phase Reaction can occur the first time a person is exposed to a new class of medication.  With each subsequent dose, half as many people have the reaction.  The symptoms are like mild flu for 3 to 5 days.  The treatment is lots of fluids, and Tylenol (Acetaminophen) if needed.

Persons who have never taken any bisphosphonate before, can experience an acute phase reaction the first time they take Reclast (Zolendronate in osteoporosis dose).  This happens in about one-third of persons who have not taken Fosamax (Alendronate), Boniva (Ibandronate), Actonel (Risedronate), or Atelvia (enteric coated Risedronate) before their first dose of Reclast.  This happens in about one-sixth of persons after their second dose.  Third dose is down to one-twelfth.

Acute phase reaction is a significant nuisance.  However, a Fracture is a significant problem.  Reclast will reduce Fracture Risk by more than half compared to no osteoporosis medication at all.  See the visuals for fracture risk in women and men without osteoporosis medication.  Remember to check for good enough kidney funtion (GFR at least 45) before each dose.

It’s all about avoiding Fractures.

Jay Ginther, MD

No GERD with Reclast

July 23, 2014 @ 7:32 am
posted by Dr Ginther

Bisphosphonates are often associated with Gastro Esophageal Reflux Disease (GERD).  When GERD cannot be adequately controlled by medication, we cannot use oral bisphosphonates.  Yet there is an advantage to taking a medication which will accumulate in bone and last well beyond the last dose.  That is where Reclast shines.

Reclast (Zolendronate in osteoporosis dose) is given IV.  Intravenous (IV) means no Gastro-Intestinal issues at all.  Therefore persons with Irritable Bowel Syndrome (IBS), or Crohn’s, or Colitis can take Reclast.  The once a year dosing is convenient.  But giving a whole year of medication all at one time requires extra care.

Blue Zone Weekend

July 20, 2014 @ 5:25 pm
posted by Dr Ginther

All three kids were home this weekend along with both grandkids.  That put us in a Blue Zone.

One year old Gwen was showing off that she can walk by herself – especially when she had an audience to cheer her on.  Three weeks ago she could manage only a few steps at a time.  Now she can walk across a room.  Amazing difference!  Until you realize that she took 5% of her lifetime to learn that new trick.

Almost 4 year old RJ is a perpetual motion machine.  Saturday he went out with his uncles (both starting sweepers in high school) and came home with a complete soccer outfit for his classes starting Monday.  He tore around the yard with them kicking the ball ahead of him.  Under duress he took off the cletes and shin guards for bed.  More running at the family picnic today with his cousins.  He is sleeping in the car heading back to MN in the entire outfit.   Good thing his car seat is in the back and downwind.

Engagement party last evening, for son Greg and his fiance Erika, gave them the opportunity to see our friends who knew him in HS.  He is certainly not a kid any more.  In fact he and his siblings are all in their thirties.  When did I get old enough to have kids that old?

Family is a Blue Zone.

Jay Ginther, MD

 

Bisphosphonates accumulate in your bone.  When OsteoClasts gobble up your bone, bisphosphonates are released into the Osteoclasts and disable or kill the Osteoclasts.  This is great news when the problem is Osteoclasts Gone Wild.  Bisphosphonates preserve bone by slowing down bone resorption.  However, after a few months, bone formation by OsteoBlasts also slows down, resulting in slow bone turnover.

Moderate and balanced bone turnover is good.  You repair microcracks in your bone when OsteoClasts resorb the bone around them and OsteoBlasts fill in the void with new bone matrix.  A mix of new and old bone is far stronger than all old bone.  Some OsteoClast activity is necessary to heal fractures, especially incomplete (stress) fractures.  That is where long term bisphosphonates can be too much of a good thing.