Archive for the ‘Osteoporosis’ Category

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.

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.

Bisphosphonates are the most commonly prescribed Antiresorptive medications used to prevent or treat Ostoeporosis.  We know them as Fosamax (Alendronate), Boniva (Ibandronate), Actonel (Risendronate), Atelvia (enteric coated Risendronate), and IV Reclast (Zolendronate).  All but the last are pills taken weekly or monthly.

If your bone is strong enough that preserving it is sufficient to prevent fractures, then Antiresorptive medication is what you need.  If you are able to follow the protocol of taking the pill on an empty stomach, followed by one or more full glasses of plain water, and eating or drinking nothing else for at least 30 minutes (60 for Boniva) while remaining upright, Oral Bisphosphonates are the medication for you.