Archive for the ‘Medications’ Category
The biggest problem with oral Bisphosphonates is GI upset, especially Gastro-Esophogeal Reflux Disease (GERD). Another problem is that you must take them on an empty stomach – then eat nothing for 30 to 60 minutes. Atelvia attempts to evade those issues with enteric coating. Atelvia is Risedronate (Actonel) which does not disolve until in the small intestines. It can be taken with food. This is definitely more convenient.
Published studies show Atelvia to be as effective in decreasing fracture rates as daily Actonel (the orginal dosing of Risedronate). That is good.
The enteric coating should make GERD much less common than with regular Actonel. Surprisingly, there are no published studies to back up that obvious supposition. Nor are there any studies about other GI problems common with regular bisphosphonates. Fortunately, we do have some samples for patients to try in order to determine if they have any GI problems with Atelvia, before getting a paid-for prescription.
Atelvia is still new enough on the market that we have no long term experience. It may acquire the niche market for an oral Bisphosphonate without GERD.
Having an additional osteoporosis medication option is good.
Jay Ginther, MD
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
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.