Archive for the ‘Medications’ Category
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
Recently a patient asked me to review all osteoporosis medications for her to consider and choose from. We had already optimized her Calcium intake, 25-hydroxy Vitamin D level, Protein intake, Multiple Vitamins & Minerals, and Exercise program. These had all helped substantially, but not enough for her peace of mind. She feels that she needs osteoporosis medication too. Here they are:
Our Amgen Medical Liaison met with us this week. Her job is to supply information which has been published or presented at major meetings. She meets only with practitioners (MD, NP in our case) and cannot market any medications.
This is good. For the first time in 5 years, I missed ASBMR (American Society for Bone & Mineral Research). She was able to show us several studies presented at that meeting that were most helpful.
NP Katie and I, like most practitioners, always approach scientific papers with a critical eye. The studies answered several questions. They also raised further questions. Perhaps those answers will come next year.
Legislators pass rules and regs to keep medical practitioners away from information supplied by persons employed by Pharma. They fail to understand the value of critcally evaluating new scientific data. Detailed information about each available medication is needed if we are to find the best osteoporosis medication for each patient each time.
No single osteoporosis medication is right for everyone all the time. Every osteoporosis medication is the best choice for someone at some time. There are times when no medication is the best choice.
The more information Katie and I have about medications, the smarter we are when helping to choose what is best for each individual. No one can go to all meetings or read all published studies. A Pharma Medical Liaison helps gather relevant information.
YOU too can gather information before and after you visit your doc. Use the left column to find blogs about topics that interest you. You can Take Control.
Jay Ginther, MD
Forteo is a daily shot. That is a nuicence, but a small price to pay for the only Anabolic, the only osteoporosis medication which will increase bone mass in spongy (cancellous) bone. Diabetics give themselves a daily shot for the rest of their lives. Forteo is for only 2 years and uses a tiny insulin needle.
People worry about the warning that lab rats got Osteosarcoma after being given very high doses of Teriparatide for the equivalent of 70 human years. We have not seen this in humans, or chimps, or monkeys, or dogs. Rats have bones that grow all their lives. We do not give Forteo to growing humans, pregnant women, nursing women, persons with Paget’s Disease or unexplained elevated Alkaline Phosphatase, or persons who have had radiation to their bones.
Remember that you must take adequate Calcium, with food, spread out over 3 meals. You must take enough Vitamin D3 to be able to absorb Calcium. You must eat enough Protein for your OsteoBlasts to make new bone matrix.