A delicate balance between bone formation and bone resorption is needed for Healthy Bone. This balance is naturally present until menopause in a woman or “Low T” in a man. The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). OsteoClasts are cells that resorb or take away bone (Resorptive). Both live on the surface of bone. OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. Women make Estradiol from Estrogen. Men make Estradiol from Testosterone. Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. Estrogen is back on board. Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. They both mimic the natural process, but in different ways. We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD
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