Posts Tagged ‘Bisphosphonate’
How do you know when an Antiresorptive medication is best? First, the situation needs to be beyond the capability to Take Control Naturally with Calcium Citrate and Vitamin D3 alone. A dropping Bone Mineral Density (BMD) or a worsening Vertebral Fracture Assessment (VFA) despite adequate Calcium and Vit D3 indicates the need for medication.
Second, the bone needs to be Good Enough that preserving it at current levels will prevent fractures. Good enough means no Fragility Fractures and no Vertebral Compression Fractures detectable on the VFA by DXA machine or by lateral spine x-ray.
Studies of combinations of osteoporosis medications expanded at the American Society for Bone and Mineral Research (ASBMR) 2012. Previous meetings featured alternating the anabolic, Teriparatide (Forteo) with a Bisphosphonate Antiresorptive, usually Alendronate (generic Fosamax), and, more recently, simultaneous Alendronate and Forteo. This time we heard about the first study of Denosumab (Prolia) combined with Forteo. [Disclosure: I am on the Orthopedic Advisory Board for Prolia, and Speakers Bureau for Forteo]
The Bone Mineral Density (BMD) increase at one year was much better for the combination than for either drug alone. This is the same effect we have seen with previous combinations, but higher BMD numbers. This study had small numbers of patients (<200), and a short period of time (<2 years). It is not clear, whether the greater BMD of this combination is of any significance, and how well it will hold up over time. Also, BMD is not the whole story.
Dr David Dempster presented spectacular pictures to the 2012 meeting of the American Society for Bone and Mineral Research (ASBMR). They show clearly the different actions of the anabolic, Teriparatide (Forteo), and the antiresorptive Bisphosphonate, Zolendronate (Reclast). I had seen preliminary pictures at a small, private presentation last year, but the latest bone biopsy studies were incredibly impressive.
Reclast suppresses bone resorption, as do all antiresorptives. This preserves the bone already present. Forteo stimulates new bone matrix formation, including resorbing some old bone and replacing it with new bone. Each strategy works very well in properly chosen individual patients. Neither is best for everyone.
The FDA has approved Prolia for men with osteoporosis, who are “at high risk for fracture”. This affects a sizeable number of men. High fracture risk includes men with crumbling spine “humpback” vertebral fractures (kyphosis), other fractures (especially hip), inhaler and other steroid use, parental history of fractures, and smoking. See the posts about these topics and FRAX.
Prolia is especially useful in individuals with Heartburn or Reflux Disease (GERD) and decreased kidney function, including many older individuals with older, tired kidneys. Women have had Prolia available since 2010. Having this additional option for men is important.