Posts Tagged ‘Bisphosphonate’

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.

Match Medications to Your Needs

June 3, 2014 @ 6:48 am
posted by Dr Ginther

Are your bones still good enough and just need to be maintained?  Or have you fractured several times and need to rebuild your bones?  Are Steroid Inhalers supressing your Osteoblasts – the cells that build new bone?  (not good)  Or have your Osteoclasts – the cells that eat away bone – gone wild (even worse) now that you are post-menopausal or an older guy?

Different problems require different classes of medication.  Bisphosphonates, Hormone Replacement Therapy, Synthetic Estrogen Receptor Modifier – Evista, and RANK-Ligand Antibody – Prolia, are all Antiresorptives, which act in different ways.  They slow down the Osteoclasts that have gone wild and are eating up the bone.  The Anabolic, Forteo, stimulates the Osteoblasts that make new bone matrix.  Antiresorptive and Anabolic are radically diferent actions.