Posts Tagged ‘Fosamax’

“Bisphosphonate Holiday” 2014

March 8, 2014 @ 8:56 pm
posted by Dr Ginther

“You are entering a Data-Free Zone”   That was unfortunately the messasge at the joint meeting of the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) last month.  We simply do not have data from a study involving tens of thousands of patients.  We do know some things that are helpful.

Bisphosphonates build up in bone over time.  After about 5 years of Bisphosphonate therapy, you should have enough medication in your bones to last for additional years.  How many years?  That depends.  Different individuals lose Bisphosphonates from their bones at different rates.  Different Bisphosphonates tend to stay in bone longer or shorter than others.  We call the time you are able to stop taking medication for a while (because you have enough in your bones already) ”Bisphosphonate Holiday”.

Bone “Good Enough” for an Antiresorptive?

November 30, 2012 @ 7:07 am
posted by Dr. Ginther

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.

Interesting Medication Combinations from ASBMR

October 25, 2012 @ 8:45 pm
posted by Dr. Ginther

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.

Prolia Is Now For Men Too!

October 1, 2012 @ 9:09 pm
posted by Dr. Ginther

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.