Posts Tagged ‘GERD’
This weekend is Aunt Henrietta’s 90th birthday. I have just the right gift for her, Adora Premium Chocolates. My Aunt Henrietta has been our posterchild since the beginning of Cedar Valley Bone Health Institute of Iowa. Her adventures are well chronicled.
I had to tell her Endocrinologist about the Anabolic, Forteo. She agreed to give herself a daily shot. Then she proved that treatment had worked by falling down the stairs and not breaking anything.
Finally she locked in the gains of Forteo by starting the Antiresorptive that gets along with her severe GERD and aging kidneys, Prolia.
She can live alone in her own home because she Took Control of her bone health, with Calcium, Vitamin D3, Protein, Multiple Vitamins and Minerals, and Osteoporosis Medications. They are all necessary.
Happy Birthday Aunt Henrietta!
Jay Ginther, MD
Denosumab (Prolia) mimics the natural process that keeps OsteoClasts (the cells that gobble up bone) under control before menopause. OsteoCytes release Osteoprotegrin (OPG) when Estrogen (or Testosterone) is on board. OPG controls the formation and activation of OsteoClasts by blocking RANK-Ligand, which is necessary for OsteoClast formation and activation. This decreases fracture risk.
Prolia mimics OPG and blocks RANK-Ligand, thus blocking bone resorption by preventing OsteoClasts. It is a RANK-Ligand Antibody. It is like birth control for OsteoClasts. Prolia is given as a shot under the skin twice a year. Prolia is very effective at first, but begins to fade by 6 months. Without another injection , Prolia has totally lost effectiveness by 12 months after the last shot.
Evista (Raloxifene) can both prevent breast cancer and prevent osteoporosis! Evista has been approved for both indications. Not often can a woman treat two dreaded conditions with a single pill.
Evista is very similar to human estrogen. Evista is an “Estrogen-Agonist-Antagonist”. That means Evista acts like natural human estrogen when it prevents osteoporosis. But Evista also blocks human estrogen when it prevents breast cancer.
Evista convinces the OsteoCytes that estrogen is on board. The OsteoCytes release Osteoprotegrin (OPG), which is the natural substance that keeps the OsteoClasts (the cells that gobble up your bone) from going wild. Your bone is preserved, just like it was before menopause. This action is just like Hormone Replacement Therapy (HRT).
The most common side effect of Evista is menopausal-like symptoms. Fortunately, these usually fade within 1 to 2 months. Rare side effects include a slight increase in blood clots in persons with a personal history of blood clots or a strong family history. We also suspect a slight increase in heart problems over the age of 70, as in HRT, but not enough women have taken Evista beyond the age of 70 to find out if this is true.
Evista is a daily pill with no heartburn or GERD issues. It preserves bone by stimulating the natural process of a premenopausal state. Evista prevents breast cancer. Evista is a great choice for women looking for that combination.
Take control of your future.
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