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Posts Tagged ‘Ibandronate’

Recent studies have shown that the order in which we use osteoporosis medications matters.  Traditionally most docs have used Antirsorptives first to preserve bone.  All osteoporosis medications except one are Antiresorptives.  Only when that failed, would they consider the Anabolic medication, Forteo, to build new bone.

As a practicing orthopedic surgeon, I started treating osteoporosis in the worst of my fracture patients.  It was obvious that they needed to build bone first since there was very little bone to preserve.  Therefore, I usually started with the Anabolic, Forteo.  Once I had built up the bone, I preserved that improved bone with an Antiresorptive osteoporosis medication.

As the National and International Osteoporosis Foundations, (NOF and IOF)  are now focusing on preventing second fractures, many more practioners are treating patients with one or more fractures.  They are facing the dillema of how to prevent fractures in bone that is not good enough.  None of the Antiresorptives work as well in patients with multiple fractures as they do in patients who have not yet fractured.

This year studies have shown that using Forteo after an Antiresorptive usually results in Forteo taking several months to overcome the previous slowing of bone turnover,  Therefore, 2 years of Forteo results in less improvement when used AFTER the Antiresorptives tested, than we normally see in a patient who uses Forteo first.

At NOF and IOF this year speakers suggested that we change our approach.  They suggested using an Anabolic first, and an Antiresorptive second should be the standard sequence for best results.

Would you rather only trying to preserve your bones after they have proven insufficient in multiple fractures?  Or would you want to improve your bone first, and then prserve that improved bone matrix and improving BMD?

Do everything you can to improve and preserve your Bone Health.

Jay Ginther, MD

Acute Phase Reaction

July 26, 2014 @ 6:12 am
posted by Dr Ginther

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

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.

Atypical Fracture of the Femur (AFF) and OsteoNecrosis of the Jaw (ONJ) are rare complications of Untreated Osteoporosis.  They also occcur rarely in patients treated with long term Antiresorptives including: Fosamax, Boniva, Actonel, Allendronate, Ibandronate, Atelvia, Reclast, and Prolia, at a higher, but still very low, rate.  Neither has been reported in Evista.  Forteo is commonly used as a treatment for AFF and ONJ.

AFF and ONJ are rare even in patients treated for Osteoporosis with Antiresorptive medications.  Rates are estimated at between 1 in 1,000 and 1 in 10,000.  Let’s label AFF (X),  ONJ (Z), and patients with neither (O).  Here is a graphic representation, if the worst case estimate is correct:

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOXOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOZOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

These are very rare problems, even in patients on Antiresorptive Osteoporosis Medications for over 5 years.  Fractures from Osteoporosis in patients Not taking Medications are much more common.  See the Graphics for women and men.

Jay Ginther, MD