Posts Tagged ‘IBS’
You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
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.
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.
Fracture Risk is the elephant in the room. Fractures can keep you from doing what you want for weeks or months. Fractures can put you in a Nursing Home, sometimes forever. Complications of fractures can kill you. Fractures are what you want to avoid if at all possible.
Increased Fracture Risk was defined as Clinical Osteoporosis by NIH in 2000. We may still think of Osteoporosis as a T-score of -2.5 on DXA. This is inaccurate. Fracture Risk increases with age and other factors at any given T-score. Over 80% of the persons who fracture have a T-score better than -2.5 !!! Accurately calculating your true Fracture Risk requires a Complete Bone Health Evaluation.