Posts Tagged ‘Osteoporosis medication’

Aunt Henrietta’s Birthday

August 28, 2014 @ 9:11 pm
posted by Dr Ginther

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.

First, she broke one wrist when she was thrown down by a throw rug.  Then she broke the other wrist when her bifocals did her in.  Then she broke her shoulder when she thought all the ice had melted.  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

Enteric Coated Atelvia

July 29, 2014 @ 7:57 pm
posted by Dr Ginther

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

 

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

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.