Posts Tagged ‘Prolia’
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
Aunt Henrietta enjoys her independent life at 90. Especially when compared to how she was 4 years ago!
I visited her while out east for NOF. She easily walked the 3 blocks to and from church. She led the procession up and down every aisle in the huge Shoprite and the Rite-Aid, while stocking up on provisions for the month. She even strolled more than 1/4 mile across the Delaware River pedestrian bridge.
She lives alone in a 2 story house. I am not happy about the stairs, but she does not fall too often, and has not broken anything in 4 years.
Before Aunt Henrietta started treating her osteoporosis aggressively, she was rightfully terrified to do anything. She was talking about dying in her house. She had broken one wrist, then the other wrist, then her shoulder, in 3 separate falls. Her plight and response has been an inspiration in my efforts for bone health.
She started Adora Chocolates (she loves dark) for Calcium, then added high dose Vitamin D. I harrassed her into eating more protein. But when she fell, she broke. Her Quality of life was in the Dumpster. Time for drastic action!
I talked her into the Anabolic, Forteo. She failthfully gave herself a shot every day for 2 years. Because of her aging kidneys, I followed with Prolia. She has worked hard on proper nutrition. She was determined to regain her Independence. She succeeded.
Aunt Henrietta resurrected her Quality of Life. She is stronger, more active, stubbornly Independent, and Fracture Free! At age 90, that is everything.
Aunt Henrietta beat her osteoporosis! You can too.
Find out what you need to correct with a Complete Bone Health Evaluation.
Take Control to Avoid Fractures and remain Independent.
Jay Ginther, MD
Recently a patient asked me to review all osteoporosis medications for her to consider and choose from. We had already optimized her Calcium intake, 25-hydroxy Vitamin D level, Protein intake, Multiple Vitamins & Minerals, and Exercise program. These had all helped substantially, but not enough for her peace of mind. She feels that she needs osteoporosis medication too. Here they are:
Anabolic medication for osteoporosis actually increases bone thickness and strength! Antiresorptive medications for osteoporosis (Fosamax, Alendronate, Actonel, Atelvia, Boniva, Evista, Reclast, Prolia) only preserve bone.
We have talked about all of the Antiresorptive medications over the last 2 months. They are excellent treatment if slowing down the OsteoClasts (cells that eat away your bone) is sufficient. That is not always the case.
Now it is time to talk about something completely different. Anabolic medication stimulates the OsteoBlasts (cells that make new bone matrix). OsteoBlasts can rebuild your bones. If you have Fractures, your bones may need to be rebuilt.
Forteo (Teriparatide) is the only Anabolic medication for osteoporosis in the USA. Close cousins of Forteo are available in other countries.
You may need the Anabolic, Forteo, if you have a hip fracture, multiple other fractures, or if VFA testing reveals a Vertebral Compression Fracture. A DXA T-score well below -2.5 can be reason enough without fracture.
Glucocorticoid (Cortico-Steroid) medications (Prednisone, Steroid Inhalers) specifically supress OsteoBlasts (cells that make new bone). Stimulating the OsteoBlasts with the Anabolic, Forteo, can offset the bone loss from Steroid medications. Smoking also supresses OsteoBlasts, leading to bone loss. Stopping Smoking would be best, but Forteo can help.
Not everyone needs an Anabolic, but some individuals do. A Complete Bone Health Evaluation will tell you if an Anabolic is right for you.
More about Forteo (Teriparatide) next time.
Jay Ginther, MD