Posts Tagged ‘Reclast’
How do you know when an Antiresorptive medication is best? First, the situation needs to be beyond the capability to Take Control Naturally with Calcium Citrate and Vitamin D3 alone. A dropping Bone Mineral Density (BMD) or a worsening Vertebral Fracture Assessment (VFA) despite adequate Calcium and Vit D3 indicates the need for medication.
Second, the bone needs to be Good Enough that preserving it at current levels will prevent fractures. Good enough means no Fragility Fractures and no Vertebral Compression Fractures detectable on the VFA by DXA machine or by lateral spine x-ray.
Dr David Dempster presented spectacular pictures to the 2012 meeting of the American Society for Bone and Mineral Research (ASBMR). They show clearly the different actions of the anabolic, Teriparatide (Forteo), and the antiresorptive Bisphosphonate, Zolendronate (Reclast). I had seen preliminary pictures at a small, private presentation last year, but the latest bone biopsy studies were incredibly impressive.
Reclast suppresses bone resorption, as do all antiresorptives. This preserves the bone already present. Forteo stimulates new bone matrix formation, including resorbing some old bone and replacing it with new bone. Each strategy works very well in properly chosen individual patients. Neither is best for everyone.
The FDA has approved Prolia for men with osteoporosis, who are “at high risk for fracture”. This affects a sizeable number of men. High fracture risk includes men with crumbling spine “humpback” vertebral fractures (kyphosis), other fractures (especially hip), inhaler and other steroid use, parental history of fractures, and smoking. See the posts about these topics and FRAX.
Prolia is especially useful in individuals with Heartburn or Reflux Disease (GERD) and decreased kidney function, including many older individuals with older, tired kidneys. Women have had Prolia available since 2010. Having this additional option for men is important.
I recently saw a patient who has not improved her Bone Mineral Density despite 2 years of Forteo followed by 3 years of Reclast. The good news is that she stopped having Fragility Fractures. But she is very disappointed that her BMD has not improved.
Her problem is obvious. She is willing to take high-powered osteoporosis medications. She is not willing to take Calcium either in her diet or in supplements.