Posts Tagged ‘Reclast’

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.  That Graphic next time.

Jay Ginther, MD

Match Medications to Your Needs

June 3, 2014 @ 6:48 am
posted by Dr Ginther

Are your bones still good enough and just need to be maintained?  Or have you fractured several times and need to rebuild your bones?  Are Steroid Inhalers supressing your Osteoblasts – the cells that build new bone?  (not good)  Or have your Osteoclasts – the cells that eat away bone – gone wild (even worse) now that you are post-menopausal or an older guy?

Different problems require different classes of medication.  Bisphosphonates, Hormone Replacement Therapy, Synthetic Estrogen Receptor Modifier – Evista, and RANK-Ligand Antibody – Prolia, are all Antiresorptives, which act in different ways.  They slow down the Osteoclasts that have gone wild and are eating up the bone.  The Anabolic, Forteo, stimulates the Osteoblasts that make new bone matrix.  Antiresorptive and Anabolic are radically diferent actions.

“Bisphosphonate Holiday” 2014

March 8, 2014 @ 8:56 pm
posted by Dr Ginther

“You are entering a Data-Free Zone”   That was unfortunately the messasge at the joint meeting of the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) last month.  We simply do not have data from a study involving tens of thousands of patients.  We do know some things that are helpful.

Bisphosphonates build up in bone over time.  After about 5 years of Bisphosphonate therapy, you should have enough medication in your bones to last for additional years.  How many years?  That depends.  Different individuals lose Bisphosphonates from their bones at different rates.  Different Bisphosphonates tend to stay in bone longer or shorter than others.  We call the time you are able to stop taking medication for a while (because you have enough in your bones already) ”Bisphosphonate Holiday”.