Hi, My doctor and rheumatologist wants me to take Alendronic Acid. But I am very reluctant, mostly because of the side effects which may affect my stomach, which honestly is delicate enough. The rheumy suggested a yearly injection. Although I have the tablets, I have not as yet taken them. Besides my tummy probs, I don't fancy a full glass of water and standing up for half an hour. Would value any of your comments please.
Hi, I am a newbie on the site and someone with a lot more experience will get in touch with you. They are a great bunch on here so you are more than welcome. Good luck.
Pat
You don't have to stand! Just sitting upright, as on a dining chair is enough - you just mustn't lie down or bend over.
However: Have you had a dexascan? That is the scan to see what your bone density is like. The consideration as to what bone protection you need (or don't need) should only be made after a scan that shows what state your bones are in. I had my first a few months after starting pred and it was fine. I had another after well over 3 years of taking pred - it was to all intents and purposes the same (done on a different machine but it was still acceptable). All I have taken in the meantime is calcium and vit D supplements. That is the starting level of "bone protection" recommended by the British Association of Rheumatologists. Other stuff should be used only when shown to be needed.
Only about 40% of people on pred develop osteoporosis and I personally want to know whether I really need to take something like AA. It isn't just the gastric aspect - many dentists won't do some procedures on patients who are taking or who have taken AA - but they only find out when it becomes necessary. It should not be taken for more than 5 years (latest recommendations from the FDA) and I would prefer to keep it as an option when I need it - I may never do so.
If the single annual injection version is zolendronic acid then the gastric side effects are minimal - it may cause nausea but there isn't the risk of the reflux and damage to the gullet that is a reason for not using it in patients with pre-existing problems.
However - first of all: a dexascan to see if you need it at all yet.
Hi gladioli
Have had PMR for 8 months and have been on 70 mg Alendronic Acid tablets taking 1 a week. I have found them to be no problem what so ever at the moment. I was advised against the injection which I believe is much stronger and can cause more damage in the long term.
Others who have more experience than I on this forum may advise otherwise but this is my personal experience of them. Hope it helps.
Hello gladioli, yes the good old alendronic acid Drs like to dish out like sweets if any of their patients are taking steriods for any given length of time, regardless of wether any bone density tests have been carried out. Steriods are not good for bones and we all want healthy bones so that the risk of fractures is reduced. But I believe that as soon as we're prescribed prednisone we should also have a bone density scan followed by periodic bone density cheks. Surely that makes much more sense?
Your stomach is the last of your worries when taking alendronic acid. It also can damage your top and bottom jaw bones, and once they are damaged should you ever require a tooth extraction, you could be confronted with complex problems re your jaw bones.
I stupidly took alendronic acid for a year before finding out about the jaw bone problems, needlessly to say I don't take it any more but according to all research the
Effects of the drug are in your bones forever. 😥
if I were you I'd ask your Dr for a bone density test and see what that reveals. I also take vit d, and calcium supplements along with others. Good luck, christina
Hi Gladioli - I have been taking 70 mg Sodium Alendronate tablets (Fosamax) once a week for 11 months and do not appear to have had any reaction - although I was initially concerned due to comments by others.
As EileenH mentioned, you don't have to stand up - I usually just sit and do my emails before eating breakfast - and drink 6 oz of water with the pil on an empty stomach.
Dave
Hi, like you I have been prescribed Alendronic Acid and queried this with my doctor as I had no wish to add any more problems apart from dealing with the PMR. Apparently the standard advice is that if you are over a certain age, 60 or 65 I think, 'the book says - DEXA scan not required' - so they just prescribe the drug as at that age you are cosidered to be automatically at risk of osteoporosis ! I guess you can arrange to have a scan carried out privately, I don't think it is a prohibitive cost.
Hi Diana, I have no idea what the cost is, hopefully it won't be too high, however, before you go down that route, talk to your gp first, you never know they may be willing to send you for a scan, and you will have saved yourself some expense! After all if you don't ask you don't get! Christina
There is this assumption that older people are automatically going to have osteoporosis - but it is based on our mothers' generation. If you have been on HRT it is less likely for one thing. I know two ladies who are just under and just over 80, who have been on pred for 5 years or longer and whose bone density is perfectly OK. It ain't necessarily so. The age is over 65 I think but I would hold out for a dexascan.
PS Gladioli - where do you live?
Hi there. I have been on pred for one year and Alendronic acid for around six months. It gives me wind but that's about all. I am worried about what it's doing to my body though. I have had gum problems in the past and have lost a lot of bone there. I'm thinking of having a chat with my dentist this month because I may need to lose a back tooth at some point and I need to know where I stand. Angela.
Yes Angela, definitely speak with your dentist re the alendronic problems with teeth. As I said extractions are the problems. Also, see the links above, do you really need AA could you not simply benefit from a bone density scan then periodic check ups then take it from there, not the other way round. Christina
That's what I'm thinking Christina. I am 61 so it could be my Rheumy thinks it's best, but I haven't had a Dexa scan yet. I see him in February so will mention my concerns.
hi i have been taking alendrinic acic since july when i was diagnosed with GCA
I have no side effects i sit for half an hour and take it with a glsaa half pint of water,
I also take Lansoprazole to protect my stomach. Hope this helps
Hi Eileen, I live in the Huddersfield area. And to answer your other query, I have had a Dexa scan, it showed thinning of the bones, but not full blooded osteoporosis. Why do you need to know where I live? Having read all the replies, nothing I have read will convince me to take AA.
Gladioli, as Eileen has said, do ask for a DEXA scan to check your bone density BEFORE agreeing to take any bone protection meds. I was initially refused a DEXA by both my GP and rheumatologist so I paid to have one done privately as I felt it important to get a baseline reading in order to judge the continuing effect of the steroids on my bones. The results were good so I took nothing. I wasn't even offered calcium or Vit D throughout 5+ years of Pred treatment - apparently both my GP and rheumy believed the other had put me on the supplements! I had repeat DEXAs during the next few years and only suffered a very small deterioration in my bone density into the osteopenia stage but not needing any treatment. I do now take a Vit D supplement for 3 months every winter. During my years on steroids, I ate loads of calcium-rich foods, including yoghurt and oily fish - all can help our bones.
I asked because many of the people who post on here are from all over the world - makes a big difference in terms of what system of health care they are under. I also believe that Southhampton (for example) offers very reasonably priced dexascans to anyone - it was in the event you hadn't had a dexascan and if you lived south of London the going to S'hampton might have been worth it.
There is an outstanding PMR/GCA consultant at Leeds - just in case your rheumy gets particularly shirty when you refuse AA.
No, I wouldn't take AA unless they proved to me I had osteoporosis - or at the very least osteopenia that was bordering very closely on osteoporosis. It is something that should be kept for need. Unfortunately the company that developed it marketed it as the best thing since sliced bread to prevent hip fractures and there is a generation of doctors which was brought up on the wonders of AA. Things that they learn at a particular stage of their career tend to remain in their minds and it is very difficult to persuade them otherwise. In the meantime the thoughts have changed a bit - they then lag behind.
I have been on Alendronic Acid for nearly a year, have suffered no side effects and I have a sensitive stomach.
You have to weigh up the pros and cons. I have osteoporosis and being 72 years old, don't want to fall and break something. People are too ready to scaremonger people. Osteoporisis if not treated and is advanced can kill. Yes, it is a pain swallowing a glass of water with the pill, but it is a small price to pay if you protect your bones. Like somebody else on here, I check my emails while waiting for the 30 minutes after taking. So long as you sit upright, it is OK. Good luck !
Hi I am on the Alendronic Acid have been for a year now as my ostioporosis is worse from the steriods its ok. it has not affected my tummy so far you can sit down for half an hour I do as I did not like standing
Hi Eileen - you mention the info from around the world and indeed I agree that the systems are very different.
FYI - United States Preventive Services Task Force (2011) that provides standards for many of the 'masive' US medical insurance companies states the following -
" the risk for osteoporosis increases steadily and substantially with age. Relative to women aged 50-54, the odds of having osteoporosis were 5.9-fold higher in women aged 65-69 and 14.3-fold higher in women aged 75-79, in a study of over 200,000 postmenopausal women. Low body weight or body-mass index (BMI) and not using estrogen replacement were also consistently associated with osteoporosis but to a lesser degree than age. Other risk factors for fracture or low bone density found in some, but not all, studies include white or Asian ethnicity, history of fracture, family history of osteoporotic fracture, history of falls, low levels of physical activity, smoking, excessive alcohol or caffeine use, low calcium or vitamin D intake, and the use of various medications. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.
Bone mass measurement (BMM) is considered medically necessary if ANY of the following criteria are met:
· A woman determined to be estrogen-deficient and at clinical risk for osteoporosis based on medical history, age and other findings; OR,
· An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture; OR,
An individual receiving (or expecting to receive) glucocorticoid therapy equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months; OR,
· An individual with primary hyperparathyroidism; OR,
· An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy
DEXA/DXA is considered medically necessary for those on Corticosteroid use with hip or rib pain; OR, Low impact / vertebral fracture.
The Frequency Standards - BMM screening is considered medically necessary once every 2 years (given at least 23 months have passed since the month the last covered BMM was performed).
More frequent BMM is considered medically necessary for, but not limited to, the following indications:
· Monitoring members on long-term glucocorticoid therapy of more than three months
· Confirming baseline BMMs to permit monitoring of members in the future......."
It seems that in the US, regular wellness care for the elderly is saving insurance companies a great deal and many of the osteo issues are being financially covered and put into action - hopefully based on professional evaluation by qualified specialists.
Dave