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iSpine Discuss Biophosphanates and ADR or fusion in the Main forums forums; Maria recently posted a wonderful review article about treatments for osteopenia/osteoporosis which indicated that biophosphanates actually make bones more ...

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Old 01-17-2010, 04:02 PM
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Default Biophosphanates and ADR or fusion

Maria recently posted a wonderful review article about treatments for osteopenia/osteoporosis which indicated that biophosphanates actually make bones more brittle and talked about taking a vacation from them after 5 years of use.
I have been taking Actonel for about that long now for osteopenia which is present in my hip but not my spine. I have had some but not dramatic improvement in my bone density measures with the drug and exercise, and my cervical ADR is looking fine in X-rays, so I am wondering if it is time and if it would be safe to take a vacation.
Does anyone here with fusion or ADR take biophosphanates and if so, have you been advised to take a vacation from them?
Any thoughts on this?

Thanks.
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Old 01-21-2010, 04:35 AM
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Bayla, does this same hold re: brittle bones for Forteo? If not, maybe a consideration? Best, Allan
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Old 01-21-2010, 06:12 AM
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I went back to the article Maria posted and yes, Forteo builds bone rather than inhibits resorption. However, it is only recommended for severe osteoporosis.
I think it's very iffy about whether I even need to be treated and I am also on hormone replacement treatment, including estrogen, which should be protecting my bones. With all that I am doing--calcium, vitamin D, Actonel, estrogen, exercise on the positive side--I think I have reached my maximum effect. The one major negative is smoking (okay, okay, no comment).

My PCP actually called me today to discuss a "plan": he indicated that he has seen regression in bone density as soon as 2 years after stopping biophosphanates, which was startling to hear. The plan right now is to keep taking the Actonel until I can totally quit cigarettes and then take a vacation from it. It will be interesting to hear what my gynecologist says.
And I will also ask Dr. Regan for his opinion since he actually drilled into my vertebra!
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Old 01-21-2010, 07:23 AM
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I'm glad you're following up on this. My doc said you need a -2.0 bone density for insurance to pay for Forteo. You're doing almost everything right. I'm gonna get an appt. with Regan. This time, if you're in LA, we must meet!@

Be well, careful of those desert washes. Hope there's lotsa snow on Mt. Lemmon and the other mtns.

ans
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Old 01-21-2010, 08:48 PM
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Default I took a vacation

And my bone density got worse. It went from t -2.2 to t -2.6 in the lumbar spine.

I have a family history of osteoporosis so I shouldn't have taken the drug vacation but I felt the drug was bothering my GI tract and tried to get my PM on board with moving to Forteo before a test indicated this decrease in BMD but she stalled and said we had to wait until I got another test and then it would have to be significantly worse re my BMD before I could take Forteo re criteria for which it was presribed and paid for by insurance.

So in my case it appears that's what a vacation of a year did for me...
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Old 01-21-2010, 10:22 PM
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Oh no. Were you on proton-pump-inhibitors Maria as they can cause low bone density. Sorry to hear this. - ans
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Old 01-22-2010, 01:40 AM
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Maria: Thank you for letting me know what happened when you took a "vacation"--it confirms my PCP's experience. I am also anxious to hear your reply to ans' question about whether you were taking another med which could have contributed to the significant decrease in DEXA scores.
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Old 01-22-2010, 04:01 AM
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Here's something that may be of consideration bone experts. My DEXA scan of my hip(s?) was -2.5 to -2.7. However, my CT bone density scan of T12, L1, and L2 was averaged to be - 1.0.

So my internist, who's pretty smart (but I have questions on this) said that the CT is a more reliable source and a new CT of the hip is unwarranted. I said, but what if there is some higher bone density from DDD at L2 and I was dismissed.

So I don't know but maybe a CT scan for confirmation? If so, of what? Hip as proxy or such levels?

Do we have a resident rheumatologist, bone biologist, and radiologist on-board?

Good luck; sorry this happened.

ans
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Old 01-22-2010, 08:32 PM
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I just did a brief google search and it appears that your internist is correct when he says that the CT scan is more accurate and is less prone to distortion by DDD and scoliosis because it only looks at trabecular bone. Did you also have DEXA of the spine and if so, was there a significant difference between the DEXA and CT scores?
My DEXA scores indicate no problem with the spine but osteopenia in the hip, so I am showing a similar pattern. I do wonder whether there might be some distortion elevating the DEXA spine scores but I really think it's just a hip issue.

BTW, in my brief search, I found a research article which concluded by recommending cervical spine CT bone density evaluation of endplates prior to implantation of hardware (fusion or ADR)....hmm...
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Old 01-23-2010, 12:24 AM
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Thanks B, the 'ol researcher genes kick in. I wonder w/DDD if the endplate trabecular network is so distorted as the bone (in my MRI) looks hyperdense. One surgeon said that this is good for ADR/surgery.

I would feel better w/a bone density CT of the hip but insurance would fight.

Good luck in your tough quest.

I can't get a grip on the Mt. Lemmon snow forecast/conditions. Lots of lightening?

Be well. - ans
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