Biophosphanates and ADR or fusion

sahuaro · #1 (**permalink**) 01-17-2010, 04:02 PM

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.

ans · #2 (**permalink**) 01-21-2010, 04:35 AM

Bayla, does this same hold re: brittle bones for Forteo? If not, maybe a consideration? Best, Allan

sahuaro · #3 (**permalink**) 01-21-2010, 06:12 AM

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!

ans · #4 (**permalink**) 01-21-2010, 07:23 AM

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

Maria · #5 (**permalink**) 01-21-2010, 08:48 PM

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...

ans · #6 (**permalink**) 01-21-2010, 10:22 PM

Oh no. Were you on proton-pump-inhibitors Maria as they can cause low bone density. Sorry to hear this. - ans

sahuaro · #7 (**permalink**) 01-22-2010, 01:40 AM

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.

ans · #8 (**permalink**) 01-22-2010, 04:01 AM

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

sahuaro · #9 (**permalink**) 01-22-2010, 08:32 PM

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...

ans · #10 (**permalink**) 01-23-2010, 12:24 AM

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

JeffreyD · #11 (**permalink**) 01-23-2010, 05:06 PM

Regarding Dexa scans, it is very important that subsequent scans be made using the same equipment, and the same operator, if possible, as your first scan.

FYI.... I have been on Fosamax for almost five years now following my first ADR (3-level lumbar) surgery. During this surgery my bones were reported to be very soft. Following surgery, I had a Dexa scan - results were osteopenia (-2.1 lumbar). Results have improved to within normal range as of last November. Results were -1.7 after the first year, so for me, Fosamax works.
Incidentally, I had a 2-level cervical ADR in 2007 with no subsidence or post-surgical structural events of any kind.

My bone specialist explained to me that the question of "brittle bones" as a result of Fosamax use is impossible. Biophosphates, he said, can not change the way your body builds bone; it only changes (slows down) the natural reabsorption rate of bone within one's body.

-Jeff

sahuaro · #12 (**permalink**) 01-23-2010, 08:23 PM

Jeff:
Thanks for the info--as my PCP indicated, the literature on biophosphanates is confusing and often contradictory. You certainly had a dramatic improvement with the Fossamax, which is terrific. Were you able to have DEXA scans with the ADR's and if so, did they have to make any adjustments? I'm asking because when I went for my scan, they asked if I had any metal in my body and when I indicated that I had a cervical ADR, the response was that the scan wouldn't be near there so it was a non-issue. I am kicking myself now for missing an opportunity to glean some information about this...

From your and Maria's experience, I guess I am leaning towards remaining on the Actonel...

ans · #13 (**permalink**) 01-23-2010, 08:54 PM

Glad Fosomax helped you! I thought this Rx kept bone density at a stable level unlike Forteo which I heard "grew" bone.

Maria · #14 (**permalink**) 01-28-2010, 01:08 PM

I don't consider it a wise move. It was stupid in fact because I already had osteopenia in my spine and hip but I felt like it was bothering me when I took it altho I think that I just didn't have a good grip on my GERD at the time.

Oh well investigate this vacation idea fully before implementing it would be my suggestion...