Bone-building meds offer benefits
DEAR DOCTOR: I’m 71, and after a recent bone scan, my doctors are insisting I take a bone-building medication. I couldn’t tolerate Fosamax, so they want me to take Prolia. I’m worried about it, but my mother had severe osteoporosis, so I’m worried about that too. How can I choose what to do?
DEAR READER: If there is a way to improve your bone density and decrease your chance of fractures, you should do it.
Taking 500 to 1,000 milligrams of calcium a day and maintaining an adequate blood level of vitamin D are important, but to increase bone density, the firstline drug therapy is a bisphosphonate. These drugs, including Fosamax, increase bone mass and decrease the incidence of fractures. I would assume that you couldn’t tolerate Fosamax due to irritation of the esophagus and stomach. If that’s the case, you could consider injectable bisphosphonates such as Boniva or Reclast.
All bisphosphonates can have rare, but potentially serious, side effects such as osteonecrosis of the jaw, an increased risk of fractures of the femur and, in the case of Reclast, atrial fibrillation. People with kidney failure should not take bisphosphonates.
Prolia, given by injection twice a month, is different. It’s a monoclonal
antibody that binds specifically to a receptor within bone, inhibiting the normal bone breakdown. In a trial comparing Prolia to Fosamax, those taking Prolia showed a slightly greater improvement in bone density after one year.
That’s not to say Prolia is for everyone. Like Fosamax, it can occasionally lead to osteonecrosis of the jaw and atypical fractures. And, for people with kidney disease, it can lead to drops in calcium levels that can cause muscle spasms and abnormal heart rhythms. Finally, because Prolia is injected into the skin and may affect immune function, it may slightly increase the risk of skin infections at the site of the injection.
In summary, if you cannot tolerate Fosamax, you should consider injectable Reclast or Prolia. These medications do have rare, but severe, side effects. However, their benefits appear greater than their risks.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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