drug of choice for osteoporosis

[k9ophile]

I see an endocrinologist. I also have thyroid issues. Surprisingly, he knows about the malabsorption issues I have. He's did a fellowship in endocrinology and metabolism at Duke, then served on the faculty at Vanderbilt. I know that there are probably some docs with the same credentials, yet since those are the southern equivalent of the Ivies I definitely feel assured.

 

[DSRIGGS]

I just hope I don't have to see an Endo to get tested because they suck on my area and are almost impossible to get in to see.

 

[Petunia]

Is an Endocrinologist who one sees for bone osteoporosis? I would have thought a PCP or Orthopedic Doc.

My PCP first gave me the prescription pills for osteoporosis but I had really bad flu symptoms so she referred me to the Endocrinologist for other options. My gynecologist is the one that usually orders the bone density, now the endo does that.

 

[Clematis]

@DSRIGGS Just ask your PCP for the dexa scan order. (My gyro orders mine but the PCP would do it if I didn't have a gyno.) If something is really amiss, then you'll be referred to an endo. You will be a rare man in the department -- around here the machine is back with the mammogram machines. My husband had to have a partial mammo for what turned out to be a swollen gland and he and everyone laughed that they only had pink gowns.

 

[Happy DSr]

My PCP went straight to the ones that can be infused, my choice was Reclast but the side effects can be wicked for a few days. Others are doing Prolia but that is twice a year. Then there is a version of Boniva that can be infused. Avoid oral meds.

Liz, are you aware of any studies to support our malabsorption of the oral meds? My doctor isn't experienced with DS, but she is very supportive and will take my lead. It would be helpful if I could explain the evidence or show her the studies.

I did find this article
http://bariatrictimes.com/therapeut...rosis-in-the-surgical-weight-loss-population/

 

[Spiky Bugger]

not sure if like any of these solutions
- lose jaw bone while not absorbing the Bisphosphonates
- take daily shots of Forteo for two years, with refrigeration logistics to be managed, and hope it takes
- take annual shots/infusions and potentially deal with side effects for long time while drug works out of my system

It will be an interesting discussion with my doctor

I sooo need to figure this out for me. Thanks for the thread.

 

[Spiky Bugger]

Liz, are you aware of any studies to support our malabsorption of the oral meds? My doctor isn't experienced with DS, but she is very supportive and will take my lead. It would be helpful if I could explain the evidence or show her the studies.

I did find this article
http://bariatrictimes.com/therapeut...rosis-in-the-surgical-weight-loss-population/

The fastest way I have found to prove the malabsorption of oil-based drugs is to humor your "new" doctor and take the standard Vit D prescription that works for everyone else. For three weeks. And then do a blood test. Case closed. That PCP said, "Thanks for humoring me."

 

[Spiky Bugger]

Looks like they are TRYING to figure it out...just not with all the drugs we want to consider:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571763/#!po=22.8261

(ETA--I don't know why it links to page 11, so I don't know how to fix it.)

 

[k9ophile]

I just hope I don't have to see an Endo to get tested because they suck on my area and are almost impossible to get in to see.

The doc who does mine is an internist. It's one of those "Ain't science grand?" things. It's read by machine so there is no nail biting waiting on results. I get a copy before leaving the room. Any doc can write the orders. Look at the results and then plan your next step.

 

[Happy DSr]

The fastest way I have found to prove the malabsorption of oil-based drugs is to humor your "new" doctor and take the standard Vit D prescription that works for everyone else. For three weeks. And then do a blood test. Case closed. That PCP said, "Thanks for humoring me."

yeah, it's unfortunate that some doctors need to see their patient's results tank before taking malabsorption seriously. I'm luck to have a doctor prepared to work with me


so are you saying that the oral osteoporosis meds are oil based? If so, then that would be a strong argument to go with the injectables.

 

[Happy DSr]

as a DSer, when I have a choice, I will go with injectable forms of my medications.

I have rheumatoid arthritis, and chose to take methotrexate by weekly self injection rather than a daily pill, because I wanted to ensure I got the best consistent dose of the medication. But methotrexate is not oil based, so it probably wasn't necessary. And the cost of the injections was similar to the cost of the pills, both very low cost and covered by insurance.

for the osteoporosis, the cost of the orals seems to be much, much lower than the injectables. I think I need an evidence based reason to request the much higher cost. The Bisphosphonates seem to be a dry tablet. What is the science to support the case it is not recommended for DSers?

 

[Spiky Bugger]

yeah, it's unfortunate that some doctors need to see their patient's results tank before taking malabsorption seriously. I'm luck to have a doctor prepared to work with me


so are you saying that the oral osteoporosis meds are oil based? If so, then that would be a strong argument to go with the injectables.

I have no idea.

 

[Spiky Bugger]

as a DSer, when I have a choice, I will go with injectable forms of my medications.

I have rheumatoid arthritis, and chose to take methotrexate by weekly self injection rather than a daily pill, because I wanted to ensure I got the best consistent dose of the medication. But methotrexate is not oil based, so it probably wasn't necessary. And the cost of the injections was similar to the cost of the pills, both very low cost and covered by insurance.

for the osteoporosis, the cost of the orals seems to be much, much lower than the injectables. I think I need an evidence based reason to request the much higher cost. The Bisphosphonates seem to be a dry tablet. What is the science to support the case it is not recommended for DSers?

From wikipedia...why I don't want oral bisphosphonates...
Oral bisphosphonates can cause upset stomach and inflammation and erosions of the esophagus, which is the main problem of oral N-containing preparations. This can be prevented by remaining seated upright for 30 to 60 minutes after taking the medication.

 

[southernlady]

MY PCP understands malabsorption (not necessarily the DS tho), so he just skipped over oral drugs altogether. He went straight to infusions which was fine by me...and apparently okay with my Medicare Advantage insurance as they didn't balk at paying for it (minus the applicable copay).

 

[marissamast]

Hello All

please tell me about your drug of choice for osteoporosis

I am a 10 year successful vet, IMHO. Labs are all good, weight loss maintained, good health. But annual bone mineral density scans have shown a slow but continual decline. I just had my most recent scan and my PCP has called me in for an appointment. I think she want to talk medication.

I have been doing a version of Major Mom's recommendation - strontium, boron, K-2, mag citrate, and I take 150,000 D plus 3000 calcium citrate daily.

So if it is time for osteoporosis medications, what are the pros and cons of the options for those of us with malabsorption. What are your experiences and advice?

Happy



this thread was helpful, but an update would be great
http://bariatricfacts.org/threads/i-have-osteoperosis-now.906/

I have osteoporosis now. Found out when after a week of meetings 16 hrs a day in heels and dress pants, I ended up with 4 stress fractures in both feet. 6 weeks in dual walking boots! July of 2018 I slipped and fell and broke my pelvis. Sept 29th I fell off some stairs and snapped my femur right in half. Had Reclast in Feb 2018 and I am getting a dexa and another infusion before the end of the year. The first one cost me $1200 so I wasn't going to do it again but since this fracture I have met my out of pocket max so I will do it again. I had no adverse affects