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Re: Bisphosphonates From: Garry E. Siegel, M.D. (garrys@mindspring.com) Fri Apr 28 08:58:10 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Seele, Mona: "Re: US neonatal mortality and morbidilty, was Homebirth, was VBAC, ect" Previous message: Garry E. Siegel, M.D.: "Re: Section on demand**Experience**" In reply to: Joanne Bulley, MD: "Bisphosphonates" Next in thread: Terrence.Jones@kp.org: "Re: Bisphosphonates" It sure is nice to be unencumbered with knowledge or knowledge of the literature, as shooting from the hip is so easy. I'm optimistic that one of the fine listers (Terrence) will give you the "right" answer soon, should it exist. Bone growth and loss are slow processes, like watching paint dry. I don't think that there is much reason to repeat studies more often than every few years. Arbitrarily, I go for 5, as 2 years (what we all "grew up" with) is just not long enough to see much change, given the slow nature of change and the inherent imprecision in any measurement. I would keep her on them forever, as best we know. Does anyone think that oral or IV Boniva is a fair/safe substiture for Actonel weekly or Fosamax weekly? Garry At Fri, 28 Apr 2006, Joanne Bulley, MD wrote: > >When you are treating woment with a bisphosphonate do you > >1) leave her on it forever > >2) treat for 1-5 years and stop and observe > >3) something else. > >How long do you think she should remain on the bisphosphonates? > >I have a patient whose mother had horrible osteoporosis. Mom was put on >Fosamax (After many fractures) and stayed on treatment until at end of >life from other isseus. When they stopped the fosamax, the daughter >said it was as if the bones started shanging shape - getting >protuberances that could be seen and felt by the caregivers (primarily >this daughter). Have any of you seen that sort of thing when coming off >Fosamax after 10-15 years use? > >I have asked the question at a number of conferences regarding IF the >bisphosphonate permanently blocks the osteoclasts - what happens IF the >woman had a standard fracture after being on the drug for 5-10-20 years? >Can the bone still remodel and if so does it remodel properly? > >I have never gotten any sort of straight answer - usually some skirting >the issue and "we don't really know" > >This patient of mine has now been on Fosamax since 2001. Spinal BMD >down to T score of -3.1 at its nadir and femur at -2.2. Both have come >up some and staibilized at spine -2.5, femur -2.0 on treatment. I have >explained the bone microarchitecture and the decrease fracture risk even >if the numbers don't head back toward T score of 0. She has had a >couple of significant falls without fracure. > >Anyhow - I have seen docs treat for 2-3 years then give a break - but >what are Listers doing? As others have said - this is where I get >valuable in-the-trenches information! > >-- >Joanne Bulley, MD >Keene, NH, USA > >"Love is indescribable and unconditional. >I could tell you a thousand things that it is not, but not one that it is." >— Duke Ellington, American jazz artist (1899-1974). > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Seele, Mona: "Re: US neonatal mortality and morbidilty, was Homebirth, was VBAC, ect" Previous message: Garry E. Siegel, M.D.: "Re: Section on demand**Experience**" In reply to: Joanne Bulley, MD: "Bisphosphonates" Next in thread: Terrence.Jones@kp.org: "Re: Bisphosphonates"

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