Re: Bisphosphonates
From: Joanne Bulley, MD (islesannie@yahoo.com)
Sun Apr 30 21:11:05 2006
Doug
Welcome back - haven't seen a post from you for a long time!
I thought Fosamax was bound irreversibly to the osteoclasts - so you
have to make new osteoclasts before bone loss can resume. Am I
mistaken?
I have seem some patients the endocrinologist has taken off Fosamax
after being on for 3-5 years with the plan of checking a BMD after 2
years off to see how things are behaving - with the loss not that sever
after those 2 years. At lest not compared to what they were before
starting therapy.
Joanne
At Sun, 30 Apr 2006, Douglas Krell wrote:
>
>Forever is the right answer since when you stop, bone loss resumes in
>earnest,...however Fosamax has more nearly complete bone turnover
>suppression and theoretically there is a greater risk of osteonecrosis with
>this drug. People have talked about short drug free holidays with Fosamax.
>Long term Actonel administration has been associated with osteonecrosis
>although the risk is significantly reduced.
>Evista, on the other hand, as a SERM, works through the estrogen receptor
>and reestablishes a normal relationship between osteoclasts and osteoblasts
>and there are no such complications.
>
>--
>Douglas Krell MD
>
>>From: johnprov@sympatico.ca (Dr. John Provatopoulos B.Sc. M.D.C.M.
>>F.R.S.C.)
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: Bisphosphonates
>>Date: Sat, 29 Apr 2006 09:03:14 -0500
>>
>>At Sat, 29 Apr 2006, Jim Lie wrote:
>> >
>> >Yesterday I saw a woman who has T5 & T8 crush fractures just from
>>suddenly
>> >forward flexing. When we were discussing the options - including
>> >biphosphonates - she was aghast that I mentioned it - because she heard
>>on
>> >TV about how horrible this drug is --> causing osteonecrosis. I did a
>>google
>> >search and found nice lawyer sites (in USofA) asking for people to come
>> >forward to sue the doctors and the drug company.
>> >
>> >James Lie MBBS
>> >Albany
>> >Western Australia
>> >
>> >> >When you are treating woment with a bisphosphonate do you
>> >> >
>> >> >How long do you think she should remain on the bisphosphonates?
>> >> >
>> >>
>> >> Forever,--
>> >> Take care, John
>> >>
>>
>>This is par for the course in any affluent society: never mind that most
>>people who get Avascular osreonecrosis also had cancer, diabetes and
>>peripherial vascular disease and where most likely put on on
>>biphospantes because they where high risk for osteoporosis and
>>osteonecrosis. Unfortantely estrogen is also associated with avascular
>>osteonecrosis so your options for preventing osteoporosis keep getting
>>smaller.
>>
>>--
>> Take care, John
>
--
Joanne Bulley, MD
Keene, NH, USA
