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Does anyone know if I can get dental work done before starting reclast
Osteoporosis & Bone Health | Last Active: Nov 27 3:23pm | Replies (30)Comment receiving replies
mayblin, the thing being different is that romosozumab suppresses CTX by disabling the production of osteocytes and consequently the entire remodeling system. P1NP jumps, but not fast enought to catch
the osteoclasts. It stands to reason that as remodeling is halted just at the trigger for osteoclast formation.
All roads lead to Forteo.
Sando's dilemma is needing the oral surgery between Evenity and Reclast. With the endo looking at the 64 limit of Evenity in the system. Insistent enough to indicate that approval for a next application of Evenity in some future would be compromised. The duration of use of these antiresorptives would make me avoid any of them until after the oral surgery is completed. Worse is that there are two endocrinologists. Oral surgery July 20.
The risk of ONJ after Evenity is lower than the risk with bisphosphonates. Forteo can only help both with the surgery and halting the damaging proliferation of osteoclasts. The oral surgeon is more likely to prescribe a short course than the unhappy endocrinologist. And Sando's bone markers would be a guide and a tiny window into Forteo after Evenity. But I would like you to throw your weight in the opposite direction.
These are dental implants.
Replies to "mayblin, the thing being different is that romosozumab suppresses CTX by disabling the production of osteocytes..."
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After rereading the original and subsequent posts, it seems sando finished evenity on 5/20, endo(s) gave 7/20 as last day to start reclast or prolia as antiresorptive. Sando is trying to get oral surgery done sometime during this 2 med-free months. Oral work includes pulling teeth and something less involved, i.e., not an implant. Correct me @sando if I didn't fully understand the situation here.
In any case, I agree with @gently not going with prolia, a problematic drug. If dental work doesn't involve implants or bone related healing too much, reclast might be okay. It may delay any bone related healing somewhat. Reading from various sources, it's surprising to know that necrosis of jaw occurs very rarely, with most cases involving large dosing in chemo patients. The problem with reclast here is the long length of its antiresorptive effect - something to keep in mind just in case your dental needs turn out to be more extensive than you had previously thought.
Taking FORTEO during extensive dental work involving bone healing is ideal. Since sequential usage of FORTEO after evenity is not well studied yet, introducing FORTEO during the short window after evenity as @gently suggested might be very tricky. The question is whether or not the early anabolic effect of FORTEO will overpower the suppressed osteocytes production/remodeling system brought on by evenity, in a timely fashion. IF, sando's dental work is not urgent, then use of a short-term bisphosphonate will allow "lock in" bone gained with evenity, while allow ample time for coordination of scheduling, planning with docs as well as possible insurance approval process of FORTEO.