Dental work while on Reclast

@hopeful33250

You're very welcome!

My husband has steroid-induced osteoporosis, something we had never heard of until I saw he had a spinal fracture on an x-ray with no injury we could remember.

He was diagnosed with PMR (Polymyalgia Rheumatica) in 5/2023 and then with GCA (Giant Cell Arteritis) in 2/2024. With PMR, he was put on 30 mg prednisone, and by the time he was diagnosed with GCA, he had tapered down to 12.5 mg. When he developed GCA it became very serious and he was admitted to the hospital where they did 3 days of 1200 mg methylprednisolone. That's a lot of steroids but it was the only thing that would save him from losing his sight, having a stroke, aneurysm, heart attack etc etc So we didn't hesitate. We really had no other choice.

He was then put on 80 mg of daily prednisone in 2/2024 and is now tapering (with the help of a weekly injection Actemra) and is now down to 15 mg.

But all the prednisone caught up with him. The sad story is doctors should discuss the bone issue with patients when they put them on prednisone, anything over 7.5 mg and some studies say even as low as 2.5 mg per day. They didn't tell us of the possibility he would develop osteoporosis. Once I saw the fracture I raised concerns and it took a while but I was able to finally get him a bone scan. It revealed he had -3.4 t-score on his lumbar spine. He had new back pain a couple months ago so I insisted on another x-ray which showed two more fractures. Since learning of the two new fractures, one likely caused by emptying the dishwasher, they have limited him to lifting no more than 5 pounds and no bending. Which has really restricted his life in ways we didn't expect. I had to fight for it but I managed to get him on the best drug for steroid-induced osteoporosis - Forteo. So we're doing daily injections that started on Monday and are hopeful it will help rebuild bone. Then after two years he'll go on Reclast. We are wanting to get the dental work done before the Reclast.

That was a long answer to your question. LOL For him it's not hereditary, it's from steroid use. Has your dad ever used steroids? For any length of time? There are other drugs that can also cause osteoporosis in people, including men.

Here's a list I found online:

Many drugs can affect bone metabolism and increase the risk of osteoporosis, including:

Glucocorticoids
Prednisone and methylprednisolone are examples of glucocorticoids that are commonly associated with drug-induced osteoporosis. Patients taking glucocorticoids should take the smallest dose for the shortest time possible.

Selective serotonin reuptake inhibitors (SSRIs)
SSRIs like fluoxetine (Prozac) and escitalopram (Lexapro) may weaken bones, especially with long-term use or if you take multiple medications that affect serotonin.

Diuretics
Diuretics can reduce bone mineral density in the hip.

Progestins
Medroxyprogesterone acetate (MPA) is a progestin preparation that's often linked to bone loss.

Other drugs that can increase the risk of osteoporosis include:
Heparin
Warfarin
Cyclosporine
Methotrexate
Loop diuretics
Excess thyroid supplementation
Aluminum-containing antacids
Lithium
Hormone blockers

I appreciate the added information about the causes of your husband's osteoporosis. On Connect we do have a discussion about PMR. In case you haven't seen it, here is the link,
--Polymyalgia Rheumatica
https://connect.mayoclinic.org/group/polymyalgia-rheumatica-pmr/
Here is another discussion on how PMR progresses to CGA
https://connect.mayoclinic.org/group/polymyalgia-rheumatica-pmr/
I appreciate the list of medications that can result in osteoporosis. My dad died at age 82, after treatment for numerous chronic health conditions. Perhaps some of the medications might have contributed to his osteoporosis, but he has been gone for several years now, so it is difficult to determine the reason.

I can understand the difficulty you both must face with his physical limitations. It certainly must be frustrating.

If you haven't read the above discussions, please take a look at them. You can probably offer and receive encouragement there.

Is your husband going to have another Dexa Scan prior to beginning Reclast?

I appreciate the added information about the causes of your husband's osteoporosis. On Connect we do have a discussion about PMR. In case you haven't seen it, here is the link,
--Polymyalgia Rheumatica
https://connect.mayoclinic.org/group/polymyalgia-rheumatica-pmr/
Here is another discussion on how PMR progresses to CGA
https://connect.mayoclinic.org/group/polymyalgia-rheumatica-pmr/
I appreciate the list of medications that can result in osteoporosis. My dad died at age 82, after treatment for numerous chronic health conditions. Perhaps some of the medications might have contributed to his osteoporosis, but he has been gone for several years now, so it is difficult to determine the reason.

I can understand the difficulty you both must face with his physical limitations. It certainly must be frustrating.

If you haven't read the above discussions, please take a look at them. You can probably offer and receive encouragement there.

Is your husband going to have another Dexa Scan prior to beginning Reclast?

@hopeful33250

I tried the link to the PMR/GCA page and it went to the main PMR page. Could you please check the link again?

Thanks for pointing that out, @isabelle7. Here are some links about PMR and GCA.

--How often does PMR progress to GCA
https://connect.mayoclinic.org/discussion/how-often-does-pmr-progress-to-gca/
Also:
--GCA and PMR
https://connect.mayoclinic.org/discussion/temporal-arteritis-1/
--Here is an article from BMJ which you also might find interesting,
https://ard.bmj.com/content/83/1/48

Dear Lori, I can not believe how fast the Summer is passing. I have been very preoccupied with trying to find some answer to address my hip pain, with x-rays and doctors apts. It appears that as is the case with my shoulders, that the only answer is to have the joint replaced.
I am wearing my denture during the day and the only issue is that sometimes when I drink something the denture becomes loose enough that it would actually fall out, if I was not careful. I am reluctant to use adhesive at this time so I am just careful. It is comfortable when in place. I do have what feels like a sharp splinter pocking through the gum in front. Could this be a sliver of bone? The last time I had an extraction, I got these slivers and they eventually worked their way out through the gum. However there was nothing blocking them. Now the denture is covering this area so I am wondering if it will be able to work its way out through the gum. I did ask the oral surgeon what I should do if I get these splinters after this extraction and he said don't worry about it. They will come out. I can just feel the point of the splinter with my tongue, at this time. It feels as though it is not protruding any further as time goes bye.
Lori, I am so very happy that you are well and that you are willing to be a mentor. The courage you have displayed through your journey is so inspiring. I am so grateful that you shared your story ! I will hold your " favorite quote-life motto" close to my heart. I will always remember your wisdom ---"The only two things we really have control over are our effort and our attitude" You are the personification of encouragement, support and hope ! I treasure my notebook of "Lori's Wisdom". I will keep you updated.
Holly

Dear Lori,
I have been dealing with Rheumatology appointments, but I know that I need to shift back to my oral health now because this sharp point of "bone" on the upper gum is not working its way out. I wanted to ask you if I should see the dentist or the oral surgeon about removing this sliver. Thank you, once again I am so grateful that you are with me on this journey.
Holly

Hi Holly, I’m not exactly sure whom you should call either. Our dental office performed oral surgery and extractions so we were in the position to remove little bone spurs. It’s usually not complicated as they are near the surface. Since your oral surgeon did the extractions they may be the person to actually do the followup. But I also know their schedules are usually pretty full.

Ok, here’s a plan: I think the easiest would be to call your dentist office. Mention that there is a bone spur working its way to the surface and you’re wondering if the dentist can remove it or if you need to call the oral surgeon.

There’s no harm in calling either one. But your dentist may want to see you to make sure the denture is fitting properly and may be able to ‘encourage’ that little sliver out.
Have you tried any adhesive yet?

Dear Lori, As soon as I read your reply, I relax and feel that I know what to do. You always give me a plan to move forward with and having a plan makes my anxiety go away. So I called the dentist and they told me to call the oral surgeon. I got an appointment with the oral surgeon, but as you said, they usually have a full schedule so he can't see me until next week. I should be fine until then, because it does not hurt.
I have not tried any adhesive yet. I admit that I am hesitant to try adhesive. I think that it may be because I have severe COPD and the thought of having something "stuck" in my mouth makes me uneasy. I am sure that this will pass and as I adapt to the denture I will be ok with adhesive. I'm just really taking things slow. Thank you, again, for being there for me. You always seem to know exactly what I need.
Holly

@hlp123,
Hi Holly,

I'm glad to hear that you will be seeing the oral surgeon next week, that was great that you called! I noticed you have worries about using an adhesive for the first time. So, I decided to chime in with some more ideas! You could start with just a dot of adhesive in three places, the front, and then a dot on each side. Sometimes starting small is better than using a lot. That way you can see if it would help.

Will you give it some thought?