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What is minimum period of Alendronate to minimise Prolia rebound?
Osteoporosis & Bone Health | Last Active: Jun 3 10:54am | Replies (20)Comment receiving replies
I believe my doctor was not even aware of the need for an exit plan for Prolia as he had assured me that I could switch to oral biphosphonates at any time
My concern with the transition is that the longer one is on Prolia, the harder it is to mitigate the rebound effect. Don't quote me on this but if I remember correctly, Prolia works differently from Alendronate. Unlike Alendronate which kills the osteoclasts (the ones that break down bones), Prolia only puts them into a state of suspension. The longer you are on Prolia, the more of such "suspended osteoclasts" accumulate and once you stop Prolia, the brakes are taken off and these osteoclasts come back with a vengence!
Once you are on Prolia for 2 or more years, Alendronate may not be sufficient and you may need a stronger anti-resorptive like Reclast. And if you are on Prolia for even longer say, 7 years, it may not even be possible to prevent the rebound effect. So basically you would be stuck on Prolia for life which is worrying given that there is safety data for only 10 years
On the liquid intake for Alendronate, it's not a typo. My understanding is that you need to take the tablet with 6-8 oz of water. Other than that, there is no mention of further liquid intake in my Alendronate leaflet. The recommendation for the additional 2oz of water during the 30 min fasting period was in some other material I came across. I have not read anything about needing to take 8+8 oz of water but there certainly wouldn't be any harm (and probably a lot of benefit) in doing that
Oh, do you have the link for the NIH study that mentioned absolute values for BTMs? I have only come across 1 article which states that, if no baseline BTMs are available then we should target the lower half of the relevant reference range (not very helpful as I understand the reference range is very large) - see link below:
https://www.ccjm.org/content/90/1/26
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The link to the NIH survey was the one I gave you previously and you indicated you already had that essay.
The following is quoted from a portion of that publication , summarizing what various countries are recommending. It is the last sentence that provide BTM targets for 'an adequate response'
"The European Calcified Tissue Society (ECTS) provided the most updated guidance on the issue. Guidance for denosumab discontinuation is stratified according to the duration of use and individual fracture risk [39]. Individuals with high fracture risk treated with denosumab for more than 2.5 years should continue denosumab for up to 10 years or alternatively switch to zoledronic acid starting 6 months after the last denosumab injection and monitor BTMs 3 and 6 months later, and a repeat dose should be considered if BTMs are persistently elevated. Alternatively, zoledronic acid should be given at 6 and 12 months after the last denosumab injection if BTMs are not available. Oral bisphosphonates for 12 to 24 months can be used in place of zoledronic acid. Conversely, individuals with low fracture risk treated with denosumab for less than 2.5 years may be switched to 1 to 2 years of oral bisphosphonates or zoledronic acid with close monitoring of BTMs and BMD. BTM targets of CTX < 280 ng/L or P1NP < 35 µg/L were specified as targets for an adequate response."
Hope you find this helpful.