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Dilemma: How aggressively to treat my 86yo mom w/ dementia for OP?
My mom is 86 and fairly physically fit (walks 3/4 mile 2-4 times a week and her only rx medication is a memory pill called Memantine). She has early to mid stage 6 Alzheimer's but/and she is very happy and enjoys her life.
Her advanced directive (from 10 years ago) is to welcome natural death if/when she is bed-bound or so confused that she doesn't know us and is agitated, etc. She actually dictated into a recording to slow down on accepting antibiotics for infections when she's close to that stage because she does not want to spend years in Stage 7 Alzheimers where she'll be bed-bound and nonverbal and 100% incontinent. She was very thorough, but didn't mention OP treatment. She said to be aware of natural "off-ramps" when she gets to that stage. Thankfully we are not there yet -- she enjoys her life in the moment (though she doesn't remember what she's just enjoyed 5 minutes ago), so I want to help her continue the highest QOL possible.
Her former doctor discovered OP when she was 65 and she had 2-3 reclast infusions 11-14 years ago. I pushed for a DEXA from her newer doctor recently and her numbers have slipped again. Her osteoporosis presents like mine where her hips are her issue rather than spine (-3.6 total hip, -2.7 femoral neck, -1.5 spine).
I accepted a referral to take her to the local hospital infusion center for Reclast soon, but NOW I've learned several of her teeth are loose. I realize that I need to cancel her Reclast appointment and do some research on her behalf because of the contraindications of bisphosphonates for someone with dental issues (I am medical POA and DPOA). I think her doctor will say that her teeth are more important than treating an increasingly house-bound person for OP, but maybe I need to sharpen my Prior Authorization pencil and get her approved for one of the anabolics (?) Or maybe, given her age and prognosis, she is a rare candidate for Prolia...
TLDR: 86 year old mother with Stage 6 Alzheimer's has been rx'd Reclast for her recurred osteoporosis of hip. But I've just been told she has several loose teeth. Her advanced directive is to "DNR and welcome natural death" when she no longer enjoys her life (but she currently does!). Should I get busy and jump through the hoops to get her an rx for Prolia or one of the anabolics? Should I take her for Reclast and risk her loosing teeth (she's already struggling to keep weight on). Her doctor is very hands-off. I think he thinks I should not worry about her OP (or much of anything, for that matter), but he's usually amenable to anything I want to advocate for. Hellllp....
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Maybe Prolia makes sense given her age and condition? She could just stay on it.
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1 ReactionAnnie208,
I'd sharpen my pencil for Forteo for her.
She might take Prolia and not have any side effects. Some have such debilitating effects that they go to bed suffering and never resume walking. She is more likely just to have joint pain. Prolia depresses the immune system. She would be more susceptible to passing flues and viruses, but also pneumonia. If she were to experience side effects, she'd be stuck for six plus months. Of course, she may not have side effects.
Forteo build bones they way our bodies naturally build bone. It is strong, integrated, flexible bone, resilient under the pressures of the minor falls a person is likely to experience.
Some experience side effects, but the drug leaves your system usually within 4 hours. So you can just stop taking it. I'd risk any of the other meds before risking Prolia. It might make her miserable.
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4 Reactions@annie208 I'm going to be the "bad angel" sitting on your other shoulder. My cousin, who is only 75, is in the same state. But she also resists taking medication. After a lot of conversations, her daughter & sisters (one of whom does elder-care case management) decided on NO medication.
Have you discussed the decision on whether or not to treat at all with her primary physician?
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2 ReactionsAt the very least you could check a vitamin D level and treat if low. Very noninvasive and unlikely to hurt anything. Doubting it goes against anything in her living will. Also she could sit outside some on nice days; that will help her vitamin D also. You could take a look at her diet to ensure high in calcium.
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1 ReactionThe objective for treating osteoporosis is only to prevent fractures. A hip fracture at her age and the resulting immobility would likely mean an end of life situation. Repairing the fracture would require surgery which would mean she is bed-bound for an extended period.
I think you need to consider her fracture risk and what the reduction in risk would be on a medication, weighed against any side effects that would potentially interfere with her quality of life.
If you want to preserve her current level of activity then it may be prudent to consider treating her osteoporosis to reduce the risk of a fracture if she falls but every treatment option will have some kind of impact on her life and it seems like the less invasive the better.
Good luck with a very difficult decision.
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2 ReactionsIf that were my mom, I would not have her take any OP drugs out there. She's 86 and has lived a good life and now she already is dealing ( as well as you) the effects of Alzheimers disease. That disease is enough to deal with let alone all the tests, drugs for osteoporosis with potential unpleasant side effects. Keep her comfortable. The end stage of Alzheimers is horrible. Of course, this is my opinion.
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2 ReactionsI would make sure she stays off of Prolia especially if she has teeth issues. I think Prolia as well as any bisphosamates can cause Osteonecrosis of the jaw. I know that is very painful because a friend of mine is 86 and she just started having jaw pain and was diagnosed with that.
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2 ReactionsDon’t forget about preventing falls as much as possible. I think Medicare will pay for a healthcare provider to come to the house. I’m really not sure what kind of provider it is. One would hope one of the goals is to identify and remedy fall risks, perform a falls risk assessment, discussing fall risks such as area rugs, clutter, inadequate lighting, slippery surfaces, appropriateness of using the stairs, high bathtubs, need for grab bars.
Also vision problems increase risk for falls, could discuss with eye doctor.
I guess what I’m trying to say is just because you say no to IV meds doesn’t mean you can’t help decrease her risk of fracture
Your friend may not know about Forteo being the one drug prescribed to resolve osteonecrosis.
Teeth issues are terrible for us because it complicates our ability to get nutrition.