Connect
Which Osteo Meds Don't Need to Be Followed Up with More Meds
I see that with some meds, like alendronate, you take a pause after a few years and then see if you need to continue or take another med. With others, like Evenity or Prolia, it seems once you start, you need to be on some kind of osteo med for life. I am puzzled by this, it sounds like if you don't start another med immediately, you are worse off as you start losing bone density right away. Do those drugs change something in your bone chemistry that causes fasterloss when you are off of them? And, which meds can you take for a while and then pause, or even stop medicating?
Thank you.
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
None. If there was a way to just take one med for a while and be done with it forever, we'd all be celebrating.
That said, you can take drug holidays with biphosphonates. The idea is to reduce the risk of side effects. But there is still some risk of fracture.
https://mcpress.mayoclinic.org/healthy-aging/taking-a-break-from-osteoporosis-medicine-what-you-need-to-know/
Bone building mechanism: drugs "artificially" change this. If you stop, the effect goes away and even reverses.
https://my.clevelandclinic.org/health/body/24871-osteoblasts-and-osteoclasts
-
Like -
Helpful -
Hug
4 ReactionsThe bone builders require a bisphosphonate to hold the gains. Once you stop a bone builder (anabolic like Tymlos, Forteo, or Evenity) your body resumes it's unbalanced bone metabolism in which you lose more bone than you build.
Bisphosphonates also remain in your bone for a long time after you stop so this is another reason you sometimes don't need to take anything afterwards for at least a while. For example, Fosamax will remain in your bones for at least 10 years while Reclast is 1 to 3 years.
I view osteoporosis as a lifelong chronic condition, especially for those of us who are older women who are post-menopause. I suspect I will need to take some kind of medication for the rest of my life but hopefully there will be some medication pauses in between.
-
Like -
Helpful -
Hug
7 ReactionsThank you both. My doc didn't mention this part of the story when prescribing Evenity.
I was on Fossomax for 4 years, after 2 I showed DEXA gains, and then after 2 more, showed loss even though my labs were good. Now, I wonder if the DEXA was accurate as I have read it isn't always for very small, thin women. I wish I would have asked for a repeat DEXA, even paying out of pocket. But, I will have had 3 doses of Evenity, so at this point, a DEXA might reflect some Evenity gains and it would be hard to sort out.
-
Like -
Helpful -
Hug
2 ReactionsSmall correction here. It's reclast that is the longer lasting more powerful med. Fosamax is less powerful and less long-lasting. Reclast in general has stronger side effect possibilities. Though, Fosamax does have the risk of upper GI irritation that can be pretty significant.
-
Like -
Helpful -
Hug
2 ReactionsWell, I think we need to differentiate between powerful and long-lasting. Reclast may be more powerful in that it can suppress osteoclast activity with just a single dose that lasts at least a year and maybe up to 3 years while it takes weekly repeated doses of alendronate taken over years to achieve the same osteoclast suppression.
However, alendronate has a half-life of 10 years because it is taken up by bone and is only released when bone breaks down again. If you come off alendronate, osteoclast activity will resume and when the bone breaks down, the drug is released into your blood and is taken back up by the bone. This means that its effect lasts longer than Reclast. This is also one of the reasons that it's recommended that anabolics be used first before bisphosphonates because a bisphosphonate like Fosamax can blunt their effect. Unfortunately, this is the situation that I am in since I was on it for so long and am now on Evenity.
Edited to add after doing more research that Reclast also binds to bone surfaces and exhibits the same effect as alendronate with regards to being released and taken up again by bone. So it looks like both have lengthy durations of effect in that regard but yes, Reclast is more powerful being that it only requires one dose.
-
Like -
Helpful -
Hug
1 ReactionI had the same experience with Fosamax. During the first two years I had significant gains in my T-scores but then they started going down again. My current endocrinologist told me this was because the drug stopped working. I found that interesting but neglected to ask her why.
-
Like -
Helpful -
Hug
1 ReactionWould going on hrt hold in the gains longer
Hi @oopsiedaisy
I think we're sort of coming together here. I am quite surprised that the half-life of alendronate in bones is stated to be 10 years. I had thought you had mixed up the two meds. My apologies.
Try as might I could not find any similar info for zoldronic acid (Reclast). So I can find no data in order to compare the two meds as to how long they last in bones. Since Reclast is shown to still be exerting effects 3 years after a single dose I suspect it is in your bones for a very long time.
Best of luck in dealing with your bone issues
There are plenty of other factors to use in comparing the two drugs so no need for me to dwell on the half-life in bone factor
-
Like -
Helpful -
Hug
1 ReactionHi @oopsiedaisy . Many thanks for this information, it is helpful.
@njx58 Somehow, both of my endos never mentioned this issue of reversal of changes for most do these meds, they only mentioned it for Prolia, so I assumed that only happened with that drug and not the others...