New Thinking on bisphosphonates

[JanW]

Interesting update from my doctor today -- he said that the standard of care in terms of fosamax and others of this type of drug is that people should be taking 'holidays' from them so as not to have to stay on them 30, 40, 50 years at a time. With younger and younger people being diagnosed with osteoperosis and its precursors, doctors are looking seriously at the thigh fractures particularly and how they are occurring in people who have been on the drugs long term.

My doctor says that I will stay on fosamax until my next scan (in about a year, so I'll total 2 years on the drug). If there is no change between scans I will go on a holiday and my urine will be continue to be monitored for signs that I am still not shedding more bone than normal. When, and only when, those values start to climb, will I be put back on fosamax.

He agrees with most people here that this is a drug you want to keep in the arsenal for 'real' osteo, not for people who are on steroids whose doctors fear that they may develop this condition. And the urine test should be ordered frequently (every couple of months). These are serious drugs with serious side effects (as I know Sangye has been saying!).

[drz]

Interesting update from my doctor today -- he said that the standard of care in terms of fosamax and others of this type of drug is that people should be taking 'holidays' from them so as not to have to stay on them 30, 40, 50 years at a time. With younger and younger people being diagnosed with osteoperosis and its precursors, doctors are looking seriously at the thigh fractures particularly and how they are occurring in people who have been on the drugs long term.

My doctor says that I will stay on fosamax until my next scan (in about a year, so I'll total 2 years on the drug). If there is no change between scans I will go on a holiday and my urine will be continue to be monitored for signs that I am still not shedding more bone than normal. When, and only when, those values start to climb, will I be put back on fosamax.

He agrees with most people here that this is a drug you want to keep in the arsenal for 'real' osteo, not for people who are on steroids whose doctors fear that they may develop this condition. And the urine test should be ordered frequently (every couple of months). These are serious drugs with serious side effects (as I know Sangye has been saying!).

What is the urine test they use? I want to discuss this my rheumatologist at next meeting?

[JanW]

I'm taking this strictly from WebMd, because I've never asked the name, but I believe it is called: Urinary N-telopeptide of type I collagen, or uNTX. I see the uNTX or NTX referred to several times on the web as relates to fosamax.

In any case, it's either this or a blood test that will tell whether or not these drugs are actually working, so docs should give you tests for these markers as part of your regular WG workup if you are on one of these drugs.

[Sangye]

That's great info, Jan. Thanks for sharing! Glad you get to take a holiday from the drugs soon, too.

[JanW]

Only if I don't have thyroid problems, Sangye, so keep those fingers crossed for me. My rheumy says an endo would probably want someone with thyroid issues to remain on these drugs for life. My rheumy says that he always keeps in mind that any drug is a poison as well as a cure, which is one reason that I like him. I find that it's hard to find a doc who will hold back on drugs, as opposed to going full speed ahead with a bunch of stuff "just in case." I'm very glad that he never started me on prednisone, for instance.

[Sangye]

Dr Seo is just like that. He doesn't like to increase dosages, add new drugs or re-treat unless necessary. They are rare birds, that's for sure.

With a slightly (but consistently) elevated pulse and bp I'm more inclined to think you have a spinal misalignment stimulating your sympathetic nervous system and/or thyroid. If that's the case it's an easy correction. Also, if that's the underlying cause, leaving it uncorrected can lead to overt thyroid disease at some point, as the thyroid is receiving aberrant information from the CNS.

We see this sort of thing all the time in practice-- a patient gets adjusted and their subclinical signs/symptoms resolve, or a patient with overt disease gets adjusted and has improved glandular function. The latter might not be able to go off meds--the egg might be boiled at that point-- but they can often reduce their doseage, sometimes dramatically. That scenario demonstrates that the spinal misalignment was the likely cause of the disorder in the first place but that it's too late to reverse the disease process completely.

[elephant]

Sangye, if I were to come in your practice...how would you know if I had a spinal misdalignment? Ct scan? Physical exam? Sometimes I wonder if that is going on with me...I get on/off mid back pain.

[Sangye]

As part of a first visit, chiropractors do a general physical exam, including measuring range of motion, palpation for muscle tightness or laxity and joint mobility. Chiropractors are highly trained to palpate for spinal misalignments. It takes years to get good at it. In addition to palpation we use posture analysis, gait analysis and other types of observation. Some chiropractic techniques use x-rays or thermal analysis in addition. Advanced imaging like CT or MRI are only ordered if there are red flags that warrant it-- certain trauma, suspect cancer or other disease, etc....

If you want to get an idea of how well chiropractors can palpate, try this little exercise we do. Put a long hair between the pages of a yellow pages phone book. Cover the hair with a few pages and see if you can feel the hair. Chiropractors can palpate through at least 20 pages-- no joke.

[elephant]

Thanks Sangye for the information. Wow, that is amazing ...20 pages.

[Sangye]

I remember being a brand-new student and could only feel a hair through one page. I thought my teachers were exaggerating. But by the time I graduated I could do over 20 pages.