If your blood test shows your Vit D levels are low, your doctor will usually prescribe a booster dose of 50,000 IU at least once and maybe more often. Depends on your need and body's absorption of it. After that he may have you take OTC Vitamin D in 5000 IU doses until you stabilize. The recommended dosage is 1000 IU a day.
Taking more without a doctor's OK, can be harmful.
Look for the UPS symbol on your supplement to insure a quality product.View Thread
How old are you? Have you fractured any bones since age 40? What are your T-scores? Are you on hormone therapy?
Your history of steroid therapy puts you in a high risk for fractures category. You definitely need a medication. The benefit you'd get from being on one far outweighs any slight chance of a side effect from that med. More people who take these meds report NO side effects. It's the ones who notice anything different after beginning one who talk. Whether you have side effects or not, the medicines do reduce your chances of breaking a bone, and that's a good thing.
Your steroids are much more risky than any osteo med, so make your choice based on your lifestyle, any gastro issues you might have and cost. They're all effective.
My personal advice would be Reclast. The reason being that you only get it once a year and don't have to worry about refills or taking it while traveling, etc. It's also paid for out of your health insurance, not drug policy because it's given in a medical setting. My brother and mother take this with no problems.
I wouldn't do the Prolia unless other meds don't work. Our medical director, who is an osteoporosis expert as well as rheumatologist, says she won't prescribe it for her patients except as a last resort. Her preference for whatever reasons.
Boniva is good. A lot of people just prefer not to take the pill, especially if they have problems with heartburn or Reflux.
Just remember that all of them require calcium and vitamin D in order to work effectively. The calcium (1200 mg/day) should be taken in 500-600 mg increments several hours apart. If you take a supplement, take it with meals for maximum absorption. The Vit D can be taken any time. Most people like to get a calcium supplement with D.
You can also go to the National Osteoporosis Foundation website (www.nof.org) for a lot of information about the different drugs and all things osteoporosis.View Thread
I think they're denying Binosto because it's a new medication and patents are still pending. It's pretty Standard Operating Procedure nowadays for insurance companies to deny at first, then capitulate to those who challenge and challenge.
Why are you opposed to trying another medication? If you have a problem swallowing pills, I'd suggest Reclast. It works the same way as Binosto but is an annual IV injection. Because it's given in a hospital or doctor's office setting, your health insurance or Medicare B pays for it instead of RX insurance.
While I agree with your argument about being a paying customer, the reality is.....it doesn't work that way anymore. They'll tell you that you can still get the med you want, but you'll have to pay full price. Stinks, doesn't it?
Just know that in order for any osteoporosis medication to work effectively, you must consume 1200 mg of calcium every day and 1000 IU of Vitamin D. Without these, the medication doesn't have anything to work with. Calcium should be spread out during the day for maximum absorption.
Good luck with your battle. I've been there. Took me 2 years, but I prevailed. I wouldn't advise you going without medication for longer than a month.View Thread
The stories about subtrochanteric femur fractures are not quite complete.
The information from them is coming from a study by a group in New Zealand who has made it its life work to disparage the osteo drugs.
The study was not a controlled study. The results are not reliable.
What is not being said is that these fractures happen just as often (which is not often) to people who have never been on the bisphosphonate drugs.
I'm so sorry you've had this fracture. It may very well be that your bones were already at high risk for fracture. With RA, I'm sure you were taking medications that interfere with bone health.
The osteo drugs do not carry a no fracture guarantee. They only reduce your risk for fractures. Also remember too that if you do not consume 1200 mg of calcium, the drugs are not as effective. It's like hiring a bricklayer and not giving him any bricks.
I understand about the fear of falling and the balance issues. It's ironic that a fear of falling actually increases your chances of falling. I would suggest that you look on the National Osteoporosis Foundation website (www.nof.org) and look at the balance exercises they have. Do them. Taking a yoga or T'ai Chi class would also help with balance and strength building.
Another suggestion is to wear a backpack instead of carrying a purse. It leaves your hands free in case you stumble and it also aligns your spine naturally.
You're too young to live like this. There are options for you. For sure you need to be on another medication to improve the health of your bones. You don't want another fracture. For what it's worth, I totally do not believe the Boniva caused your fracture. I think your bones were not in good shape either because you never reached your maximum bone mass, your genetic history or your RA meds weakened your bones.
Don't throw the baby out with the bath water. Do what you can now to become as strong as you can.View Thread
Women need 1200 mg of calcium a day. Because the body can only absorb about 600 mg at a time, it can be tricky to get in the required amount every day. That's why it's probably a good idea to take a supplement.
The good thing about calcium supplements is there's no good or bad. We do tell our patients to avoid oyster shell because of the small risk of lead.
Read your label carefully. Many health food stores sell a calcium that requires many pills a day to get in your required amount.
Look at the serving size. Calcium carbonate - like Oscal and Viactive - are one pill per serving. That would get you 600mg.
Calcium citrate, like Citracal, require 2 pills per serving to equal 600mg.
Get a supplement that also has Vitamin D. Take them with meals for better absorption.
Also look at your food labels. Many products have calcium in them. It's not just about milk now. For example, Orange Juice with calcium has 350 mg per 8 oz serving. That's more than milk!
Read the label for the calcium per serving. If it's given in a %, simply drop the % and replace it with a 0. So..OJ with 35% calcium would equal 350 mg. Earth Grains bread with 10% per slice would be 100 mg per slice.
Keep track of what you normally consume in a day, and make up the rest with a supplement.View Thread
Start with the Reclast. Use Prolia only if you get no positive results with Reclast.
The way you'll determine if you've had positive results is not by an increase in T-score, just as a decrease in T-score does not necessarily mean a loss of bone mass.
Two years after you begin the Reclast, have your test repeated at the same place. The technologist doing the test should, according to a specific formula, determine whether any change in your BMD (not T-score) is within the parameters set forth by a precision test done on their equipment. That is the only way you get an accurate reading.
What this means is that the testing center does a precision test on the machine to determine how closely they can replicate a DXA reading. It's quite involved and many places don't do it. It requires taking either 30 patients and putting them on the table for a DXA, taking them off, and immediately repeating this. Or..they can use 15 patients and do a test 3x. The then compute (according to a strict formula) the LSC or Lowest Significant Change for each site (hip and spine). In our center the LSC is .029 and .028. This is basically a margin of error. If your test results fall within this range you are considered stable, and that's good. If they are outside this range, depending on whether greater than these numbers in a positive or negative reading, you are considered to have a "significant" loss or gain.
This is how you can tell if your medication is working. Period.
If the place where you're tested does not have an LSC, go somewhere else because you're not getting a quality test. The harm in this is that you may or may not be taking a medication you may or may not need.
Also remember to consume 1200 mg of calcium each day, taken a few hours apart. We suggest that our patients take one supplement with lunch and one with supper. The body can't process more than 500 mg at a time. You also need to take 1000 IU of Vit D each day. This is what sends the calcium to the bones.
So what are your T-scores? Have you had a fracture? Are you on estrogen? Do you have a family history of hip fracture or osteoporosis?
Reclast is a good drug and is only given once a year. It has been proven to reduce your risk of fracture, which is the goal of all osteo drugs.
Prolia is a different class of drugs and is not to be considered just another choice in the array of osteoporosis medications. It is to be used after all other meds (except Forteo) have been tried with no success.
Just make sure with any medication that you consume 1200 mg of calcium a day - doses separated because your body can't absorb more than 500 mg at a time. Also you need 1000 IU of Vit D to send the calcium to the bones.View Thread
The good news is that you don't have severe osteoporosis. You have osteoporosis. A -2.5 in an otherwise healthy 66 year old with no history of fractures is not alarming. It just means that you have to take steps and interventions so that you don't fracture.
Glad you're doing the Boniva. It does come in injection form should you not tolerate the oral. The acid reflux can interfere with your calcium absorption. Do you take your Caltrate pills with meals and at least 4 hours apart? Don't take both at the same time.
Sounds like you're on the right track. If you don't see improvement at your next scan, don't fret. As long as there's no loss,you're considered stable. And don't let the T-scores fool you. A loss isn't simply having a lower T-score. You can go from a -2.5 to a -2.6 for example and not be experiencing a loss. It's all in the BMD calculations as determined by your testing center's precision test. Ask the tech doing the test what their LSC is. If she looks blankly at you, ask if they've done a precision test and what is the determining number to signify change. If she still doesn't understand or says they don't do a precision study, have your testing done at a place that does.View Thread