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<p>Alendronate is the generic for fosomax, I believe. Where do you get it for $4 a month? I’d love to know…</p>
<p>I think I read some research fairly longtime ago that showed that people who take these drugs have denser bones, but that the rate of hip fracture did not decrease despite the increased bone density. Don’t remember where or when I read that… I menopaused fairly early (47), and have some bone density loss, but I’m reluctant to take anything. Just like I’m not convinced that sunscreen actually prevents skin cancer (I think the research is out on that still)…</p>
<p>A few short statements from someone who treats osteoporosis. I have a DEXA scanner in my office, just upgraded as my last one was > 5 years old. It is a full scanner doing spine and hips. </p>
<p>All meds have a risk/benefit ratio. The risks exist, the benefits are proven. Generally the benefits far outweigh the risks. I see compression fractures of vertebrae and hip fractures frequently. Also I see falls with pelvic, arm, forearm and wrist fractures. I have had patients whose neighbors, sister, friend has had ON of the jaw and have spoken to dentists and oral surgeons who have treated a case. But have never seen a patient who developed it while on treatment. IT IS NOT COMMON. Fractures are real, daily events. ON of the jaw is not. Risks of bisphosphonates (Fosemax/aledronate, Actonel, Bomiva) are low, but exist. If one gets GI irritation STOP THE MEDS AND CALL YOUR DOCTOR. Esophagitis, Barrett’s Esophagus, ulcers happen more when patients continue meds despite some bothersome stomach symptoms. The weekly is better than daily for this. The monthly even better than weekly. It is not as likely the dose but the frequency of dosing, so less often is better. The newer option is Reclast: a once a year infusion (or once every 3 mos Boniva infusion but who wants to go every three months when you can go once a year.) There are NO GI effects from an infusion that does not pass through the esophagus/stomach etc.</p>
<p>Osteonecrosis (ON) of the jaw is VERY UNCOMMON. So are sheer fractures of the femur. They seem to be related to the lack of bone turnover that happens with long term use. Low bone turnover IS GOOD for osteoporosis, but can contribute to other problems. New recommendations are for the use of a bisphosphonate for 5-7 years max, then off for 2-3 years or as long as BMD stable, then if BMD drops, back on for 2-3 years then off for 2-3. This allows for return of bone turnover, but on/off/on keeps from getting to actual bone loss again. </p>
<p>If you drive, your risks are greater driving than they are of ON of the jaw on a bisphosphate. Me, I still drive. It is a risk benefit ratio, and my benefit (quality of life) outweighs my risk of injury or death driving. We take risks every day, rather large ones, in fact.</p>
<p>Evista is an option, especially if the loss is more spine than hip. It is a SERM( selective estrogen receptor modulator) not a bisphosphonate. It is not a hormone. No risk of ON. Reduces the risk of estrogen sensitive breast cancers ( it makes the bones THINK you are on estrogen, but it actually blocks the effect of any estrogen in breasts.) Some women get hot flashes.</p>
<p>Forteo is parathyroid hormone. It is a daily injection. Med comes in a pen like syringe and is easy to self administer, kinda like insulin. It is used for 18-24 mos max. It is very expensive and usually used for severe cases or failure of other meds or for side effects to other meds.</p>
<p>IF YOU CHOOSE NOT TO TAKE PRESCRIPTION MEDS, get your vit D3 level checked, and maximize your supplementation, especially if you are deficient. Maximize your Calcium, and if Calcium Carbonate constipates you or otherwise bothers you, use Calcium Citrate. If it still bothers you, start it one twice a week. After a few weeks go to three times a week. Then daily. Finally slowly try twice a day. If your bones are really thin, slowly work up to three times a day. With meals. If you go up slowly you really can tolerate calcium. If you can’t tolerate prescription meds, take the time to go up slowly and MAXIMIZE your calcium. This is true for those on meds and off.</p>
<p>Finally, there is an isoflavone from soy-GENESTEIN that has clinical data showing it can increase bone density. It works on estrogen receptors, but does not have estrogen activity. It seems to act like a SERM. It is available by prescription (Fosteum) but can be found OTC. It used to be you had to search for it at the health food store. But now you can find it at the drug store. And Citracal and Oscal are putting it in calcium and selling it as Caltrate Bone Builder, or Oscal Bone Builder. IT IS A GREAT ALTERNATIVE for those who don’t tolerate prescriptions or who don’t want to take them. Dosing is 30 mg twice a day.</p>
<p>VIT D should be at 1000-2000 units a day UNLESS YOUR DOCTOR SAYS MORE.
Calcisum should be at 1500-1800mg a day UNLESS YOUR DOCTOR SAYS MORE.
Genestein should be 30 mg twice a day UNLESS YOUR DOCTOR SAYS MORE.
You can take Ca with D, and even Ca with D with Genestein and minimize the number of pills you taks. </p>
<p>Exercise. Weight bearing (NOT weight lifting/using weights) as in exercising while bearing your own weight (ie exercise in water/pool or lying on the floor are not going to help) is best. Walking is great. Running can be too hard on the joints. Stepping, yoga, pilates, and othe classes good but still walk. Move your whole body and use all your muscles for prevention or treatment of osteoporosis. The more a muscle pulls on bone, the better. But it needs to be generalized, not working individual “parts” with weights. Water exercise may work if you take a class while wearing a water weight belt. And swimming lots of laps will get alot of muscles groups going. But you have to swim longer distances for it to be as effective as walking.</p>
<p>Sunnyflorida, thank you SO much for that summary of treatments and risks. Now why couldn’t my Dr. have said that upon my osteopenia diagnosis, rather than mumbling about maybe a biophosphenate perhaps not being necessary yet? Will go out and look for the genestein tomorrow, as I’m doing the Vit D, the calcium, the walking. </p>
<p>One more question, how does nasal calcitonin fit into the above range of treatment options?</p>
<p>Where do you get Alendronate for $4 a MONTH???</p>
<p>[Kroger</a> - Pharmacy - $4/$10 Generic](<a href=“http://www.kroger.com/generic/Pages/womens_health.aspx]Kroger”>http://www.kroger.com/generic/Pages/womens_health.aspx)
ALENDRONATE SOD TAB 35MG FOSAMAX TAB 35MG 4 - $9 16 - $24
ALENDRONATE SOD TAB 70MG FOSAMAX TAB 70MG 4 - $9 16 - $24</p>
<p>Thank you, sunnyflorida!</p>
<p>Walmart has a whole host of generics for $4 a month and $10 for 90 day supply. I cannot verify that aledronate is on the list but it just might be. Target has a smaller list of $4 meds.</p>
<p>Nasal calcitonin is not effective AT ALL on hip or nonvertebral bones. If you have spine thinning, hips are good, and you can’t tolerate bisphosphonates, and your number’s are not that bad, Miacalcin and Fortical are OK. They just don’t work all that well, and have sort of fallen by the wayside. It is still an option, but the benefits are not that great. It’s better than nothing when spine is a big issue but hips are good.</p>
<p>Alendronate cannot be on the $4 list because the wholesale price of a one month supply is a little less than $4. Some companies do sell if for $9 per month, but even with that price, you are still losing money.</p>
<p>After three broken bones (for no good reason) in four years, I was given an bone density exam. I have been on alendronate for over 10 years, and no problems since. My nurse friends will not take it though, and have tried to talk me into stopping. I had a grandmother with a broken hip (she had premature white hair, as do I, which is a risk factor for osteoporosis), and that was the beginning of the end. My prescribing physician does a lot of research on everything he prescribes and continues, so I trust him.</p>
<p>Early graying is a risk factor for osteoporosis? I’ve been going gray since I was 22 (now 53) and that’s the first I’ve heard of it. Can you document please?</p>
<p>I have seen this a couple of places. In my own family, I have a male cousin with the same prematurely white hair, and he had an unexplainable broken bone in his foot. The grandmother broke a hip; I have had the various broken bones; my dad had the hair, but he was very heavyset, did not break any bones. </p>
<p>I googled this and found:</p>
<p>[Diagnose-Me:</a> Condition: Premature Hair Graying](<a href=“http://www.diagnose-me.com/cond/C574183.html]Diagnose-Me:”>Premature Hair Graying - Symptoms, Diagnosis and Treatment)</p>
<p>[Premature</a> graying of hair is a risk marker for osteopenia – Rosen et al. 79 (3): 854 – Journal of Clinical Endocrinology & Metabolism](<a href=“http://jcem.endojournals.org/cgi/content/abstract/79/3/854]Premature”>http://jcem.endojournals.org/cgi/content/abstract/79/3/854)</p>
<p>Ask your doctor.</p>
<p>^^^ Huh. Who knew.</p>
<p>sunnyflorida, a question: You said weight-bearing exercise is the best, and I do that and it’s helped, but it was my understanding that what I refer to as “lifting heavy things over my head” (ie, weight lifting) is extremely useful as well. This is what I’ve read in several books on preventing/reversing osteoporosis.</p>
<p>Thanks, very helpful. I will discuss this with my doctor.</p>
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<p>Alendronate is NOT on the list at either Target OR Walmart. AND there isn’t a Kroger within states of where I live. Maybe it will get added to the generic list for Target or Walmart…I keep checking…but it’s NOT there.</p>
<p>I was warned about possible bad reactions on Fosamax but never had any difficulties. After 2+ years, my densities had gone back up enough that my doctor took me off it. I do take a lot of Calcium and D though.</p>
<p>I had a bone density scan a few months ago because my gastroenterologist was concerned about the possible adverse effects of one of the medications I’ve been taking for Crohn’s Disease for a number of years (it’s not prednisone, but is a type of corticosteroid called Entocort). As it turns out, I do have a rather pronounced degree of osteopenia, probably as a side effect of that medication (since I don’t think it’s that typical to have osteopenia at 54). But all the doctor told me was to take Caltrate with Vitamin D; he didn’t suggest anything else. Certainly I don’t want to progress to osteoporosis or to shrink when I get older – I"m only 5’ 2" as it is! So, hopefully, the Caltrate will do the job. Because Entocort is one of the few medications I’ve taken in the last 30 years that’s actually helped me and allowed me to go into remission for the time being. I’m not stopping it if I can help it.</p>
<p>^^ It is actually not uncommon to have some osteopenia at 54. There was an article in the WSJ (I think) a few months ago that really questioned all the hysteria over bone degradation- especially the “osteopenia” label. Yes, you need to watch it and take some measures if necessary, but the bottom line is that we DO lose bone density and a lot of times the medication is not warranted.</p>
<p>Sunnyflorida, I began taking Citracal Bone Density Builder about a month ago, when I first found it at the drug store. Is this the combination you recommend? <a href=“http://citracal.com/Product/Plus_BDB.aspx[/url]”>http://citracal.com/Product/Plus_BDB.aspx</a></p>
<p>Thanks, MOWC. I feel a little relieved. My doctor did think that given the level of the ostopenia, it probably is caused or at least exacerbated by the medication I’ve been taking. But there’s nothing I can do about that. As I said, I’m hoping that the Caltrate will at least prevent it from progressing any further.</p>