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    Osteoprosis and gastric bypass
    avatar
    pammaley posted:
    Does anyone know how osteo meds affect people who have had gastric bypass. My drug has so many instructions and I can't find any reference to gastric patients. Phyllis
    Reply
     
    avatar
    bonebabe responded:
    Absorption is a concern with the osteo meds whether you've had gastric bypass or not. That's why you have to take the oral ones on an empty stomach with only a glass of water and remain upright. This gives your body the best chance of absorbing the med, and even then you don't get 100%.

    If I were you, I'd talk to my doctor about Reclast, the annual injection. It bypasses the gut, and in your case, might be the best choice.
     
    avatar
    MarciaNana responded:
    I had gastric bypass surgery 8 years ago and have since taken Fosamax and Boniva and have not had any stomach trouble with them. I also had a Reclast IV. I decided to go with the oral medications though because the Reclast made me really sick.

    My dexa scan results have improved since I started the osteo drugs, so something must be working.

    Good luck!
     
    avatar
    NATIONAL OSTEOPOROSIS FOUNDATION
    Susan Randall, RN, FNP-BC, MSN responded:
    Here's some information NOF has published for healthcare professionals about bisphosphonate use in bariatric surgery patients. For the complete article visit http://www.nof.org/node/453 . If you've had bariatric surgery, you may want to share this information with your doctor.

    "When osteoporosis is suspected in a bariatric surgery patient, secondary disease should be suspected first, and if present, should become the focus of treatment interventions. The etiology of the clinical presentation and biochemical indices such as vitamin D deficiency, hypocalcemia, elevated alkaline phosphatase, and secondary hyperparathyroidism should be clearly defined and appropriate treatment interventions initiated. Abnormal DXA may in fact be indicative of both primary and secondary disease however, aggressive treatment of the underlying cause of the secondary disease can result in significant improvements in BMD[34>. The addition of a bisphosphonate to the treatment regimen should only be considered after clinical and biochemical resolution of secondary metabolic bone disease (MBD).

    Bisphosphonates inhibit bone resorption, slow calcium efflux from the skeleton and cause a compensatory rise in PTH. Administered in the presence of vitamin D deficiency such as that seen in our patient, normal serum calcium cannot be maintained despite dramatic increases in serum PTH, and life-threatening hypocalcemia can result[35-37>. Therefore, caution is advised when considering the use of oral bisphosphonates in this population due to the high prevalence of vitamin D deficiency and subclinical osteomalacia.

    Oral bisphosphonate use in bariatric surgery patients should also be approached cautiously due to the lack of safety and efficacy data. Specifically, tolerance has not been established in the surgical gut, and risk of ulceration at surgical anastamosis has not been defined. Efficacy of oral bisphosphonates has also come into question following bariatric bypass procedures due to the high likelihood that the drug may not be adequately absorbed. It is for these reasons that if treatment for primary osteoporosis is indicated in a bariatric surgery patient, there should be no clinical or biochemical evidence of secondary bone disease, the patient should be taking daily calcium and vitamin D supplements, and intravenous bisphosphonates should be considered."
     
    avatar
    pammaley replied to Susan Randall, RN, FNP-BC, MSN's response:
    Sorry this is so late in coming. Thank you for your help. I am taking your message to my doctor.


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