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    Reclast vs. Prolia
    cjyap posted:
    I have been taking Osteoporosis medicines for several years, and have never had any side effects. I started with Evista, and quickly was changed to Fosamax, probably due to menopause? I took Fosamax for several years, and didn't see much change in my numbers. I have misplaced my scores, but the levels were: severe osteopenia in the wrist and spine area and Osteoporsis in the hip) . Apparently I was absorbing fosamax even less efficiently expected. My doctor recommended Reclast 2 years ago. I read everything I could about it, and was very, very nervous about taking it. The side effect were frightening, especially the necrosis of the jaw, as my teeth aren't great.
    Happily I had absolutely no side effects at all from the Reclast and have had two infusions. My doctor recommended taking extra calcium a few days prior and after the treatment, maybe that's the trick. At my last visit, he mentioned that in his opinion Prolia offers all the benefits of Reclast, minus the necrosis of the jaw issue. Reading the material on it isn't very reassuring. I could use some advice: Continue with the Reclast, after all I know I don't have any side effects see what next year's bone scan says, and then maybe switch to Prolia (the necrosis does worry me) or switch to Prolia, and hope it's side effects don't effect me, but have less worry about the jaw issue.
    I'm 51, 5'2", 105 lbs, exercise daily, postmenopausal for at least 5 years, in good health, and (knock on wood) no tooth extractions pending.
    Thank you
    bonebabe responded:
    First off, just to clarify - you have osteoporosis. The diagnosis is given based on the lowest site. Forget about the ostopenia (FYI - there is no such thing as severe osteopenia.) Now, how best to treat your osteoporosis.

    If the Reclast is working for you, and that is determined either by an increase in your T-scores or having them remain stable, I'd stick with it. Don't obsess over the jaw necrosis. It's numbers are few and far between.

    The goal is for your T-scores not to decrease significantly (determined by your testing center's precision study) but to remain in the margin of error, maybe even increasing.

    The Prolia is a drug that is to be given ONLY when all other medication choices have failed. It is not just another choice. It should be given very judiciously.

    If you're doing fine with the Reclast, have not had any fractures or unbearable side effects - why change?
    cjyap replied to bonebabe's response:
    Thanks that was my gut impression, but the Doctor told me of this alternative, and asked me if I wanted to consider it.
    adelante03 replied to bonebabe's response:
    In your opinion, is Reclast safer than Prolia?
    bonebabe replied to adelante03's response:
    Comparing apples to oranges. Two different kinds of meds. All medications have side effects on some people. I can tell you though, that our medical director who is an osteoporosis expert and on the board of the ISCD, says that Prolia should only be used when all other osteo meds have been tried. It is not an equal option - just like Forteo is not an equal option.
    undefined responded:
    The literature I downloaded earlier this week (6-17-14) lists the jaw issue for both.
    bonebabe replied to 34338988's response:
    Yes, they have too even if there's only one case of necrosis. As with every medication. Tylenol lists liver damage. Antidepressants list death. Prednisone lists heart attack. But the vast majority of people never experience these side effects,yet they're listed. I can tell you that to date - the ONLY DOCUMENTED cases of bisphosphonate related necrosis have been with nursing home patients who had cancer, were bed ridden and on IV bisphosphonates. There's a lot of press and fear about jaw necrosis, but not much verified.
    stickywicket replied to bonebabe's response:
    bonebabe, I take it you are in the medical field? I've was on Prednisone for 1.5 years for Polymyalgia. Started at 20, and as soon as I was weaned off, came down with Giant Cell Arteritis and was up to 60 mg. now down to 15 mg. Will reduce to 10 if all goes well, the reduction will be just 1 mg. a month. I Have osteoporosis of the spine and had a fracture about a month ago. Dr. wants me on OP meds and I'm afraid to combine that with Prednisone. I can't find any information about the combination. Prednisone not only contributes to osteoporosis, but destroys the immune system as do the OP meds. I also have been on thyroid meds for years which also contributes to op. Had hypothyroid, treated with radioactive iodine to lower it and now on Synthroid..
    bonebabe replied to stickywicket's response:
    Being on prednisone and having had a compression fracture puts you at an extremely high risk of having another fracture. You certainly need to be on an osteoporosis medication.

    ALL of our patients (and we see about 4000/year) who are on prednisone and/or who have had a compression fracture are advised to go on a medication. No exceptions. Our medical director is a rheumatologist and puts all of her high risk patients on a med. to reduce their risk of fracture.

    The synthroid is not as big a player in this as is the prednisone. I wouldn't worry about the thryoid at this point. Did you know that having one osteoporosis fracture doubles your risk of having another? Did you know that half of all people who have a hip fracture will die of complications of that fracture within one year? That is certainly something you want to avoid if you can. A medicine will increase your odds of staying fracture free.

    You say you have osteoporosis of the spine. We don't differentiate within the bones. You have osteoporosis. Even if your T-scores were in the normal or osteopenic range, the presence of a hip or vertebral fracture gives you a clinical diagnosis of osteoporosis.

    Depending on your T-score and other risk factors, your doctor should talk with you about your selection of medication. Might be forteo if your numbers are very low. That's the only medication that actually grows new bone. The others strengthen what you have.

    Whatever you choose, make sure you're getting 1200 mg of calcium a day combined with 1000 IU of Vit D. Without these, your medicine isn't as effective.

    Avoid forward bending and twisting of the spine. Also no jogging or anything else that pounds the spine. These movements can cause tiny bones within your vertebrae to fracture, leading to another compression fracture.

    You have a lot going on. Don't make it worse by avoiding an osteoporosis medication based on fear or "what if's."
    roszella replied to bonebabe's response:
    After two Reclast infusions with no side effects, my dexa showed a modest increase in bone mass. Then my primary doc switched me to Prolia stating it's more effective, more convenient since it would only be two injections a year as opposed to a yearly infusion which I really didn't mind. When I asked the doc at the clinic who gives the injections, she told me all of the above reasons plus that Reclast was being phased out anyway. I don't remember any side effects after the 1st Prolia, but after the 2nd injection my health seems to be falling apart. I have pre-existing conditions that cause chronic upper body pain but from the waist down I had no complaints for a 70 yr old. That changed a week after the 2nd Prolia injection. I had a sudden onset of total body muscle pain and weakness plus joint pain. Lab work pre-injection showed my PTH level to be 120 so she referred me to an endocrinologist but gave me the Prolia injection anyway. I had to wait 2 months to see the endocrinologist who then had my PTH level retested. During that 2 month wait my PTH had dropped to 86 which is still high, and she diagnosed secondary hyperparathyroidism but with no explanation as to what it was secondary to. She ordered PTH level to be rechecked in 3 months. Now it's time for a 3rd Prolia injection. During all of this waiting, I've been reading on my own. Tonight on an NIH site I read an article that clearly states Prolia raises PTH levels. I've also read what damage the high PTH does over time, and also that Reclast is still alive and well. All of my problems could be unrelated and I'm just being paranoid over conflicting info, but I'm afraid of, and am going to refuse, a 3rd Prolia injection. Primary doc is not going to like this, but he's not the one enduring the pain, weakness, and just feeling generally crappy since 2nd Prolia. Now I'm being referred to a cardiologist since BP started to go crazy also. I feel like I'm being Prolia'd to death. Any thoughts on the Prolia/parathyroid connection?
    bonebabe replied to roszella's response:
    Our medical director does not put her patients on Prolia unless all other medications have been tried with no success. She firmly states that it is not just another option as an osteoporosis med.

    Specifically, I don't know about the PTH connection. We really don't have many patients on Prolia. Maybe a handful.

    The Reclast is a good drug. It is not being phased out, at least to my knowledge. My mother just had her injection last month.

    If your T-score hasn't fallen more than the margin of error, you are considered stable - and that's a good thing. It sounds like it was working just fine for you. Like you, I'm more than a little suspicious as to the reason for the change.

    If you don't want to continue the Prolia, you have every right to refuse it. The doctor shouldn't get angry, even if he had a good reason to suggest the change. Ask him why he changed you if the Reclast was working. Ask him about your findings regarding the PTH.

    Being hyperparathyroid is a big osteoporosis risk in itself. It's something you should pay attention to. Like you, I'm curious as to yours being secondary to what? If you never had it before and have it now.....what's up with that?

    If you were satisfied with the Reclast and your numbers were stable, tell your doctor that's what you want to do. Not Prolia. Even if the Prolia isn't the cause of your new symptoms, you would forever be connecting them in your mind and that would cause you angst that you don't need.

    Just be sure to take the 1200 mg of calcium each day so that whatever medication you take has something to work with. Without calcium, they just aren't effective.
    roszella replied to bonebabe's response:
    I'm so happy I stumbled upon this community and thank you for your reply. Your next to the last paragraph is so true for me. Right or wrong, I would be making a connection. Your reply has given me a little back bone (bad pun intended) to stand firm when I tell my doc I want to go back to Reclast, and I will certainly tell him about the Prolia/PTH study which was posted on a .gov website. I also need to give him a nudge that I'm past due for a bone scan, and as of last night from reading one of your previous posts, I'm bumping my Vit D from 500 IU to a1000. Thanks for sharing your knowledge.
    edgeview replied to bonebabe's response:
    I have read your posts here with interest. I have a new primary care doc because the one I've seen since the 1980's recently retired. He ordered a DEXA scan because I hadn't had one in about 5 or 6 years. I don't recall the details of that first scan other than being told it was "excellent" and I had no signs of osteoporosis - back then.

    This time my T-scores ranged from -1.1 to -3.2 and my new doctor told me my bones were "mush." He recommended Prolia over the other more "well known" medications, he said, because it builds bone while the others only prevent further bone loss.

    I just had the DEXA scan and my visit with him today, so I haven't had much chance to read a lot about it. I did one search to track its history with FDA, then a "reclast vs prolia" search and found your posts here. I am really interested to understand why your medical director feels so strongly about using Prolia only as a last resort, especially since it was this doctor's first choice.

    It might be helpful to note that I have Hashimoto's disease and my new doctor is concerned that my armour thyroid dose is too high. He is friendly with the doctor who is treating the Hashimoto's but he has "philosophical" differences with how he evaluates and treats thyroid disease, in general. I'm becoming concerned that the dose might be too high too, in light of fact that my first DEXA scan was before my thyroid disease was diagnosed. In other words, I started the armour thyroid medication after that first DEXA scan.

    That is all by way of background. I understand that Prolia uses monoclonal antibodies, so it works by an entirely different mechanism compared to Proclast and other medications. I am still reading more about that, but I am most curious to understand why your medical director would only recommend it when all else fails. That sounds frightening in contrast to the little bit I've read (which is probably promotional) that makes it sound like such an effective new approach.

    Thanks for any light you can shed on this!
    bonebabe replied to edgeview's response:

    How old are you? Have you had a fracture? Height? Weight? Other than the synthroid, are you on any other long term medications?

    The Prolia may be more than you need. If you have an infection that amoxycillan will cure, why take Vancomycin? If you have a cut that will clot with only a Band-Aid, why stitch it?

    Prolia may be the right choice for you because it may very well be that your thyroid med is too high and is draining your bone mass. But it might not.

    While the -3.2 is pretty low, the number in itself doesn't tell the whole story. It's merely a means of measurement for change. If you're young (younger than 70 or so) and haven't had a fracture and are not on any long term risky medications, you could possibly do fine with one of the bisphosphonates.

    Prolia is a fairly new drug that is being heavily promoted by the sales reps. I'm not sure primary care doctors who don't have a specific interest in osteoporosis are real clear on when it's appropriate to use and they bow to their time constraints and the drug company's PR.

    For sure you need something. The question is what? I'd get another opinion on the thyroid too.

    Whatever you decide, you'll need 1200 mg of calcium a day (spread throughout the day) and 1000 IU of Vit D in order for your medication to work properly.
    olavia replied to bonebabe's response:
    I had my first DEXA at age 50 and am now 64 and have been watching the T-scores decline over the years even while taking Fosamax faithfully for over 10 years. For the past 2 years I switched to Evista but the scores still declined in my spine although the hips seem to have stabilized. I take 1200 mg calcium and 5000 Vit D a day. My thyroid is normal. I've had no fractures. Now I've been referred to a specialist for possible yearly Reclast infusions. My sister also has osteoporosis and has seen significant improvement in her T-scores on Prolia injections after 3 injections with no side effects. Reclast is just another form of biophosphonate — so I'm thinking that since Fosamax was ineffective , I should try Prolia which is the denosumab class. I've been reviewing info for both drugs and am trying to make a decision before my appointment with the specialist. Am I on the right track with my analysis?

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