• 6 months ago

    Declining bone density while on Reclast

    Age 79 female of Norwegian descent. BMI 24.2. Mother with hip fracture in her 80s. DXA indicates osteoporosis is worsening despite treatment with Fosamax and then Reclast (2018, 2017, 2010, & 2009. I am scheduled for another infusion in March of this year. Report from DXA scan in September 2018 concludes my 10-year fracture risk is 51% for major osteoporotic fracture and 39% for hip fracture. The previous scan in 2016 was 48% and 36%. Daily intake: calcium citrate (1260 mg) and vitamin D 2000 IU (blood level in July 2018 was 54). I cut down from 20 mg to 10 mg of omeprazole daily a year before the 2018 DXA. In 2004-5, I took prednisone (starting at 80 mg) for 18 months for polymyalgia rheumatica. Also took prednisone for some time in the late 1980s for tendinitis. In addition, I was on a small dose of Accutane for at least a year during the 1990s for acne rosacea. I did not do any regular exercise/walking. Despite a torn meniscus, I have recently started walking 1 mile 4 times a week and have joined the YMCA where I am in PT for the knee and back pain (arthritis and stenosis), as well as balance and fall prevention including Silver Sneakers Tai Chi and Yoga. My rheumatologist wants me to have Reclast for 2 more years and then switch to something else (assume Prolia, though I don’t like the side effects I read about, especially increase in cholesterol since I already take a statin and have a lipoprotein-a score of 84). A 2009 article on webMD entitled “Do Bone Tests Help Monitor Ostoeporosis? Study Shows Bone Density Tests May Be Misleading for Patients Getting Bisphosphonates” by Salynn Boyles, states: “Even if the test were completely accurate, bone mineral density testing is not a particularly good measure of fracture risk, says Juliet Compston, MD, University of Oxford professor of bone medicine.”
    Another article reviewed in July 2018 on webMD entitled “Monitoring Osteoporosis Therapy: The controversy of bone density testing in patients already taking osteoporosis medication” makes me wonder if my worsening fracture scores are an accurate indication of fracture risk. At what point can a person stop treatment, and how concerned should I be? My primary care physician is very concerned.
    Thank you!