OfflineI have (among other problems) bad pains on both sides of my T8.
Ortho suggested possible fractures in ribs. Bone mapping (the stronstium test) suggested (among other problems) fractures in T8 transvere process.
They say it is a by-product of the prednisone - I am taking for years (against RA, among other meds) - which might cause osteoporosis.
However, my bone density measures rose (because of Fossamax?) from 109% to 111%.
How can this be explain with spinal (or other) fractures caused by osteoporosis?
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
Yona , what does your doc say about the results and how the use of the Fossamax plays into it???
6\2007 MRI...C4-C5 Disc Degeneration..C5-C6 Central disc protusion effacing the ventral aspect of the thecal sac..right foraminal encroachment. C6-C7 Osteophytes.7\2007 ACDF C5-C6 with Titanium Plate and Screws..Donor Bone..Bone Spurs Removed. 11\2007 Diagnosed with Fibromyalgia and RLS. 1\2008 MRI..Scoliosis of the Lower Thoracic. 5\2008-6\2008...Medial Branch Blocks and Ablation.
7\2008..Myelogram..C4-C5 Disc Degeneration with Disc Bulge\Herniation..C6-C7 Broad Based Disc Bulge\Herniation..Tune into tomorrow for the next episode of....
So far I have spoken with GP & Rheumi & ND.
Tomorrow I'm doing a CT to see if I do have T8 fracture. When I get the results - I shall meet an Ortho.
Tomorrow, just before my CT I am seeing a Neuro because of the oains near the T8 ribs and a pain along my left leg which may be sciatica (how do they check this? can CT help diagnose it?).
Prednisone reduces bone density and this could explain osteoporotic fractures.
Osteoporotic fractures can come 'naturally' with aging.
Fossamax enhances Calcium absorbance by the bones and should prevent fractures.
The fact that my bone density is really good and yet there might be spine fracture - is against logic.
My only explanation is: Medicine is more of an art than exact science.
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
Hello there. I can possibly shed a little light on this. i was an osteoporosis specialist selling a bisphosphanate for a major drug company (similar to fosomax called Actonel)....very similar.
Bone density is just a marker and a gauge. It does not always correlate to less fractures. In fact about 5-7 years ago BMD was what everything was gauged on. Now there are many other factors. Bodyweight, smoking and steroids (prednisone) among others.
In fact fosomax did a study that showed at higher doses it built greater BMD's but fractures increased. Think of bone this way....Like a ladder with rungs. If the ladder loses a rung (which in bone is called horizontal struts) then no amount of building of bone will prevent fracture. It would be like adding extra wood to the sides of the ladder, which will increase the volume of the ladder but prevent the rung from breaking.
Fosomax is a bisphosphante which suppresses osteoclastic activity. What happens when a woman is post menopausal the osteoclasts (digger cells) dig deeper holes in the bones and
the osteoblasts (fillers) can not keep up. By suppressing the clasts it allows the fillers to play catch up and maintain homeostasis. Calcium can NOT be taken with fosomax or it will render it uselss. It can be taken the next day as it helps with absorption and also Vitamin D MUST be taken.
Once you are osteopenic you must be on medicine> no amount of calcium can stop this disease. However, bisphosphanates are very effective.
Please look after yourself because studies show once you fracture the likelihood of another subsequent fracture within the 1st year goes up dramatically.
My mother is osteoporotic and has fractured a long time ago> now she is on fosomax/actonel she is doing fine. Also if you feel you are having a backache please get it checked out. Many crush fractures present as back ache for about a week and then it dissipates.
Good luck
Pmazz, your post was very informative, and it sounds like you know much!! Do you have any opinion as to which bisphosphonate works best? I recently switched from Fosamax to Boniva. Do you have any opinion? Thanks for your input---Mazy
I have not sold it in a couple of years when boniva first came out. In terms of clinical data they all have good data.....
Fosomax - has a hip study
Boniva - did not have a hip study and was not inicated at the hip which meant it was just indicated for vertebral fractures
Actonel - was indicated across the skeleton (meaning hip and vertebral)
** however that does not mean boniva does not work at the hip (in fact it may)...it just means it is a newer drug and probably has not done one yet.
*** they are all bisphosphanates and are very very similar
Actonel had a better safety profile in terms of upper GI disorders which bisph. can cause....(that is why you must remain upright for 1/2 an hour)
I think you are in good hands with Boniva......also FYI....Actonel just came out with once a month also.....
I used to be a chemist (not as in the UK were they use this word for a pharmacist).
I can understand part of what you say.
I didn't realise that the bisphosphante is not working evenly in all directions of the bones.
I perfectly understand that once such a fracture comes, the possibility of other fractures is even higher.
I was never told that Calcium can NOT be taken the same day with fosomax but, my intuition said to take Ca only once, in the evening of the day I take the bisphosphante.
I take Ca + Vit D twice a day.
Few months ago they found that I have Vit D defficiency so I am taking extra vit D and I am still under the desired level.
I don't understand much in the physiology of it all (I also don't understand how different painkillers work)
I had high bone density when I started with 1 Ca/day.
Started to take 2 Ca/day when I started to be on Prednisone + Fossamax from the very beginning of the Prednisone taking more than 3 years ago.
And still...
Had CT done yesterday. Will have the results explaining the problem in my D8 in a few days. I had unbearable pains there about a month ago. Bone radioactive mapping gave all sorts off "extra absorbing".
I still feel the pain but it isn't as bad.
They CT'ed yesterday also my L2-L4 in order to find an explanation for my very bad leg pains which are lasting for more than 2 months.
When these started, I thought they were RA pains.
I became aware of spine problems with my neck. Had C6 corpectomy (because of spinal stenosis & osteophytes) 11 months ago.
I am trying to lower the prednisone maybe stop it.
Will it be possible to stop taking the Fossamax?
Is there a connection between all my spine problems?
Any relation between them and my RA?
I am realy full of questions...
Just one more: What did you mean when you wrote "dissipates", the pain or the fracture?
Thanks a lot.
Yona
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
When i said dissipates i meant the pain from the crush fracture...
Once on a bisph. should be on it forever, but with OAM dosing that is not a big problem
Prednisone wreaks havoc on bone density....
You can take Calcium the evening of the fosomax but we used to tell the patient for ease of remembering calcium 6x per week and fosomax once per week
Vitamin D deficiency is a concern. You may need to get a shot of Vitamin D. The reason i say this is that Vitamin D in your body is depleted and no matter how much you take orally you can not catch up. It is like pouring water into a pot with a hole in the bottom in small amounts. It will be lost. To get back to homestasis you must get a large dose. A doctor at the Univ. of Connecticut did a study on that and i can not remember her name. My mother had to have the shot as do many in the northern part of the US.
I tried to sign up as your buddy but did not give me access
Pmazz10,
I had a long reply (because you explain things so nicely) and it was erased!
So Sorry. I'll have to write it all over again. Some other time.
Please try again to sign up as my buddy I did all I can from my side.
Yona
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
Thank you for all of this info! I hope I get enough Vitamin D! I get it with my calcium daily, and I get out in the sun every day. I heard recently that if you wear sunglasses all the time, your body doesn't absorb enough Vitamin D and it can contribute to depression. Don't know if that is true or not. Does anyone know which is REALLY better--calcium carbonate or calcium citrate?? I hear different things about which is absorbed better. Now I am taking calcium carbonate with D. I wish I had paid more attention to this stuff when I was younger!! (unfortunately MORE wisdom does come with age...)Mazy
Mazy-
Stay with the carbonate. It is what is used in all the clinical trials. I can not remember the reasons since i do not sell those drugs anymore but we used to distribute the carbonate for free to patients.
I think the Vitamin D thing is a hoax. Lack of sunlight can contribute to depression......thats why i moved to Florida!!!! LOL.......they did not tell me excess heat does too.....
Living in Israel doesn't help me much with the vitamin D...
Perhaps it's because I cannot stand the heat.
BTW, are fossamax and Actonel interchangable?
We have Teva's generic for Fossamax. Any idea if it is as good as the Merck's original?
Thanks.
Yona
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
They both are excellent drugs. The only difference is that Actonel has a slightly better safety profile for Upper GI symptoms. However, even that is slight.
My mother was on Fosomax and got switched to Actonel so going from one to the other is not a big deal. I would get whichever one is cheaper since they are so similar. Also, i believe Fosomax's patent is up this year and will be generic. I fo not know if that is what you are referring to, but if that is i would go that route if it saves you $$.
The difference now is that Actonel is in Once a Month dosing as is Boniva.
I would not hesitate to take any of them. They are all basically "Me too" drugs. Which means they are modeled after fosomax and molecular altered only slightly.
Also it is a good sign that your BMD is going up. In the US they are designated T-Scores. This is a comparison to the mean of a healthy 30 yr old woman. If you are a -1 then you are now Osteopenic and over a -2.0 is Oseteoporosis. They are given 2 scores one for the spine and 1 for the hip. Just to let you know.
Although BMD is not an end all be all in predicting fractures it is a good sign that it is building, but like i said before you want to build "Good Bone" not just thick bone. Flouride built huge BMD gains and the bone was fragile. Actonel has done a study called McClung that showed improvement of the microarchitecture of the bone improved which is the only drug to have done that study.
I appreciate you answers.
You are a very good teacher take it as a big complement!
I haven't still rewrite my lost post.
Y.
RA - since early 2005
Successful C6 Corpectomy July 2007.
My hands & arms skin - less itchy this is being treated with steroids. I dislike the idea because I am on prednisone & other no-goodies for nearly 4 years.
New pains & findings, summer 2008:
L1-L2 bulging disk
L4-L5 herniated disk pressing the dural sac & nerve root at the interlaminar foramen (this is probably the reason for my sciatic pain)
L5-S1 bulging disk
Preneural foraminal cystic-like structures at both sides of S2.
Also, degenerated D7-D11 vertebraes with osteophytes and changes in the facet joints (this was 10+ on pain scale and it's now 3).
...Medical terms are translated from Hebrew...
Bone density - much HIGHER than the average for my age, inspite of steroids etc.
Once a spiney, always a spiney?
Are spinal problems related to RA?
Osteoporosis is something I have been diagnosed with as well. My dr has me take Fosamax plus D as she felt it was better than just Fosamax. I also take calcium. I think there is a once yearly drug but I am not sure about this. jade
I also sells Actonel. Some of the information that you have been recieving is old and we now know to be inacurate. First, only Fosamax and Actonel have ever been studied in steroid induced osteoporosis. Both are indicated for the treatment of steroid induced osteoporosis, but only Actonel is approved in the US for prevention of steroid induced osteoporosis. Second, hip fractures have been studied with Boniva, in the study used to get Boniva FDA approval, the reduction of nonvertebral fractures with Boniva was similar to placebo and this was consistant across all sites studied including hip (this is taken from the Boniva PI). Third, if your doctor did blood D levels and they were low he will recomend suplimentation. Most likly this will be oral, not a shot, as it is cheaper and easier as well as more available. Only oral is available in the US right now. Fourth, the latest data indicates nearly 25% of patients with a fracture will fracture again within 12 months. According to the American College of Rheumatology Actonel is the only treatment to be shown to work at 12 months. Fosamax took 2 years to reduce fracture. I hope this helps.