Men's Osteoporosis Support GroupUpdate on my DXA results as of December 2007 I last reported my bone mineral density (BMD) information in an Update in April 2004. At that time I noted, "My L1-L4 spine T-score is now -0.48 and my left femoral neck T-score is -0.77. The previous scores from the test done 4/27/2001 were -0.76 and -1.31 for the spine and hip, respectively. Thus, my hip and spinal BMD are back in the normal range." Shortly before posting these results I had begun a maintenance dose of Fosamax at one-half the normal dosage: 35 mg Fosmax (alendronate) once weekly rather than the normal 70 mg once-weekly dose. This is not an approved or recommended maintenance dose. In fact, I'm unaware of any official or recommended maintenance dose for individuals who reach normal bone density other than the standard dose of any of the FDA-approved osteoporosis medications. But I felt I would be monitoring my BMD closely and wanted to see if it would maintain the current level on the reduced Fosamax dose. I have had two DXA scans since starting the 35-mg/week Fosamax. I will show the results below, including my starting BMD in 1995 shortly after I was diagnosed with osteoporosis.
At this point, about three years after reaching normal BMD levels for the left hip neck and the spine, there appears to be no loss of BMD with the reduced Fosamax dosage. I will also state that I have been on omeprezole, a proton pump inhibitor (PPI), to reduce stomach acid for almost two years, too. A recent Update discussed a study which found increased fracture rates on individuals using PPIs. This was not a clinical trial involving individuals taking approved osteoporosis medications, nor did it even test if vitamin D and/or calcium supplements might have affected the results. So we don't know if those of us being treated for osteoporosis are at increased fracture risk when taking PPIs, more studies are needed. What we do know from this study is that for individuals not taking an approved osteoporosis medication there is an increased fracture risk when taking PPIs, and the risk increases with the length of time and the increased dosage of the PPI. I may be testing the conclusions of this study because just yesterday my physician doubled the dose of my PPI for at least the next three months. This is a real difficult situation because failure to control the acid reflux can lead to very serious esophageal cancer. At this point it is uncertain if the higher dose PPI will increase the risk of osteoporosis. So I will have to go with the high-dose PPI for now and hope I can reduce the dosage eventually. Hopefully some good clinical trials will be forthcoming regarding taking PPIs while also taking an approved osteoporosis medication. Perhaps the osteoporosis medications cancel out the negative effects of the PPIs regarding BMD and fracture risk. Here is a summary of my treatment for osteoporosis. I was diagnosed in late 1994 at age 50 and started testosterone injections then--the only therapy available. In 1996 Fosamax was approved and I started the 10-mg/day regimen which was changed to 70-mg/week when that was approved. I have switched to 5-mg/day Androderm testosterone patches for the last few years and find that much better than the injections. I also take at least one Rolaids daily for both stomach acid reduction and calcium supplementation along with 800 I.U. of vitamin D. At this point that regimen has brought my BMD back into the normal range and I hope to keep it there permanently.
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