Osteoporosis - It's a long road to hard, solid bones

If there is ever a good time to take Boniva then this was it. A beautiful Sunday morning in Hilton Head, South Carolina.

A few energetic people out on the beach early,  dogs being exercised and pelicans flying overhead in formation.  

Boniva is a once a month medication to try and improve bone density. It's not that difficult to take - a little difficult to swallow but then you have to stay on your feet for at least an hour. This is to guard against partically digested particles of Boniva coming back up into the esophagus and causing irritation and possibly ulcers.

Walking is a great way to take up the precautionary hour.

News had just come out that Amgen's Prolia ( refered to scientifically as denosumab) has had the next stage of FDA approval. The committee which advises the Food and Drug Administraion voted 15 to zero that denosumab should be approved to treat menopausal women with osteoporosis. The committee voted (12 to 3) against recommending denosumab for treatment of moderately weak bones (osteopenia). 

The big advantage of denosumab is that you get an injection every 6 months. So far I've been taking Bonivia on schedule exactly as recommended but the general experience is that within thefirst year most people stop taking the medication because it's both unpleasant and you have to keep track of when it's time to take the tablet again.

Listen to the video of Professor Stevens talking about the denosumab trial which lead to the FDA committee saying yes. The New England Journal of Medicine paper mentioned in the video is this one.

Nexium and Osteoporosis

I take a Nexium capsule every morning so I'm interested in news about Nexium.

This month's issue of the Mayo Clinic Health Letter has a piece about the increased risk of osteoporosis from taking drugs like Nexium to stop acid reflux. The Mayo Clinic Health Letter come to be through the mail and I don't know whether there is an electronic version available - hence to way to let you click through to read the piece for yourself.

The issue is that to stop acid reflux you either take one of the proton pump inhibitors (like Nexium, Aciphex, Prevacid, Prilosec, Protonix, Zegerid) or take one of the H-2 receptor blockers (like Pepcid, Zantac) but they reduce proper absorbtion of calcium from food. As a result bones become weaker and down the line there is the possibility of a fractured hip.

Not taking Nexium or one of the others is not a good option because you get acid reflux back and left untreated you could eventually be dealing with a cancer in the throat.

The Mayo Clinic answer is to:

• keep taking the pill for acid reflux
• take your calcium supplement in the form of calcium citrate
  
• take the calcium supplement multiple times spread through the day
• increase calcium from food e.g. dairy if dairy is part of your diet, dark green veggies
• make sure you are getting enough Vitamin D (for most people that means supplementing with Vitamin D in Winter and even in Summer if you always go out with sunblock already applied.)