I've been on Prolia for about 5 years. I was told by a Naturopathic doctor that the longer a person is on Prolia, the more likely you will get a fracture in thigh bone that can be devastating. I'm not sure who to listen to. She also said you should take a Prolia holiday for an extended period of time, so the bones don't turn to be porcelain-like. She based this on the latest studies on Prolia. Any thoughts?
My brother who is a dental surgeon just emailed me the following information on osteoporosis drugs in response to questions I have about Prolia.
"The two types of drugs used for osteoporosis are the bisphosphonates (fosamax) and monoclonal antibody (prolia). Both affect the osteoclasts that resorb bone so in theory tipping the balance in favor of the osteoblasts that form bone. The bisphosphonates are accumulated in bone, and act like a “poison” to the mature active osteoclasts when they start to resorb that bone. The effect is cumulative and permanent. Once it’s in bone, it can’t go away unless that bone is resorbed- but it can’t be resorbed because the osteoclasts are inactivated as soon as they hit it. Osteoclasts communicate with osteoblasts in normal bone turnover so it may be that new bone formation is affected too, which may be related to the brittleness after time? The observation is that the jaw bone becomes avascular and less able to heal following injury, and can even become necrotic spontaneously. The longer it’s taken, the more it accumulates and the higher the risk. It’s recommended to stop the drug 9 months before doing oral surgery. But problems don’t really start until 2.5 years of oral medication.
Prolia doesn’t accumulate like the bisphosphonates. It acts on osteoclasts at various stages (inhibiting maturation, decreasing activity of mature ones etc). It’s recommended to wait 3 months after stopping to do oral surgery. Problems don’t really start until after 3rd dose (so 1.5 years).
With either drug at osteoporosis levels, the risk of a jaw problem is fairly low (as long as fosamax is not taken for more than 4 years). In your case, the risk is even lower as you have a relatively healthy mouth. It can occur spontaneously but it’s more likely to start after a tooth extraction, or in a smoker.
IV bisphosphonates or MABs which are given during certain cancer treatments are at much higher dose and are much more risky than the medications at osteoporosis doses.
I think fosamax was the main culprit in femur fractures, partly due the excessively long time some woman were taking before they realized that it builds up. I don’t really know if prolia does something similar but my sense is that the osteoporosis fracture risk is higher than the medication induced fracture is. And I certainly think that you don’t need to include jaw bone risk from taking prolia in the first year and a half. After that, if you’re doctor did want to keep it going, then that risk should be included in the decision.
I asked my doctor (who does "functional" medicine which is traditional + alternative), another doctor friend, and my physical therapist about the side effect of increased risk of thigh bone fracture when taking any of the osteoporosis drugs for longer than recommended tx time (Fosamax, Prolia, infusions, etc). They all said that if you have osteoporosis (not osteopenia) the risk of fracture is far far greater if you DON'T take any medication than if you take medication. Serious side effects are rare and usually associated with other risk factors - advanced age, mobility issues, taking other meds, other illnesses (cancer), etc. Plus fractures are so common with osteoporosis that they account for some of the rare "side-effect" fractures, especially with older women who have other risk factors. My doc says it is hard to separate out the fact that often much older women start these drugs after their osteoporosis is well advanced or they've already suffered a fracture and they are the ones who are more likely to have a serious side effect. This is why she wants me to take it now...to build up bone while my osteoporosis is still mild and I am healthy and able to benefit from an effective maintenance regime during and after treatment (diet, supplements, strength training, etc.). I have been told by my docs (and will verify with an endocrinologist) that bone built with these drugs is no different than normal bone. The idea that bone built while on these drugs is different is an ongoing theme (myth?) on the internet. I have read about this and it scared me so I want verification. So much to learn!!!
I've heard that Prolia works differently than the older Fosomax type drugs where you have to take a drug holiday. Have your dexa scores gone up? If so, then you may be able to stop and see if you can maintain bone density with supplements, diet and exercise. Prolia does not stay long in the body so if your bone density goes down again then you have to take another kind of med. The reason Prolia is only taken for so long is because it is so new they aren't sure of the longterm effects...much like they weren't sure about the Fosomax type drugs when they first came out.
Thank you, CVD. That reply was helpful. Since I’m in the older patient group, I feel more inclined to try the natural approach for now. The PA bone specialist at the doc caring for my arm fx did not really reassure me when I said I don’t want to jump on the prescription drug merry-go-round, because she said I’d be on an OP drug the rest of my life. Although, I’m trying to keep an open mind, I want to see if I CAN help my bone health on my own.
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