Bone “Good Enough” for an Antiresorptive?

How do you know when an Antiresorptive medication is best?  First, the situation needs to be beyond the capability to Take Control Naturally with Calcium Citrate and Vitamin D3 alone.  A dropping Bone Mineral Density (BMD) or a worsening Vertebral Fracture Assessment (VFA) despite adequate Calcium and Vit D3 indicates the need for medication.

Second, the bone needs to be Good Enough that preserving it at current levels will prevent fractures.  Good enough means no Fragility Fractures and no Vertebral Compression Fractures detectable on the VFA by DXA machine or by lateral spine x-ray.

If the bone is Good Enough, you have many options.  Bisphosphonates: Fosamax (Alendronate), Boniva (Ibandronate), Actonel, and now Atelvia, are all pills.  Reclast is given IV and can avoid reflux disease (GERD) and other GI issues.  These all accumulate in bone to control resorption.

Prolia acts to preserve bone in a different way.  Evista also preserves bone, as well as preventing invasive breast cancer.

All of these medications can preserve and protect bone matrix in the right individuals.  However, none has been proven to stimulate new bone matrix formation.  That can only be done by the Anabolic (Forteo).

If the bone has already failed with Fragility Fractures, or with Vertebral Compression Fractures, you probably need the Anabolic. Preserving bone which is already proven to be Not Good Enough to prevent fractures is not good enough for you.

Jay Ginther, MD

Categorised in: Fracture, Medications