|A reader writes: “I am 74 female in general good health. I have taken Fosamax and it’s generic for 13 years and have -4 in spine and advancing ostopenia in hip. My specialist in osteoporosis is recommending Prolia and doing tests first. I’ve never been off Fosamax and wonder if I start Prolia, should I be off Fosamax for a while?”
This raises lots of issues to discuss in GENERAL terms.
If you have been on Fosamax and Alendronate for a total of 13 years and, with a t-score of -4.0, are losing Bone Mineral Density, it is definitely time to re-evaluate. You have worsening osteoporosis, despite what should be adequate therapy. I would draw: CBC, CMP, TSH, 25-hydroxy vitamin D, and PTH to start. I would get a VFA.
I would switch to Calcium Citrate as a supplement if you do not get 1200-1500 mg Calcium in your diet. I would aim for between 40 and 80 for a vitamin D level.
After 13 years of Bisphosphonate therapy, you should have enough medication in your bones to last several years without taking any more. Most docs would stop all Antiresorptives for at least a year. Prolia is also an Antiresorptive, so I would hesitate to switch to Prolia at this time.
If have low Calcium absorption, low vitamin D level, thyroid, parathyroid, or other medical issues, you may be able to Take Control Naturally by correcting those issues. Otherwise, I would consider the Anabolic, Forteo, for failure of Antiresorptive therapy.
### Remember, I cannot make specific recommendations for any individual person without doing a full history, exam, labs, and personally reviewing the DXA and VFA.
Jay Ginther, MD