Is Alendronate no longer effective for my osteoporosis?

Question

Hi doctor,

I am writing regarding my osteoporosis, which appears to be worsening despite having taken Alendronate for the past two years. Last month, I fractured my wrist simply by catching myself during a stumble; it was not even a full fall. My orthopedist informed me that my bone density has decreased by another 4% since last year’s scan. My current T-score is -3.7 in the spine and -3.2 in the hip.

Additionally, my height has decreased by almost two inches over the past three years, and I have noticed a forward curvature in my posture that I am unable to correct. I frequently experience sharp pains in my mid-back, particularly when bending or lifting anything heavier than a gallon of milk.

Recent lab results showed that my calcium level is slightly low at 8.2 mg/dL, and my vitamin D level is only 18 ng/mL, despite daily supplementation. The doctor also mentioned that my parathyroid hormone levels are elevated, but did not fully explain the implications of this finding.

I attempted to follow a regimen of weight-bearing exercises as recommended by my physical therapist, but unfortunately, I sustained a small fracture in my foot as a result. This has made me increasingly fearful, even of walking on icy sidewalks.

My mother also had osteoporosis and became bedridden after a hip fracture at the age of 72. I am only 63 and deeply afraid of facing a similar fate.

I am concerned that Alendronate may not be effective in my case. Could medications such as Prolia (Denosumab) or Forteo (Teriparatide) be more suitable options? I understand there are risks associated with these treatments as well, but continuing with a medication that may not be working seems equally dangerous.

Thank you for your time and support.

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am sorry to hear about your ongoing challenges with osteoporosis. Based on the information you have shared, here are several important points to consider:

1. Effectiveness of Alendronate: It appears that Alendronate may not adequately prevent further bone loss in your case. Continued decline in bone mineral density and the occurrence of new fractures suggest that a reassessment of your treatment plan is necessary.

2. Alternative medications: Prolia (Denosumab) and Forteo (Teriparatide) are both well-established alternatives to alendronate:

Prolia works by inhibiting bone resorption through the suppression of osteoclast activity.
Forteo is an anabolic agent that actively stimulates the formation of new bone.

Each medication has a unique risk-benefit profile. Selection of the most appropriate therapy should involve a detailed discussion with your healthcare provider, taking into account your overall health, risk of fractures, and previous response to treatment.

3. Elevated parathyroid hormone (PTH) levels: Elevated levels of parathyroid hormone may indicate a condition known as primary or secondary hyperparathyroidism, both of which can accelerate bone loss. This condition may require further evaluation, including repeat laboratory testing, imaging studies such as a parathyroid scan, and possibly referral to an endocrinologist.

4. Risks versus benefits of alternative therapies: Although all osteoporosis medications carry potential side effects, the benefits of reducing the risk of fractures, improving bone strength, and maintaining functional mobility often outweigh the risks. Your healthcare provider can help you weigh these considerations based on your laboratory results, fracture history, and personal treatment goals.

5. Lifestyle and safety adjustments

Continue supplementation with calcium and vitamin D, aiming for a serum vitamin D level above 30 nanograms per milliliter.
Consider low-impact, weight-bearing exercises such as tai chi or supervised walking programs to maintain bone health without increasing the risk of injury.
Implement safety modifications at home, such as installing grab bars and removing loose rugs, to reduce the risk of falls.

Please consider scheduling a consultation if you would like a more personalized review of your medical test results, additional information on therapies such as Prolia or Forteo, or guidance on managing elevated parathyroid hormone levels. You are taking the right steps by being proactive, and there are still many effective strategies available to improve your bone health and protect your independence.

Feel free to ask if you need any more clarification or help with your questions.

Thank you.