Boniva vacation

My doctor, a specialist in internal medicine, is not concerned that although I have been treated with Evista, Fosomax, and/or Boniva for more than 5 years and during this time have not gained any bone mass. My numbers on the DEXA have continued to decline or have stablized. I have the diagnosis of osteoporosis now.
He is recommending a vacation from Boniva for a year. He says that the medications for increasing bone density stay in your system for as long as five years. Furthermore, he says that some people will stop responding to the medication and if a medication vacation is taken, and then the medication restarted, my bones may respond and build bone mass.
He asked if any of my relatives had hump-backs. My mother and maternal grandmother both did and both had hip fractures. Mother lived to age 86 and grandmother to 93 years.
He said that I would probably have a hump-back too as the medication will not prevent that.
At one time he talked about referring me to an endocrinologist, but now does not think this would be helpful.
Has anyone heard of or taken a vacation from bone enhancing medications? Has anyone found an endocrinologist to be helpful?

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Vacations from biphosphonates are not uncommon. These medications are -- presently -- Fosamax(alendronate), Actonel (risedronate), Boniva (ibandronate) and Reclast (zoledronic acid -- which is given only by IV).
The "ingredients" stay in your bone for 2-3-4 years.
I note your comment "my bones may respond and build bone mass". To be accurate, both Evista and the biphosphonates slow bone loss. They do not build bone, per se. This is what an anabolic medication does. Forteo aka as teriparatide -parathyroid hormone 1-34 actually forms bone but is can only be given for a 2-year period and then back to the biphosphonates.
Please check the National Osteoporosis Foundation's home page and click on "Medications to Prevent and Treat Osteoporosis". It is a detailed, readable description of the various medications and methods of use. Copy it and keep handy for your refernce.
Lucy Buckley PT

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Yes...I am seeing an endocrinologist for osteoporosis and found it to be essential to understanding the underlying cause of my low bone density and what treatment options are best. The first place they start is with a complete history and lab tests to determine if you have a metabolic or physiological reason for low bone density and if you are continuing to loose bone. The lab work is thorough and looks at all the likely reasons for having osteoporosis. Once you get the complete picture, they can recommend the best therapies to help rebuild bone and to stop further loss. I am confused as to why more people are not going to this specialist. I had to ask for the consult, but because of my relatively young age (52) my doctor was happy to refer me. Maybe people not responding to the most commonly prescribed therapy, bisphosphonates, are not being appropriately treated because they have other endocrinological reasons that need to be corrected first or they need different therapies such as Forteo and/or HRT.
I would push for the consult. I don't think it's very proactive or professional of your doctor to just tell you to expect spinal fractures and dowagers hump. If it was his spine, you better believe he would get a consult himself.
Good luck.
PS educate yourself as well and add weight bearing exercise and ca++/ Vit D to get the most benefit.

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It is not unusual for patients who have been on biphosphonates for quite awhile to be given a "vacation". No harm done. The biphosphonate stays in the bone for a long time.
Also -- just because the DEXA did not show any -- to you -- "gain" does not mean it was not helping. To stay in the same place is positive. If you had been doing nothing, there woiuld have been some natural loss.
And DEXA is indicative of only 60% of bone strength. Ther are other factors at work -- architecture, turnover, damage accumulation (microfractures and the like), and mineralization.
A "humpback" is not inevitable -- it's a result of the bone weakness compounded by postural problems and weakness of muscles that stand you up as well as tightness in the muscles that bend you over. Proper attention to your posture will minimize any hump and improve your balance (thereby reducing your risk for falls), AND make you look and feel much better! An effective exercise routine helps your posture and your bones.
Lucy Buckley PT

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