IV Medication for Osteoporosis

[spotty14]

I learned yesterday that there is an IV medication called Zometa that has an unlabeled use for osteoporosis. It's actually a cancer drug. It is being administered to patients either once a year or every 6 months. This must have been the medication my previous doctor was referring to.

[Mariaa]

Whoo hoo Spotty, I'd like to get some of that! Actually I tried the Viactiv again this past week and ended with such a severe GI bout I thought I'd be in the ER for sure~
I'm worried that when I decide to have ADR surgery my BMD levels are going to be too low as I'm already have osteopenia in the spine~
I'm going to ask my PM doc here in SD to refer me to an Internal Med doc and hope I find someone a bit progressive..

[Carolina]

Greetings Spotty and Maria-

I can't say this with authority, but I think Zolendronate IS approved for osteoporosis. I always thought it was hard to get for pure cases of osteoporosis because it required IV infusion and was so much more expensive. I can't remember the exact figure, but it is something like 30-40X more potent than the usual oral bisphosphonates like Fosamax and Aredia. Prescription/Insurance coverage might depend upon how bad the T score is?

I know a number of people who get it for treatment and prevention of bone mets from prostate cancer. Generally well tolerated in the short-term (though some people have a sort of allergic reaction with the first treatment...increased bone pain, flu-like sxs, rash...which can be reduced with concomitant benadryl) However, I have recently heard of cases of osteonecrosis of the jaw bone in people who have used Zometa for 24 + months...don't know much about it though.

Seems like a 6-12 month course to strengthen bone pre-surgery would still be worth consideration.

FWIW-
Carolina

[Carolina]

Woops...forgot to add, I think it is a monthly infusion. And one must have adequate calcium intake or bisphosphonates don't work.

C.

[queenofhearts]

Maria - you might want to ask your PM to refer you to a Metabolic Bone Disease doc instead of an internal medicine doc. The MBD I see treats nothing but bone disorders. My primary is an internal medicine doc, but doesn't seem to know a whole lot about osteoporosis and treatments other than Fosamax, extra calcium, etc.

[spotty14]

Thanks Carolina for more information. The information I was reading indicated that treatments were being done every 3-6 months.I did go back and read up on the side effects and the jaw bone condition was mentioned. I'm going to ask about it when I finish using the Forteo because I won't be able to stomach any of the pills on the market currently. I was told that I would need to take some sort of maintenance medications for a long time maybe indefinitely. Mariaa, let us know if doctor will recommend this treatment for you.

[Mariaa]

Spotty,
Who prescribed the Forteo for you if you don't mind me asking? Was it your Internal Med doc, your Spine doc? Are you just trying to get the daily requirement of Calcium thru your diet otherwise? This seems to be the only way I can take Calcium is thru yogurts and such...(I despise milk in any form..)

[spotty14]

UCDavis has a specialities section in the Internal Medicine Clinic-my internal medicine doctor prescribed the Forteo. Initially, the insurance company denied the doctor's request for approval. Then I wrote an advocated for myself and my doctor recontacted the insurance company also and I was approved for one year.

For Calcium I'm taking about 1800 mgs of Calcium Supplement-Citracal. Then I'm trying to eat between 50-70% (says on the product label) in my diet. I hate milk also but drink it sometimes as hot chocolate, and now I'm pretty darn tired of Yogurt. There are some cereals that have added Calcium like Cream of Wheat and some beans, and fresh spinach.

[Mariaa]

Hey Spotty,
That's great re the insurance coverage for a year~ I have Medicare and AARP tho the supplemental AARP plan I chose doesn't cover medications at all. This has become expensive...

So I may either see about getting on a plan that does offer some medication coverage tho not so much with Forteo in mind, rather some GI meds..

I'm eating as much "stuff" as I can to get a daily dose of Calcium. Am using Miacalcin also (when I remember).

Now I'm sure that you've posted your T-score before tho of course if you did I have forgotten what it was. My T score is -2.2. Was yours significantly below this in order to have the Forteo ordered or ws it ordered to spiff up for upcoming spinal surgery? I think that my T score would likely not encourage a insurer to pay for Forteo tho likely Actonel/Fosamax and the like. At this point I have to pay $87/mo. for the Miacalcin and then there's the GI drugs and migraine meds tho they are PRN..

[spotty14]

Hi Mariaa,
My T-score was -3.1 (getting tested again next week) and it seemed like the Forteo approval guidelines from the FDA was based on how they determined "high risk" patients. The guidelines included particularly older individuals that already had fractures and were attempting to prevent further fractures. There might have also been a T Score identified. This sounded ridiculous to me as of course you want to prevent fractures and especially if your planning on having surgery.

My doctor showed me a chart (I could probably get it for you) and the fracture risk based on age and other factors. When it was calculated out for me I was not identified as high risk because of my age and assuming that an individuals bones that are significantly older would have more brittle bones anyways. With my doctor's recommending and the two of us advocating for me, the insurance company approved and is covering it minus my copay.

You would want to definetely have good insurance coverage. It costs about $700/month for each pen plus the cost of the needles and the DEXA tests, etc., It's sure worth a try as the oral medications just tore up my stomach. I don't know what I'll do after the Forteo is over because there's no way I can take the pills.

You can also PM me if you like more information.