Thursday, August 16, 2018
Health

Mayo Clinic Q&A: osteoporosis treatments; gastric bypass and alcohol's effects

A LOOK AT OSTEOPOROSIS TREATMENT OPTIONS

The bisphosphonate drugs I take for osteoporosis aren't working in my case. My doctor has suggested a few alternatives. Any thoughts on what might be best?

Oral bisphosphonate drugs, including alendronate (Fosamax), risedronate (Actonel and Atelvia) and ibandronate (Boniva), are the most commonly prescribed osteoporosis drugs. Bisphosphonates are less expensive than the alternatives, are safe in the long term and are effective in preventing fractures. Still, some women aren't sufficiently helped by bisphosphonates, and some can't take them due to issues with swallowing, stomach upset, heartburn, low-functioning kidneys or other side effects, such as bone or muscle aches.

In recent years, the drug denosumab (Prolia) has emerged as an alternative to bisphosphonates for the treatment of postmenopausal osteoporosis. Denosumab may be considered a first-line treatment for women with osteoporosis who are at high risk of fracture or in women who can't take bisphosphonates. Since denosumab isn't metabolized by the kidneys, it's also a first-line option for women with more advanced chronic kidney disease.

When it comes to improving bone density and reducing fracture risk, denosumab may provide better results than do bisphosphonates. As with bisphosphonates, it has a small risk of serious side effects, such as skin infections, headache and fatigue. For people with osteoporosis, the risk of a condition in which the jawbone doesn't heal following an injury, such as having a tooth pulled (osteonecrosis of the jaw), appears to be lower with denosumab than it is with bisphosphonates. Long-term use of denosumab over eight years has been shown to be both safe and effective. Still, denosumab may not be covered by insurance, unless a trial of bisphosphonate drugs has been attempted.

Denosumab is given by an injection just under the skin (subcutaneously) every six months, meaning you don't need to remember to take your osteoporosis pills, and it won't bother your digestive system. The bisphosphonate drug zoledronic acid (Reclast), another option, can be given once a year by intravenous infusion.

Other drugs occasionally used to treat osteoporosis include teriparatide (Forteo), a drug often reserved for the treatment of severe osteoporosis. It requires daily subcutaneous injections. Oral raloxifene (Evista) isn't as effective in preventing fractures as either bisphosphonates or denosumab, but there are very select situations when these drugs may be considered.

Kurt Kennel, M.D., Endocrinology, Mayo Clinic, Rochester, Minn. (adapted from Mayo Clinic Health Letter)

EXTRA TIPSY AFTER GASTRIC BYPASS?

After undergoing gastric bypass surgery last year, having a glass of wine affects me much more than it used to. Is this typical?

Yes. In fact, the effects of alcohol are nearly doubled in people who have had gastric bypass surgery, compared with those who haven't had the procedure.

Gastric bypass, one of the most common types of bariatric surgery in the United States, helps you reduce your food intake by creating a small gastric pouch. Before the surgery, food enters your stomach and passes into the small intestine. After surgery, most of the stomach and the first part of your small intestine (duodenum) are bypassed, and a digestive route directs food into the middle section of your small intestine (jejunum). This helps you lose weight by limiting the amount of calories you can consume and absorb.

But, this direct route to your small intestine also allows your body to absorb alcohol more readily — and much faster. Your gastric pouch is unable to break down alcohol as effectively as your old stomach would have. In addition, your body weight is likely much lower than it was before your surgery, meaning you get a higher dose of alcohol per pound.

Several studies compared blood alcohol concentrations in women who had undergone gastric bypass with those who had not. The studies showed that, for women who had had the operation, blood alcohol concentrations peaked sooner and at roughly double the level of those who hadn't had the operation. Women who had had the procedure also felt much more inebriated for longer.

Increased sensitivity to alcohol is real. For you, having two drinks is the equivalent of having four drinks, at which point you're likely well above the legal limit. It's an important limitation to keep in mind for your safety and the safety of others.

Meera Shah, M.B., Ch.B., Mayo Clinic, Rochester, Minn. (adapted from Mayo Clinic Health Letter)

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency LLC. All rights reserved.

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