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Pharmacy/Prolia infusions

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Hello.
I'm a 55-year-old female with relatively advanced osteoporosis (diagnosed at 43-years-old).  I've been under the care of an endocrinologist who specializes in this since that time.  I'm normal weight/height.  Diet/exercise appropriate for this condition, though I have had some fracture issues in the wrist and stress foot fracture.  Once was a fall; once was from wearing very high wedged shoes all day.  In any event, my question is that I was on Actenol ) initially off-label, for many years, and he gave me a "drug holiday" due to the fact it was about 8 years into it.  I did have minor improvement and overall stability, but nothing to write home about.  Long story short, I'm now on Altevia weekly.  His ideal is that I do daily Forteo injections, which are too costly in my situation.  I am aware that this is the only bone-building drug on the market at this time.  The others are stopping bone turnover, or slowing.  The second choice I've been given are twice a year Prolia infusions.   When I look at the side effects of that, I'm freaked out, as UTIs are an issue for me anyway...not to mention the other stuff.  So in essence, isn't the Prolia just the same medication as Altevia, but maybe "stronger?"  I'm thinking it may not do any good, as the oral has basically "stopped working" more or less, and I'm concerned about spontaneous femur fractures, etc.  Sorry to go on...I have to make a decision due to insurance rather soon, and I'm just going back and forth on this.  Any thoughts appreciated with an understanding you are not giving advice as what to do or not do....Thanks for doing this service.

Answer
Hi Melanie,
Actonel and Altevia contain the same chemical, risedronate. Prolia contains the medication denosumab. This is a newer class of drugs. All these drugs prevent bone resorption and help build new bone. If Actonel did not work it may be worth trying this new class of drugs. Forteo acts by a different mechanism of action from the other two. It simulates the parathyroid hormone to increase calcium absorption, decrease calcium loss and stimulate bone building cells to improve bone mass and strength. The nuisance is daily injections and  cost.  The evidence is that there is not much benefit in using Actonel beyond 5 years. So the choice is really  between Prolia and Forteo. Cost and convenience play a factor. Which will work better is hard to predict ahead of time.
Thank you for using Allexperts.
Sincerely,
Eric Brandt, B.Sc. Pharm  

Pharmacy

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