Bone Health Battle: Patient Questions Drug Side Effects
Experts Address Osteoporosis Treatment Concerns
A 74-year-old man grappling with severe osteoporosis is seeking clarity on potential medication side effects, particularly concerning blood pressure spikes and persistent infections. His journey through various treatments highlights the complexities of managing bone density loss.
Navigating Osteoporosis Medications
The patient, whose DEXA score indicates a -3.3 reading, has experienced significant health issues following his osteoporosis treatment. After a six-month period of infections while on Prolia (denosumab), his doctor prescribed Fosamax (alendronate). Subsequently, he recorded a blood pressure reading of 201/121 mmHg.
He discovered a Phase 4 clinical trial suggesting Fosamax can contribute to elevated blood pressure. However, his physician maintains that the drug does not cause hypertension. Uncertain about switching to other bisphosphonates due to fear of similar reactions, the patient is seeking guidance on the best course of action.
Understanding Fosamax and Blood Pressure
According to medical insights, a more accurate statement regarding Fosamax and blood pressure would note that individuals taking alendronate experience similar rates of hypertension development as those receiving a placebo. During a 12-month trial, 1.9% of participants on alendronate developed high blood pressure, a rate comparable to the placebo group.
While a direct causal link is unlikely, the possibility of a rare, uncharacterized reaction cannot be entirely dismissed. It is recommended that physicians report such potential adverse events.
Alternative Approaches for Severe Osteoporosis
A DEXA T-score of -3.3 signifies substantial osteoporosis. For such low readings, medications like denosumab (Prolia) or bisphosphonates, which inhibit bone resorption by osteoclasts, may not be the primary choice.
Prolia carries a theoretical risk of increased infections, which the patient may have experienced. A more suitable alternative could be a medication that stimulates bone growth, such as teriparatide.
Furthermore, it is advisable to screen men with osteoporosis for low testosterone levels, as this condition is a significant risk factor for bone loss. According to the National Osteoporosis Foundation, low testosterone can contribute to bone loss in men.
Microplastics in Medication and Daily Life
Concerns have also been raised about the potential buildup of microplastic particles from dissolvable capsules used in medications and supplements. Microplastics, tiny polymer fragments, have been detected in human blood and organs, primarily from contaminated food and water sources.
However, the capsules used for most medications are typically made from gelatin, a plant protein, starch, or other plant-based materials, not plastic. Very few exceptions exist where the capsule shell is not intended for absorption and is excreted intact.
Therefore, medication capsules are generally not considered a significant source of microplastic intake. To reduce microplastic consumption, individuals are advised to drink tap water instead of bottled water, as bottled water often contains significantly higher levels of microplastics.
