On 28/04/2011 3:24 AM, Jel Coward wrote:
> Hi all
>
> .......can I pick some brains on a clinical issue please?
>
> Woman with T score of
> Spine -3.0
> Fem neck -3.6
> Total hil -3.6
>
> Has had a few falls and not broken anything.
>
> On tiny prednisone dose of 1mg/day but occasionally bumping up to 5 or 
> 10mg for Polymyalgia/Temporal arteritis - and probably some 
> sero-negative arthritis.
>
> Has been on prednisone at this sort of dose for a year or two (but 
> larger in past for quite some months).
>
> Takes rabeprazole for dyspepsia that re-emerges on any attempt to stop 
> it.
>
> Was on Ca and Vit D - more recently changed to just VitD and good diet 
> advice re the worries of Ca in post-menopausal women.....and she has 
> had a mild CVA in past and there was question of IHD but that was 
> finally ruled unlikely on a MIBI in 2009.
>
>
> .........she is at risk of polypharmacy - current meds - rabeprazole, 
> prednisone (as above), sertraline (depression/anxiety - been on since 
> I have known her), amitriptyline 10mg at night  (radicular leg pain at 
> night - gets good effect from this), Vit D, clopidogrel (re CVA).
>
>
> The question is whether to put her on a bisphosphonate or 
> not..........despite the T score and the long term (usually v low dose 
> pred - but higher does in past for 6m or so).....I feel a bit 
> reluctant to add to her medication load.
>
> .......but if there is good evidence that she would benefit (at age 
> 81, with no fractures) - then I would do it.  She is a bit frail but 
> lives mainly alone and copes with a bit of support from a visiting 
> person - and goes out to shops with someone with her etc.
>
> .........looking around for good evidence/opinions seems every harder 
> - particularly in these somewhat more complex situations - and so much 
> stuff is pharma influenced.
>
> Cheers all
>
Hi Jel,

Is zoledronate available in Canadia? [once-yearly infusion]
But I agree to ask her opinion - possible benefit but not clear cut. 
Hip-protector pants might be a more cost-effective measure.
-- 

Cheerio,

Graham