Bisphosphonates for osteoporosis and cardiac arrhythmias

Hi everyone,

Osteoporosis is a concern but it looks like most of the meds prescribed for it (bisphosphonates) are associated with arrhythmias. I'm wondering if anyone her has experience with this, and how you weighed out the risks/benefits of taking bisphosphonates with an already diagnosed arrhythmia. Thank you for any insights!

[www.ncbi.nlm.nih.gov].

I have done a ton of research on this, I will send you some specific articles. I would recommend getting a consultation from a Naturopath/Integrative medicine doctor. There are so many other alternatives besides the Biphosphonates.


[www.nejm.org]

[www.health.harvard.edu]

[www.midwesterndoctor.com]

I personally think that it s easy for doctors to push medication and they tend to be less inclined to recommend dietary/lifestyle modifications. There are many other alternatives if you have a personality type that is amenable to things that are better long term, but harder to execute!

Just my two cents.

Megan, if you are referring to other articles than the ones you posted, could you send them to me also?

Thank you.



Edited 1 time(s). Last edit at 07/25/2024 06:37PM by Pixie.

Actually, posting them here would be preferred so anyone reading can benefit from them now and in the future.

I should have worded my response that way, Carey. Thanks for doing that.

Another one! This one specifically mentions a two-fold risk of atrial fibrillation with the use of Biposphonates!

[articles.mercola.com]

Have you had your Vitamin D levels checked? You cannot even properly absorb the Calcium without a good Vitamin D level.

Thanks so much, Megan! I will give them a thorough reading this weekend. I did have my Vit D levels checked recently, and they looked fine. I take Vit D daily and try to get sunshine. :-) I am wary of bisphosphonates and very open to lifestyle changes, but I already have a pretty healthy diet and exercise routine, so I'm wondering what more I could do? I've also seen what osteoporosis can do (family member with compression fractures in her spine) so I'm anxious to avoid that. I think there are some integrative medicine doctors in my area that I really need to look up. I'll see a rheumatologist on Monday and see what she advises.

There are many other options. Suggest you look at Dr. Doug Lucas site and blogs. He is excellent resource on this topic. He is an orthopedic physician that looks at drugs as a last resort. Following his recommendations, I have improved my bone health. Still a work in progress, but moving in the right direction.

[www.drdouglucas.com]

The choice of meds depends on the DEXA scores and other factors. I have had 7 spinal fractures total, 3 from osteoporosis from one unwise movement. My DEXA was in the mid -3's. This one moment resulted in pain and disability for the rest of my life, frankly, so I would suggest meds for any score lower than -3, for sure.

My endocrinologist did not prescribe Reclast for me during my cancer treatment with an aromatase inhibitor, which causes bone density to decline quite a bit. Back in 2015 he was afraid it would aggravate my afib. These days the fear is for my kidneys!). Anyway, the risk of afib with bisphosphonates has since been disproven.

I did two years of Tymlos for bones, which speeds up the heart for a few hours. I went two whole years with no afib at all. Quite a surprise. Then I did Evenity for 4 months, which has a contraindication if you have any cardiovascular risk. No afib. In January I did my first Reclast infusion. The nervous endocrinologist did a 20% dose with one hour IV hydration beforehand, and infused the low dose over an hour as well. Very cautious. I got a fever for 5 days even with the low dose, but no afib. In September I will repeat the low dose. This caution is for kidneys, not heart.

I have not seen much discussion of bisphosphonates and heart issues. It certainly hasn't been an issue for me. And these meds work! My spine went from severe to borderline on Tymlos, and hip did well too. You really cannot fight the decline in estrogen at menopause long term, with diet and exercise, in my view. But certanly some get away with it.

The real problem with bisphosphonates is atypical femur fracture and jaw necrosis after too many years (3-5). And also bisphosphonates lower the effectiveness of bone builders like Tymlos, Forteo and Evenity. Bisphosphonates are used to "lock in gains" from other meds but ideally the sequence is bone builder then bisphosphonate.



Edited 1 time(s). Last edit at 08/12/2024 03:59AM by windyshores.

Evenity states in the warning as a side effect that there is a risk for stroke and heart attack. When you start on these drugs, you can only stay for specific periods of time then have to change. And keep changing. Sounds like a life long process.

Quote
windyshores
I would suggest meds for any score lower than -3, for sure.

Are you talking about a T-score or a Z-score?

Also when you say anything less than a -3, that would actually be a higher negative number to suggest starting meds, correct? since it is a negative, isn't that worse?

I see some wording on my DEXA that defines osteoporosis = T-score at or below -2.5. One of my femur neck scores is a -2.7, the other is a -2.4.

I get very confused about what is good or bad, high or low because of negative numbers & Z-scores or T-scores, etc.

And of course some DEXAs measure more areas, like both the R & L femur necks

Also, depending on your age, they may say osteoporosis is normal (as for me), but is that okay? No one told me to take any meds, which I did not want to consider anyway, but on my own I decided to try even more exercise than I already do, such as walking with a weighted vest (known as rucking by some) & also a Body Pump class (using weights & barbells); however I would rather not do the weights class as I tend to get back problems from doing the class.

Any answers to make things more clear would be appreciated.

Suggest you take a look at Dr. Doug Lucas web site. He has MANY videos on this condition, and he comments on what he sees as interventions that help this condition. He is an orthopedic surgeon who was/is concerned about these drugs. He uses as a last resort. I have followed much of his protocols and my bone density has increased. Osteogenic loading seems to be the key. You can find plenty of information on the web about loading. And you are correct in one aspect in older age if you are 70 for example, you will likely not have the same bone density when you were 30 however you can improve and maintain.

There is also another bone density test that is more accurate than the DEXA. And no radiation involved - called Echo light. Here is a web site where you can read about it:

[bonenutritionist.com]

I travel to get it and found it to be a better measure of my not only my bone density but also bone health.

All the best on your journey.

Thanks, everyone, for all the responses! I will take a look at the suggested resources. I'm really interested in the Australian study that showed increases in bone density through training with heavier weights (LIFTMOR). [onlinelibrary.wiley.com] The problem may be in finding a program near me.

Nancy, I tried to read the article on the site you gave, but it is like the articles written for professionals only - lots of statistical and analytical data - too much for me. (LIFTMOR). [onlinelibrary.wiley.com])

What about something like this Les Mills Body Pump class which involves a barbell, free weights, deadlifts, cling & press (one I am particularly uncomfortable with due to my back), squats, lunges, pushups to name some..........I have had problems with my back off & on but never had to have surgery though came close 10 yr ago A few levels of lumbar spine have severely narrowed spaces characterized as degenerative disc disease and facet osteoarthropathy. My back has hurt some several times after the classes as in right now - last did class 6 days ago, but when I stand after sitting I do not want to stand straight right away because it hurts. I am afraid of putting myself in a risky situation by doing this class; but on the other hand, I want to fortify my bones and increase muscle mass. Does this sound beneficial like the LIFTMOR?

I do modify by lowering weights or skipping some moves sometimes, but group classes can be risky due to the speed (in that they keep going even when you are having a problem) & lack of individual attention/guidance, but of course they do not cost like a personal trainer.

I do take 45 minute walks frequently & have added a 10-lb weighted vest 2x a week or so, which is very safe compared to the weights class. I practice yoga, Pilates and moderate biking. I am about to turn 75, but hope that I am not overdoing with this weights class.

The negative numbers can be confusing for many. So yes, a number less than -3 is worse! I am referring to T scores.

The info on Evenity and cardiovascular risk is not very convincing. One trial showed no difference between Evenity and placebo, and another study showed a slight but staitstically significant difference between Evenity and alendronate (Fosamax) which has been explained variously as due to chance, or due to the fact that alentronate is slightly protective. I have other concerns about Evenity such as a possible effect on B cell immunity and not enough study has been done.

I like Keith McCormick's books ("Great Bones") and videoa and Dr. Ben Leder's YouTube video "combining and Sequencing Approaches to Osteoporosis." Doug Lucas is not anti-med but leans away from meds more than most. I can see that this thread is also leaning away from meds but as a person with 7 spinal fractures, and knowing that osteoporosis has no symptoms, I urge caution for anyone with more severe osteoporosis. I got three lumbar fractures in one moment!

At any rate, the association of bisphosphonates with afib has been debunked, I was told, though I believe palpitations are still listed as a side effect. I had one hour IV hydration and the infusion was over one hour and my kidneys were fine- and absolutely no afib.

On the other hand, fractures cause afib due to crowding inside the torso!