A visit to Outpatients. Woohooo!

Well, I went to see a metabolic bone consultant. This was because I wouldn’t take bisphosphonates and the rheumatologist and my GP both preferred that I did. I think they thought he’d beat some sense into me.

The reason I wanted to avoid the bisphs was because they are reputed to mess up your stomach – cause GERD as does pred. I’m specifically not taking omeprazole (which helps to fix pred stomach probs) because it encourages osteoporosis. I had heard a lot about strontium – even though the most famous version, strontium ranelate, has been discontinued. You can buy strontium citrate on Amazon.

Anyway, I wanted to ask him about strontium citrate, but he blanked out the citrate and went on about ranelate and how it wasn’t available any more.

Then I explained my father had been on pred, lost 4 inches in height from osteo but actually died of bleeding stomach ulcers. The consultant told me that it wasn’t the pred that caused the ulcers.

Okay. So then he told me that strontium caused stomach probs in 25% of cases – which I had suspected as I was getting reflux since starting strontium citrate a couple of weeks before (which he didn’t know about as I had bought from Amazon).

So he said there’s something else you can take if you don’t want bisphs – denusomab (which I knew about already). He said I could do a trial of bisphs and if they didn’t suit I could go on to that instead.

Then he reminded me that with strontium you must drink or eat nothing for two hours before or afterwards – so don’t ingest anything for two hours then go to bed. He talked about how much people like a cup of tea last thing at night. I laughed and said he was like a car salesman – smooth talker.

So then he told me all the luxury ways I could take bisphs. Or I could go straight onto denusomab if I wanted – which would I prefer? I said “do I have to decide now???”

Then – guess what – he decided to check the likelihood of me getting osteoporosis. The first thing to know is that most of the bone loss happens in the first few months with pred. In my case I was only very borderline osteopenia. We underestimated my weight (heavier is better for bones – up to a point) but also underestimated my pred dose – I’m on 10mg but the gizmo works on 7.5mg. He assumed I’d be down to that in a couple of months. I mentioned I was going down by 0.5mg at present. I didn’t want to say it would soon be by 0.25mg, as he was horrified enough with that, but I pointed out that my GP was encouraging this slow reduction so he didn’t say anything.

Anyway, this gizmo suggested that I don’t take any osteo treatment at present but get a new Dexa in a year and see if anything needs fixing then. Obv I’m stuffing down Vitamin D3 and K2 along with other things, so in reality my bones should be the best they’ve ever been, especially with the weight gain courtesy of pred (and my hungry stomach).

So it was a bit of a mental arm wrestle, but he gave me a huge amount of time considering it was a busy NHS outpatients and treated me, maybe not as an equal but, as he would one of his students rather than a bonkers old lady. We shook hands at the end and I came away delighted that I don’t have to take anything!

(I think you can guess I might not have taken anything even if he had commanded it)

Here’s the assessment took if you’re interested. You’ll need your Dexa numbers (and, if you don’t know, glucocorticoids mean pred.)

Sheffield FRAX Tool

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