clinda, I wish you only the Best of luck. Hope it works out for you. I am not familiar with Boniva so cannot comment on that one.
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MarcieB asked a questionBreast Cancer
Boniva, anyone?
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ChicagoSandy
about 1 month agoThe two drugs, while both bone-health meds, belong to two different classes of drugs that operate very differently. Boniva (ibandronate) is an oral bisphosphonate that works by boosting the production of osteoblasts (bone cells that grow); Prolia is a RANKL inhibitor, a "biologic" (hence the $$$) that inhibits the formation of osteoclasts (bone cells that break down, making room for new osteoblasts). Bisphosphonates have a very long half-life and stay in the system (albeit less strong) for years; RANKL inhibitors wear off by 6 months, so shots need to be readministered until scans show bone stability.
Boniva, like all oral bisphosphonates, can cause and aggravate existing GERD before they've been fully broken down, left the stomach, and gone into the blood & small intestine, so one must remain upright for 30 min. after taking it. (The infused bisphosphonate Zometa/Reclast--zoledronic acid, the liquid form of alendronate, aka Fosamax, bypasses the GI system).
Both types of drugs can have rare "paradoxical" (opposite of their purpose) side effects: spontaneous horizontal thighbone fractures for both, the very rare osteonecrosis of the jaw (ONJ) for Prolia. (The risk of ONJ is much lower when no bone-invasive dental work--extractions, implants, deep-root planing, bone grafts--is done w/in 6 mos. either side of the injections, and when taken twice a year as the lower-dose prophylactic Prolia rather than monthly stronger shots as Xgeva to stop or slow the progression of bone mets).
For bisphosphonates, the fractures occur because too many osteoblasts are made relative to osteoclasts--new bone forms without sufficiently clearing out the old weak bone. Bone density improves, but past the point of diminishing returns--bones become too rigid and can snap. (The thighbone bears most of the body's weight with the lowest density of leg & ankle bones), With Prolia, it's because not enough osteoclasts are produced to "sweep out" the old weak bone--leading to too many old weak bone cells turning bones fragile & brittle. It slows jawbone remodeling--so anything that exposes or drills into bone can cause the body to resorb old bone without an increase in new cells; it also can cause orthodontia to proceed more slowly and require longer-term wearing of some sort of retainer until the jawbone has strengthened sufficiently to partially resist the periodontal ligaments' "memory" to return teeth to their original crooked positions--and wearing the retainer part of the day for life.
My MO insists on bone drugs for patients on aromatase inhibitors mostly to prevent bone mets--which are likelier to take hold in weak bones, PCP doesn't believe in administering either type of bone drug for osteopenic or mildly osteoporotic patients, preferring instead to prescribe weight-bearing bone-loading exercise, extra Mg and Vit. D, and calcium-rich foods. But in the case of women taking aromatase inhibitors or moderate-to-severely osteoporotic, he prefers Prolia to bisphosphonates. Estrogen-deprivation weakens bones beyond that caused by menopause; and bone preservation drugs are essential to prevent or slow bone mets in ER+ bc patients (when mets occur in ER+ patients, they most commonly spread first to bone & liver).
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Question: Boniva, anyone?