Ask the Doctors June 2019 Issue

Ask The Doctors: June 2019

Q: The article on osteoporosis drugs in the January issue mentioned several medications. I have low bone density and a sensitive stomach. My physician prescribed Prolia, which wasn't mentioned in the article. Why not?


Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A: The article "Don't Fear Osteoporosis Drugs" in the January 2019 issue of Arthritis Advisor focused on the most commonly prescribed drugs for osteoporosis, which are bisphosphonates. These include alendronate (Fosamax®), risedronate (Actonel®), zoledronic acid (Reclast®) and ibandronate (Boniva®).

Denosumab (Prolia®), which your doctor prescribed, is in a different drug class. We should have mentioned it in the article. Like the bisphosphonates, it prevents bone from breaking down, but the mechanism of action is very different. All of these drugs can help keep bones strong and prevent bone fractures.

The number of osteoporosis drugs and the different ways they are taken can be confusing. There are pills, injections and infusions, taken weekly, monthly or at other intervals. Your doctor chooses the best drug based on a variety of factors. A small percentage of people who take bisphosphonates have gastrointestinal problems, such as nausea, stomach pain, constipation, diarrhea and gas. This may be one reason your doctor prescribed Prolia, which is given as an injection and is easier on the stomach.

What we said in the January issue about the rare side effects of bisphosphonates-atypical thigh bone (femur) fractures and deteriorating jawbones-applies to Prolia as well. Femur fractures can be minimized with appropriate drug holidays. However, a drug holiday is not recommended with Prolia. Jawbone problems are extremely uncommon. The benefits of the drugs far outweigh these risks.

Q: I have Sjögren's syndrome, and I have dryness in my eyes and mouth. Is there anything I can do about this?

A: Sjögren's syndrome is a chronic autoimmune disease. With an autoimmune disease, the body's immune system mistakenly attacks healthy tissue with an inflammatory response. In Sjögren's syndrome, the inflammation mostly affects moisture-producing glands, especially the tear and saliva glands. This causes dry eyes and dry mouth.

You may experience a gritty feeling in your eyes, and your eyes may be sensitive to light or have a burning sensation. Dry eyes can increase your risk for eye infections and damage to the cornea. Dry mouth can make swallowing difficult. It increases your risk for tooth decay, gum inflammation and other dental problems. Some people have dryness in the nasal passages, skin and vagina. Other possible symptoms are joint pain and fatigue. Sjögren's syndrome can also affect the lungs, liver and kidney.

About 90 percent of people with Sjögren's syndrome are women. About half of people who have it also have another autoimmune disease, such as rheumatoid arthritis or lupus.

There is no cure. Treatment focuses on relieving symptoms and preventing complications. Topical treatments, both prescription and over the counter, for dry eyes and dry mouth (such as Biotene®) are available. Drugs include cevimeline (Evoxac®), pilocarpine (Salagen®) or saliva substitutes for dry mouth and cyclosporine ophthalmic (Restasis®) or hydroxypropyl cellulose (Lacrisert®) for dry eyes. There are many over-the-counter artificial tears.

Treatment often requires coordination among different specialists, including your rheumatologist, ophthalmologist, and dentist.

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