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Dear Dr. Roach, My wife's doctor wants her to take Prolia injections for bone density, but the reviews I read are extremely negative. She canceled her appointment to begin the injections (every six months) until we got positive feedback. She had bad cancer five years ago (removed weight) and appears to be in reasonably good health.
She suffers from asthma and COPD and does a little too much weight. She does not want to deal with the horrible side effects, because some do not seem to disappear (by reading the reviews). We know that a lot of what you read on the Internet is rubbish, so we ask for different opinions, including yours.
J.A.
Online reviews may be a good way to learn more about buying certain things, but I want to point out that a person who reacts well with a drug is not inclined to write a review, so that you may see a very biased sample.
Denosumab (Prolia) is an injection-administered antibody that prevents the formation of osteoclasts, the cells that break down bones. By reducing bone degradation, the bones accumulated and the rate of fractures (especially vertebral bones) was reduced to three years in a clinical trial, from 7.2% in the placebo group 2.3% in the Prolia group.
However, there are some reasons to be worried. The first is that many people (the drug has been used mainly in women) have noted muscle and bone pain, sometimes severe. Like other osteoporosis medications that work this way (bisphosphonates), Prolia can cause a drop in calcium levels and can overload bone remodeling, resulting in osteonecrosis of the jaw (rare complication but dangerous).
Atypical fractures of the dense but fragile bone (usually occurring after more than five years of treatment) are also possible. When Prolia is stopped, the bone quickly loses its strength and bounce fractures can occur. Different treatment should probably be introduced soon.
Prolia also interferes with the immune system, with some evidence that there could be an increase in infection and tumor rates in people prescribed Prolia. If this is the case, the number seems small.
I do not use Prolia as the first-line treatment for osteoporosis. There are other drugs (such as bisphosphonates, such as alendronate and risedronate) that have a better history of long-term safety.
Prolia, in my opinion, is best reserved for people who can not use other agents.
Dear Dr. Roach, I had lung surgery in 2014. The scar is still red and painful. I do not have instructions on how to handle it. Do you have any suggestions?
J.S.B.
It is a very long time that the scar remains red and painful, and I encourage you to have the surgeon or your doctor examined. For people suffering from redness and pain in a scar shortly after surgery, I recommend silicone gel (there are many available) because its effectiveness has been demonstrated. Many people recommend vitamin E oil, but well-done studies have shown that it does not help and could detract from the aesthetic appearance.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can send questions via email to [email protected].
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