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Osteoporosis Ask The Expert

Osteoporosis Ask The Expert

Q: I have been told by members of the health profession that drinking pop (more than 2 cans/day) increases the risk of osteoporosis, however nobody seems to be clear on the reason why. I've even had people tell me it was the carbonation or the caffeine. Why not drink coffee or tea? More reasonable mechanisms seem to be the phosphoric acid "leaching" calcium and/or drinking soda instead of milk. What is your opinion?

 

A: If soda increases the risk of osteoporosis, it is probably because those who consume large amounts of soda may consume very little milk, hence are deficient in calcium intake. This is a growing and alarming trend especially among young children and adolescents. Many children seem to favor juice boxes, while teenagers seem to have replaced milk with Diet Coke and Mountain Dew. There is some data that excess amounts of caffeine may inhibit calcium absorption. That is not to say that coffee or tea are dangerous per se.


Q: My 71 year old mother was put on Fosamax after a bone density test was done. She is hypoglycemic, is on nitro patches for a heart condition, has inhalers for lung problems, is on diuretics for Meniere's disease. She has developed a great deal of gas and loss of appetite - I was wondering if perhaps Fosamax might be causing some of her problems. She is allergic to many pain killers and also to a great number of antibiotics and was recently prescribed Zithromax for a lung infection. Might a second opinion be in order? Thank you in advance for your assistance.

A: The need for multiple medications certainly confuses the picture. Fortunately, Fosamax does not interact with other drugs. Fosamax can cause stomach and esophageal irritation but does not cause loss of appetite in my experience. The weekly dose seems to be better tolerated and may have fewer side effects. It is just as effective as daily dosing. It needs to be taken first thing in the morning, on an empty stomach, with water only. You must be upright and have nothing else to eat or drink for 30 minutes. A nuisance, but better to have to do only one day a week.


Q: I am taking synthroid (have for 25 years), and have learned how it depletes the calcium from the bones. I am dismayed and worry that I have to take it now, in spite of having poor bone health. Is there any alternative? Why doesn't the body thyroid hormone destroy bones? My physician has no answers. Thanks.

 

A: Synthroid, per se, does NOT destroy bones. If you are hyperthyroid, either by virtue of having an overactive thyroid gland or are taking EXCESSIVE thyroid replacement, that may accelerate bone loss. This is a good reason to have your TSH level checked periodically to make sure your levels are in the normal range. Individuals with previous thyroid cancer may need to have excessive thyroid replacement. In this case it is important, more than ever, to have adequate calcium and Vitamin D intake, exercise, and avoid smoking. Hope that helps.


Q: I have been diagnosed with osteoporosis by my internist (1-1/2 years ago). My T-score reading was normal for my spine (above -1) and for the hips, -2.25 and -2.27. I have been taking Foxamax since that first diagnosis, with no further testing. I also have taken HRT for the last 20 years, as well as living a healthy and active lifestyle. I will request another test at the end of 2 years. I had read somewhere about the effect of the parathyroid glands on your absorption of calcium. Can you give me any further information on what this gland is, and whether I should have any further testing other than the DEXA that I plan to have? Thank you for any help you can give me.

A: Since your t-scores are better than -2.5, the diagnosis would be osteopenia. This is a risk factor for developing osteoporosis. It would be helpful to know your age and complete health history. I would agree that waiting two years after changing therapy is appropriate.

To answer your question: the parathyroid glands are imbedded your thyroid gland. Their job is the fine tune the amount of calcium in you blood. If they become overactive, often the result of a benign tumor called an adenoma, the parathyroid increases the blood calcium level by taking calcium from your bones. The calcium level can be checked, and if elevated, a measurement of parathyroid hormone can be done.


Q: I am a 46 yr. old female who has recently been diagnosed with Osteoporosis of the spine and Osteopenia of the hips. Is it ok to continue Chiropractic care (for the reason being that I have a curved spine with one leg a little shorter than the other due to surgery as a child) or is this too risky for the spine to fracture? The Chiropractor says he is very careful when doing the adjustments. 2. Does the bone density test show fractures of the spine? 3. I was not tested for Hyperparathyroidism. Is it normal procedure to check this?

A: If you have osteoporosis at age 46, it might be very appropriate to check for secondary causes. Did you lose ovarian function at a very early age or undergo premature menopause? What medications have you taken? Need to know a lot of information to answer question appropriately. If the diagnosis was made by DEXA, which sites of the body were measured? Is there evidence for accelerated bone loss or did you not reach your predicted peak bone mass? Please submit more information and I will try to be helpful.


Q: I am a 57 year old menopausal female, taking HRT since 1990. I am also taking didrocal treatment for osteoporosis which was diagnosed about 4 years ago. My latest bone density has shown considerable improvement. My doctor stated that I am now considered to have osteopenia rather than osteoporosis. I would like to be able to discontinue HRT but I am concerned about the fact that my bones will return to the condition they were in before starting HRT. My question to you is will my osteoporosis get worse if I stop taking HRT but continue with didrocal, good diet and exercise? Thank you.

A: If you are referring to Didronel or etidronate, it has been shown to be more effective with estrogen than alone. In the United States, it is not an approved drug for osteoporosis and is not used often because better drugs, such as risedronate and alendronate, are approved. If you are considering stopping HRT but are continuing with a bisphosphonate, calcium, Vitamin D, exercise, and avoiding tobacco, I would recheck a bone density in two years.


Q: I am trying to find out about the recovery from pregnancy related osteoporosis. How long will it take to fully recover? Will I be able to care for my baby while I'm recovering? Is there any physical therapy or medication (vitamins, etc)?

A: Transient osteoporosis of pregnancy has been reported. It is rare and the exact cause unknown, although there may have been low bone mass prior to pregnancy. In that case, looking for secondary causes, hyperparathyroidism for example, would be appropriate. It appears that most individuals who have osteoporosis of pregnancy have remarkable increases in bone mineral density in the months following delivery. Attention to adequate Vitamin D and calcium is important. The total daily calcium should be 1200 to 1500 mg.


Q: My daughter is 34 and taking Didrocal to slow bone loss as her Bone Density showed a 30 - 40 % loss. She is also on a high Calcium eating regime and exercises. She has been approved for Envitro (sp) Fertilisation and starts the medications on the 10 Oct 2001, she seems to be getting conflicting reports about whether she should stop the Didrocal now or during the pregnancy or if it is safe to take throughout. Thank you for you time.

A: It would be important to know the cause of her osteoporosis, such as high dose steroid use, prolonged heparin, anorexia, etc. The use of drugs like Didronel have not been studied during pregnancy and I would NOT use them. In laboratory animals, albeit at high doses, skeletal abnormalities have been found. I would encourage adequate calcium and Vitamin D intake, supplementing diet when necessary.


Q: I am on once a week fosamax since September and have gained 16 kilo on my 5ft 1 frame. Three years ago I underwent a total hysterectomy and oopherectomy due to uterine cancer. Five months later I did a bone density test and I had medium loss and a year later I lost a total of 28% in my hip and in my lower back. I was on a macrobiotic diet for 2 and a half years and recently left it in its strictness. After not eating sugar for 8 years, I have eaten large amounts of chocolate. I wonder if the fosamax is a salt and is it changing my metabolism? I would truly appreciate some help in this area. I exercise 4 times a week including water aerobics (I have a torn ACL) and mild aerobic classes and treadmill. I still eat azuki beans, sesame seeds, seaweed and as much greens that I can find.

A: I can find no references to weight change, gain or loss, attributable to the use of Fosamax. It is tightly bound to bone and has no other effects. I would not expect any metabolic effect except upon bone resorbtion.


Q: I have recently been diagnosed with Osteopenia. I had a hysterectomy two years ago and have been taking Premarin .9 since then. I have stopped taking the Premarin and am supposed to start Evista next week, but the doctor also prescribed Actonel due to the bone densinometry results. Should a person take both Evista and Actonel at the same time?

A: In most cases, the use of combined therapy is not recommended. Since you do not have osteoporosis, using two drugs does not make a lot of sense to me. Hope that helps.


Q: I am a 67 year old male with osteopenia. I take Dilantin for seizure control. The question is: Other things being equal, is Fosamax therapy effective while taking the anticonvulsant bone wasting Dilantin? Or is it first necessary to switch to a non-bone wasting anticonvulsant (on advice of a neurologist).

A: I know of no drug to drug interactions with Fosamax. Dilantin may increase the rate of bone loss and being on Fosamax sounds like a very appropriate strategy, as well as maintaining a daily calcium in take of 1500 mg and Vitamin D. Exercise, and of course, no smoking.


Q: Hello. I am 25 years old and just received a report that I have mild osteopenia. I had a bone density study done on recommendation from a specialist on PXE (pseudo-xanthoma elasticum) which I have. PXE is believed to possibly be caused by calcium deposits on or around the elastin which clumps together and hardens in a person with PXE. I also have type 1 diabetes and mild anemia. Are there any suggestions that you could give me on calcium intake, etc.? I also am trying to get pregnant and would appreciate any information, cautions, etc. you may have on that issue. Thank you!

A: Your question is a very complex one. There are several references to pregnancy and PXE. It seems that the outcome is not necessarily adversely affected although there may be aggravation of skin lesions. Your diabetes is another serious consideration. I would strongly suggest consultation with a perinatologist prior to conceiving.

The issue of osteopenia is complex as well. At age 25, you have yet to reach your peak bone mass. The definition of osteopenia is the comparison to "young adult" but presumably at the peak of bone mass. You are on the wrong side of the bell-shaped curve. Nonetheless, you may be at risk of not reaching peak bone mass and should do your best to have adequate calcium (1000-1200 mg/day), Vitamin D (400IU-found in prenatal vitamins, multivitamins), exercise, and avoidance of smoking. Numerous medications, corticosteroids in particular, may affect bone mass. Hope this helps.


Q: Why should a person not take Actonel and Miacalcin concurrently for osteoporosis?

A: Actonel is a highly effective drug. Miacalcin is not. There may be some pain relief with Miacalcin in patients with pain from vertebral fractures. Otherwise, the benefits have been disappointing. It has rare side effects, but is costly and largely ineffective.


Q: I'm a 38 year old woman and my doctor has just diagnosed me as being in early menopause. The only symptom I have is no periods. Since I don't have any troublesome symptoms, I have considered not doing HRT. My only concern is osteoporosis. I have always been active, and I am large-boned. So I'm wondering if nutrition and exercise is enough at this point, or if HRT would be STRONGLY advised - if osteoporosis was my only concern.
Thanks!

A: At age 38, I would be careful to distinguish premature ovarian failure from failure to menstruate due to not ovulating or to other secondary causes. It would be wise to evaluate pituitary function, thyroid function, etc. If you have no risk factors for osteoporosis, have adequate calcium and Vitamin D intake, it might be reasonable to consider bone density measurement in the next few years, with the prospect of using estrogen/progestins, Evista, or other drugs that may be available in the future to retard bone loss. If you develop symptoms of estrogen deficiency, such as vaginal dryness, pain with intercourse, hot flashes, etc., you may consider hormone replacement with multiple benefits in mind.


Q: I am a 38 year old white female who has been diagnosed with osteopenia after the following results:
Lunar AP spine bone density t-score -2.3 and z-score -2.3 Luanar femur bone density t-score -2.0 and z-score -1.9

I have GERD's disease and have been taking Prevacid 30mg a day for the past year. I also use calcium supplements with Vitamin D since I lack much dairy products in my diet.

Approximately 9 months ago, I was in a snowmobile accident where I tipped the snowmobile over on the side and fractured my pelvis in 4 spots. This accident was not at a high rate of speed as I was in a turn going about 15 miles per hour. At the time my Orthopediac doctor felt that I didn't have signs of Osteoporosis and didn't allow me to have a bone density test. My OB/GYN had different feeling when I went for my annual exam a few weeks ago and said it should be done.

My question is what should be the next step for me in dealing with Osteopenia being pre-menopause and is an internal medicine or rheumatologist the place to start? I have severe cramping in my left calf and foot during sleep which didn't exist on a regular basis prior to my pelvic fractures? Thanks for any suggestions on this matter.

A: I would be concerned about two issues: first, you are very close in age to the time when you would have reached your peak bone mass. Does your low bone mass reflect extraordinarily rapid loss, or did you never reach the anticipated peak? Second, your z-score is very low compared to other women of your age, are there secondary causes that should be evaluated? I am not sure that your fracture was a fragility fracture, but it certainly serves as a red flag for further careful investigation. I would consult your gynecologist to do further studies or perhaps refer you to a rheumatologist or endocrinologist, if he/she is more comfortable referring you.


Q: I have a question re a particular Fosamax incident. I've taken Fosamax for the past 10-11 months, after a bone density test indicated bone loss. I am 51 years old, paraplegic (T4) for the past 13 years. My question is just about one incident where I took my dosage, and due to an unavoidable situation, only 15 minutes or so later, was forced to lay down for an extended period of time. I know that's something one is not supposed to do, and this is the only incident in which I have. But my question is whether this can cause any permanent problems or damage, or is simply a discomfort issue? Since I have no sensation below chest level, I doubt I would even recognize any expected resulting discomfort.... even if it went on for quite some time. I was however concerned about the potential that I could undergo lasting damage that I wasn't even aware of at the time. Is the warning re laying down after medication merely to avoid temporary discomfort, or to prevent physical harm. If the latter, how serious might that be and is there anything I might do to mitigate or reverse any potential damage that might have been done? Thanks for any info you can provide.

A: The reason it is important to remain upright for at least 30 minutes after taking Fosamax is to decrease the possibility of causing irritation to the esophagus. If this only happened once, and no harm occurred, I would suggest being careful to remain upright after your dose in the future. Fosamax is available in a weekly dose form, and by all accounts seems to work just as well and may reduce risk by avoiding repeated exposures to the esophagus. If you are on a daily dose, you might want to discuss this with your physician.


Q: I am 64 years old with osteoporosis. I take Fosamax weekly and 1500 milligrams of calcium supplements daily. I walk two miles daily. I have read recently that various groups are recommending jumping as an exercise to strengthen the bones. The patient is to jump vertically, approximately 4 to 5 inches and land flatfooted. Fifty jumps are suggested, and the routine is to be repeated three times a week. Can I jump 100 times per set? Can I jump every day, instead of only three times per week? Thank you.

A: There are several studies of jumping as a way of improving bone mass. The routine you mentioned is one that has been reported. The idea is to improve bone strength by increasing the load on bone. This is why weight-bearing exercise is important. My only concerns are that jumping may increase the rate of injuries especially in those who are less stable on their feet or have a tendency to fall. There is at least one study reported using vests with pockets for placement of light weights to increase weight bearing, using walking with these weights as exercise. Perhaps simply wearing a back pack would help. I agree that adequate calcium and taking Fosamax is a good strategy, and admire your interest in exercising.


Q: I have been taking Didrocol for several years following my first bone density test at age 60, showing left femur 0.67, right, 0.701 and avg. of the 1st four lumbar vertebrae, 0.874. A follow up one year later showed no significant change. I have broken ribs and collar bone in two falls since then and Fosamax is being recommended. I had chosen Didrocol initially, given its ease in dosage and effects. Are there any clinical studies comparing the relative effectiveness of both these medications? Neither build bone mass and I have just read about a new product Forteo, which builds bone mass and sounds promissing. I am now 67 and will decide following another bone density test. Thank you for any information.

A: Didrocal is not used in the United States, as etidrionate has never been approved for the prevention or treatment of osteoporosis. One year is too soon to see a change in bone density. I would suggest a minimum of two years. Fosamax can be given in a one time a week dosing. Nothing is much simpler than that. It indeed does increase bone mass and reduces fractures. I works by inhibiting the resorption of bone. Forteo will be approved soon for osteoporosis, but will be a daily injection, likely to be expensive, and probably not necessary for you unless you continue to lose bone mass in spite of treatment with Fosamax.

The fractures you have suffered are not generally considered fragility fractures. There are several factors to consider: bone quality, bone mass, force of falls, and the tendency to fall. For that reason, it is important to have a plan to improve muscle strength as well as retain flexibility and agility.

Your calcium intake, from diet and supplement if needed, is 1500 mg per day. Also, you should have 600 to 800 units of Vitamin D. Smoking must be avoided. Many medications may have a detrimental effect on bone mass. This should be discussed with your physician. Hope this helps.


Q: This past March 01' I had a Dexa scan which revealed Osteoporosis. I have had TAH & BSO at the age of 23. I'm now 30 and having continuous low back pain, with no relief from Celebrex, Vioxx, Asaids. Is this bone "pain" from osteoporosis? Ii was instructed to stop the usage of Actenol, since this one of the side effects ( joint pain). I can not tolerate Fosamax nor Effexor.. My doctor is recommending me for bone scan. I really don't understand why. Can't anything else be done to help the bone loss? My T-score -2.67 and Z-score is -0.57 of the femoral neck and my lumbar spine T-score is -2.90. I'm worried that since I'm so young, I will be unable to continue my active lifestyle after 40.

A: It would be important to know a lot more about you medical history, including why you underwent TAH-BSO at age 23. Have you received estrogen since that time? You should be just reaching your peak bone mass now. I might be helpful for you to have x-rays of your spine and perhaps a bone scan, as it is unlikely that your back pain is due to compression fractures of the spine. You represent a complicated situation that is not really amenable to answering by email. I would discuss this with your physician. It sounds like you deserve complete evaluation.


Q: What are the effects of liquor and Fosamax?

A: Obviously Fosamax must be taken only with water, but I know of no interactions with any other drugs as far a metabolism. Recent studies do not show the use of alcohol to be a risk factor for osteoporosis, however with any medications or substances that may interfere with balance or cognition, the risk of falls increases. Modest use of alcohol should not be a problem.


Q: I am 74 yrs. old , have emphasyma, and now my doctor wants me to get x-rays for suspected bone loss. I asked him about a pain that felt like a torn ligament or muscle below the thumb I have had it for a few months but now it seems to flair up more frequently. I thought osteoporosis was first a female problem, and connected with bones. Is my Dr. going in the right direction?

A: First of all, osteoporosis can affect men and women. Men generally have a higher bone mass to start with, but can lose bone mass with age, other illnesses, treatments for various conditions, and can be treated with drugs like Fosamax. The diagnosis is made with a test called dual energy x-ray absorptiometry or DEXA. Pain in your thumb is not characteristic of osteoporosis. Except when fractures occur, osteoporosis is largely "silent." For that reason, the best strategy is to prevent osteoporosis. Once osteoporosis is diagnosed treatment may slow the progress of the disease and fractures are generally reduced by 40 to 50%.


Q: At 53 years of age I am trying to justify my decision to decline HRT. I was a DES baby, my mother died of postmenopausal breast cancer, and my father has prostate cancer. I have been an avid, safe exerciser combining aerobics with substantial weight lifting for 23 years and I have during that time paid close attention to calcium intake and all the other necessary nutrients through strict nutritional practices. I had a bone density check done on my left foot and the reading was 3.4. Granted, at some age I will have osteoporosis if I live long enough, but with all the muscle work, balance work and cardio vascular work have I not substantially reduced my risk of fracturing a hip or having a debilitating heart attack?

A: I would look for a reason to use a medication, and not use one just because there is no contraindication. In other words, if you have normal bone density and no menopausal symptoms, keep doing what you are doing. However, if a need arises later, then that is the time to use medication. In addition to your exercise, make sure your calcium intake is 1200 mg daily. If you get it in your diet, so much the better. Almost any multivitamin will give you 400 Units of Vitamin D. You should have your lipids checked, and consider a colonoscopy (every ten years if you have average risk) and of course, an annual mammogram.


Q: I am 46 years old. One year ago I had a bone density scan that came up bad. Again this year it came up bad including degenerative signs in my spine. My doctor put me in Fosamax. I have not yet gone through Menopause. I am taking 1200 mg of calcium per day and walking on the treadmill approx 6 miles per week. I have been on Fosamax for 2 1/2 months and am starting to lose my hair. Is this a normal side effect, what are your thoughts on taking Fosamax?

A: Fosamax is generally not used in premenopausal women. The exception might be for steroid-induced osteoporosis. If your bone density is low, that does not differentiate excessive loss from failure to reach your predicted peak bone mass. It might be wise to look at other illnesses, medications, etc. that might explain your bone density. As far as adverse reactions, I know of no relationship to hair loss. Hope this helps. I suggest you discuss this with your physician.


Q: I have been taking HRT since my hysterectomy about 8 years ago. This year, I had a bone density study and it showed that I had osteoporosis. Since I have been take HRT all these years to help prevent osteoporosis, and still ended up with the disease, is there any point in continuing the HRT at this point?

A: There are two issues: did estrogen fail or where did your bone density start? A measurement of bone density, the way osteoporosis is diagnoses, is a "snapshot" of what your bone density is on that day. Fair or not, the way osteoporosis is defined is the comparison of current bone density to the predicted peak bone mass on the best day of your bone's life. If your bone mineral density is low, either you lost it rapidly or never reached the peak in the first place. A second bone density test at least two years from the last can help with that. It would be important to note any secondary causes in your medical history. You should discuss this with your physician. It might help to test for parathyroid and thyroid function, look for excessive loss of calcium from your kidneys, etc. The answer is not as easy as it might seem and this may not represent a failure of estrogen.


Q: I am 39 years old and have a lot of joint pain. My knees hurt when sitting to long and have trouble climbing stairs. My back always hurts. I can't lean on my wrists either for long. My mother is 57 and has osteoporosis and osteoarthritis very bad. I am concerned that I may have these. When I ask my gynecologist and regular md. they seem to blow me off saying I am too young. Since my mother is only 57 and has had several shoulder surgeries and knee surgeries attributed to these diseases I am concerned. She recently broke her clavical bone rolling over in bed. I would be interested in your opinion. Am I being neurotic or should I be concerned and look for another doctor to see? Should I just go see someone who deals with arthritis etc? Any suggestions? Thanks

A: You pose several very good questions. It sounds to me like you have symptoms of arthritis, not osteoporosis. Women are largely protected until the first few years after menopause by the estrogen produced by functioning ovaries. I assume you are still menstruating and have normal ovarian function. Arthritis seems to be associated with an increased risk of osteoporosis. Some of the medications, especially steroids like prednisone, are associated with bone loss. Inability to walk and exercise may compromise bone density further. A history of maternal osteoporosis does increase your risk. The best plan now would be to have your joints evaluated, continue to exercise, avoid smoking, get a total of 1000 mg of calcium every day, take a multivitamin containing Vitamin D, and have your bone mineral density measured when you need to make a decision about hormone replacement therapy at the time of menopause.


Q: Recently my mother was diagnosed with severe osteoporosis after a bone density test. Her doctor prescribed Actonel 30mg once weekly and 600 units of Calcium (+D) twice daily. After researching Actonel through websites, I find dosing of 5mg daily or 30mg daily to treat Pagets disease, but no weekly dosing. I know I should question her doctor, but I wanted to try to find out on my own if this was a customary dose first. He also never mentioned to take the Actonel on an empty stomach and not eat breakfast for at least 30minutes (4 hours for maximum effectiveness). Apparently calcium also interferes with absorption. Have we just wasted 9 weeks of valuable time and drugs? Should I call the drug company direct?

A: The FDA has not yet approved the weekly dosing for Actonel. Many physicians are using 30 mg once per week. The approved dose will probably be either 30 or 35 mg. Both Actonel and Fosamax are very poorly absorbed and must be taken in the morning after an overnight fast, with only water. One should have no other food or beverages for at least 30 minutes. There is best absorption in 2 hours but waiting a half hour is sufficient. One must remain upright--standing, walking, or sitting -- for the 30 minutes. This decreases the risk of irritation of the esophagus. Because of these restrictions, it is far easier and just as effective to have the inconvenience once a week as opposed to every day. Calcium should be taken with meals and preferably one dose in the evening. I would suggest once with lunch then another in the evening. She should have a total of 1500 mg of calcium a day, but this is the total needed. The calcium from diet is subtracted from the total. Remember one can on! ly absorb 500 mg at a single time, so it is best spread out during the day.


Q: I am a 38 year old female who has been diagnosed with osteopenia. My hip results were -2.0 and spine -2.3. My doctor has me on 1 per week Fosamax and 1200 calcium per day. I also am on 20 mg prevacid for gerds disease. My height was 5.7" and I now measure 5.6". I have a small frame and weigh about 138lbs. I fractured my pelvis 6 months ago in 4 places while riding a snowmobile which tipped over on it side while I was riding. My pelvis appears to have healed at this time.

I have had several blood test done and the results thus far show that I have a vitamin b12 deficiency, which I am taking injections every other day for two weeks and then monthly afterwards. I also had a 24-hour calcium test which showed high calcium content in my urine. I have been put on diazide and was given a blood test to check the parathyroid hormone levels. My estrogen level is 8.6 which shows that I am still premenopausal.

My older sister who is 41 had a bone density scan which shows mild osteopenia -1.00 spine, -1.3 hip. My mother who had polio as a child, also has Osteoarthritis since age 40. She is now 70 and hasn't taken any medications for bone loss or hormone replacement.

I have not had adequate calcium in my diet since childhood, but have supplemented calcium most of my adult life. I have had 3 children and breast fed each of them for 4-18 months each. My doctor originally felt that my bone loss was due to genetic traits which caused my body to not absorb calcium normally.

I wondered whether you feel my high calcium in my urine changes the cause from genetic. I have a son who is now 5 years old and had a spiral fracture in his femur at at 18 month from a tripping on his diaper as I was trying to tape it back up and also fell off a swing and fractured his collarbone at age 4. I am concerned whether there is any testing that should be done on my son, based on the above facts. Thanks for any comments, suggestions.

A: Your case is complicated. It sounds like your fractures were due to significant trauma, not necessarily osteoporosis. Having said that, the question must be asked if you have some other bone disorder, potentially hereditary. There are several conditions that lead to poor bone density, and I suggest that you get advice from an endocrinologist for a complete evaluation. Your comment about a history of poor calcium intake may be significant.

Fosamax is approved for postmenopausal osteoporosis, osteoporosis in men, and steroid-induced osteoporosis. I would get more evaluation. Hope this helps.


Q: I am 32 with osteoporosis (-1.5 spine -2.5 hips). I have been diagnosed at age 27 after I had my baby. I started Fosamax daily with calcium, a healthy diet and walking and weight bearing exercise and the yearly bone density test showed very little improvement. This year I had to stop it for 3 months due to gastritis, I had a gastroscopy that showed some inflammation in the esophagus which was treated with prilosec. After 3 months my stomach pain got better so my doctor started me again on the Fosamax the weekly one. My stomach pain was much better but I just got the results of my bone density and it is much worse. Spine -1.8 and hip -2.9. The first three years my test was done on Lunar machines but this year it was a different kind I think hallogenic or something like that, could that affect the results?

I have been referred to a rheumatologist last year which performed all kind of tests possible( parathyroid, 24h urine, vitamin D, n telopeptide, protein electro, estradiol, sedimentation rate-westergren, 25 hydroxy..) and all were normal. He concluded that there is no known reason for osteop. at my age. I have been healthy all my life with no medical problems and my periods have always been regular. I am considering switching to Actonel but wanted to know if it affects fertility because I want to have another baby before 35. My doctor doesn't know where to refer me this year, is there any where I can find doctors specializing in bone management? And can you give me your advice on my situation?

A: In the absence of prolonged use of prednisone, hyperthyroidism, etc.--a list of medial conditions and medications. Why even get a bone mineral density at age 32. You have not quite reached your potential peak bone mass. There is not an indication for the use of either Fosamax or Actonel. These compounds have a prolonged life span in our bodies and the effect on future pregnancy largely unknown. Comparing BMD at intervals of less than two years is usually unhelpful, as the differences in sensitivity of the test may overlap any real change. Also, if a study was done on a Lunar machine and then followed on a Hologic, a mathematical calculation must be done before any comparison can be done. I am not sure why a bone density was done in the first place. Some loss of bone density can occur during pregnancy but usually is regained.


Q: If a person has bone loss in mandible and maxilla, have there been studies that demonstrate any increase in bone mass in those areas after taking Fosamax or Actonel?

A: I am not aware of any such studies. The drug probably does work there but I have seen nothing in writing about this.


Q: I was diagnosed with ovarian cancer stage 3B almost three years ago, and have been in remission about 2 and 1/2 years now. My gynecologist ordered a heel scan a couple of weeks ago and that showed I have oeseopenia. I do not know any numbers at this time. Today I had the DEXA scan done. I see a doctor tomorrow. I thought it best to do as much research as possible on the internet before I see the doctor tomorrow and your web sight came up first on the list. My question is if this doctor puts me on Fosamax, do you know of any possibility that the drug might also stimulate any epithelial ovarian cancer cells that were not killed by chemotherapy and may just be in remission. The surgeons had left obvious cancer on my bladder when they did my cancer surgery in 1998. I would appreciate any insight you may have on this subject and I will also discuss this with my oncologist before I do anything different than what I have been doing these past three years.

A: There is no evidence that Fosamax will have any effect whatever on ovarian or other cancers. Whether or not you need Fosamax depends on many factors, not just a DEXA result. Make sure you discuss these with your oncologist.


Q: I saw on a program earlier this year that there would be a drug released later in 2001 that would build bone. This would be for sufferers of osteoporosis. Are you aware of this new drug? Please send me the name and manufacturer of this drug.

A: The drug is synthetic recombinant human parathyroid hormone which will soon be marketed by Eli Lilly and Co. as “Forteo”. It has been approved for marketing by the FDA last week but I doubt it is on the shelves as yet.

Please read the FDA Endocrinologic and Metabolic Drugs Advisory Committee Briefing on Forteo, a new drug in the treatment of osteoporosis; includes Medical Review Efficacy, Medical Review Safety, Statistics, Pharmacology & Toxicology Summary, Errata for Pharmacology & Toxicology Summary.


Q: I'm a 55 year old male who has osteoporosis. I would like to know if there is a new drug in the form of a shot for osteoporosis, if so when will it be out? Will it improve my osteo? I'm on Fosamax 70mg 1 time a week.

A: The drug is synthetic recombinant human parathyroid hormone which will soon be marketed by Eli Lilly and Co. as “Forteo”. It has been approved for marketing by the FDA last week but I doubt it is on the shelves as yet. It is uncommon for 55 year old men to have osteoporosis. Have you been carefully evaluated to find out why you have it?

Please read the FDA Endocrinologic and Metabolic Drugs Advisory Committee Briefing on Forteo, a new drug in the treatment of osteoporosis; includes Medical Review Efficacy, Medical Review Safety, Statistics, Pharmacology & Toxicology Summary, Errata for Pharmacology & Toxicology Summary.


Q: I have Osteopenia. I am perimenopausal. My doctor wants to put me on Evista, but I read that it was only for those who are in complete menopause. Should I take Evista or something else?

A: Evista is a good drug for preventing bone loss at the menopause. The main drawback for you is that it causes or aggravates hot flushes. Other drugs you could consider are estrogen (we often treat peri-menopause with oral contraceptives switching to postmenopausal estrogen after the menopause), Fosamax, or Actonel.


Q: I am 59 years old and recently had my first dexascan. I was very surprised and upset about the results as I have taken estrogen and calcium supplements since menopause. My left hip T score was -1.87 and my Z score was -0.33. My L spine T score was -1.15 and my Z score was -0.11. I was told that I do have osteoporosis. I asked about treating this with Fosamax as I have heard good reports of increased bone density with this medication; however, my physician did not want to prescribe this and instead increased my premarin from .625 mg to 1.25 mg.. He also prescribed Rocaltrol .5mcg and advised that I increase my calcium supplement to 1500mg / day. I am concerned that this is not going to increase my bone density and risk and I am also concerned regarding getting too much Vitamin D and/or Calcium. Please comment regarding the best treatment for osteoporosis in your opinion in your opinion and your opinion regarding the treatment prescribed for me.

A: Whoa! Slow down! YOU DO NOT HAVE OSTEOPOROSIS based on what you have told me. The diagnosis of osteoporosis is made when the T score is lower than –2.5. You are not there.

Since this was your first DEXA study we have no way of knowing if your T scores were ever better than –1.87 or –1.15. Fifty percent of all perfectly healthy normal women enter menopause with a negative T score. Sixteen percent of perfectly normal, healthy women enter menopause with a T score between –1.0 and –2.0. It is entirely possible, and in fact quite likely that the Premarin 0.625 is doing its job very well.

My advice: Have your doctor measure a marker of bone resorption which is generally a urine test, although blood tests for this are becoming available. If your values are in the range for premenopausal women, you are doing just fine. If they are in the range for postmenopausal women, you would benefit from more Premarin, probably the 0.9 dose.

Another option is to just stay with your Premarin 0.625 and repeat your DEXA one year after the first DEXA. My guess is that it will not have changed.


Q: I am a 30 yr old female with osteoporosis. I was diagnosed about two years ago, and my doctor told me that I have the bones of a 60 yr old. I have also been unable to get pregnant. I have had an ultrasound and an HSP, and both were normal. I have also tried Clomid, and it did not work. All tests seem to show there is nothing wrong, but I have not been able to get pregnant in the two years we have been trying. Therefore, I am wondering if osteoporosis can affect fertility?

A: Osteoporosis does not affect fertility but many of the reasons for infertility might contribute to osteoporosis. If you are not being cared for by a gynecologist who is additionally certified in reproductive endocrinology, I would recommend that you get a referral to a reproductive endocrinologis>.

References

**Note: Opinions expressed here are for educational purposes only and, as such, do not constitute a physician patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.
 
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