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Osteoporosis Ask The Expert |
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Q:I am a 40 yr. old white female of small stature. My osteoporosis is believed to be the result of prolonged use of steroids in the treatment of my lupus SLE. I have had two successful pregnancies. Following the second pregnancy, I noticed significant back discomfort and the loss of height. A bone density exam showed that overall I was about 3 standard deviations out from the norm! Further tests revealed that all five lumbar vertebra had loss significant bone mineralization as had two thoracic vertebra bodies. All seven vertebra are now stabilized by vertebroplasty procedures completed four years ago. The overall loss of height is 2 1/2 inches in the spine. I have been on Fosomax for about three years and off the steroids completely for a year! The most recent bone density exam shows a 6% favorable change in my overall results. My lupus remains under control with the use of Plaquenil and Naproxen. Must noticeable symptoms are the Raynaud's and fatigue. I have resumed most if not all of my activities following this near disability. I want very much to have another child. Realistically, I know that my family & I have been through a lot already. Because of this I am seeking out knowledgeable people and resources to evaluate my options. Can you help give me some direction and things to consider? |
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| A: A few points - first, Fosamax is Category C, meaning "chance of fetal harm exists, but must weigh risk/benefit; either no human studies were done or animal studies were unsafe or not done". With this in mind and with it considered "Not Safe" with lactation, Fosamax would probably have to be discontinued. Other potential problems are the pressure caused by a full term pregnancy on the seven verterbrae that underwent vertebroplasty. Whether they would stand up under the strain is debatable and I know of no studies regarding this. Postural changes with pregnancy can be quite severe in some. A final point is a concern about the Systemic Lupus Erythematosus (SLE). Plaquenil is similarly a Category C drug with attendant potential risks. SLE can also involve the kidneys and depending upon your renal function prior to pregnancy, there may be a deterioration in your condition. The Raynaud's is usually peripheral but one would have to maintain a level of concern about the potential for circulatory reduction with respect to the uterus and the pregnancy. To be fully evaluated for a potential pregnancy, you would need to have the orthopedic surgeon, the rheumatologist and a maternal-fetal medicine specialist confer and discuss the risks of such an undertaking. The risks would obviously be referring to both you and the baby. |
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| Q: I am a physical therapist and I've recently been questioned whether it is safe to use ultrasound as a modality for capsule stretching in a patient with a history of osteoporosis. I am not aware that it is a contraindication, please advise. Thank you. |
| A: Not being a physical therapist, I am not well versed in capsule stretching. That being said, there is no physical therapy modality that should cause problems to a patient with osteoporosis, presuming excess pressure is not put on any osteoporotic bone. There was no data on this topic in a Medline search. You may wish to ask local orthopedists or chiropractors about their experience. |
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| Q: Could you take seven fosomax pills [10 mg.] one day a week as safely and effectively as the one tablet daily. I have been taking fosomax since 1996 without any side effects and with positive results. |
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| A: There is a new 70 mg Fosamax pill taken once a week, available November 16, 2000. It's just as effective as taking 10 mg a day with no more gastrointestinal complaints than placebo. |
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| Q: When is it "too late" to treat with Didronel/Fozamax, or to begin HRT? Can Didronel or Fozamax in itself, (along with diet, exercise, etc) improve and retain bone density in a person with a T score at present of -1.9 (age 51)? How much of an influence is caffeine intake on the prevention of absorption of calcium? Is it true that coffee with milk will cancel each other out? If one is to take calcium and magnesium at the approriate doseage of about 1200 to 1500 mgs per day should it be all at night for best absorption, or spread out through the day. Raloxifine seems a poor brother as treatment with its own risks of blood clotting and potential of increasing hot flushes, is there any other med at this time? If I decide to take HRT is there a plant based estrogen-progesterone combo with minimal risks? What are these? What are the known stats on HRT therapy related blood clots, breast cancer? If one has fibrocystic breast disease along with very dense breasts is there an increased risk of Ca with HRT Rx, or just in difficulty diagnosing? |
| A:
This question is so rich with potential information, I'm going to
re-quote the question and answer each part separately.
When is it "too late" to treat with Didronel/Fozamax, or to begin HRT?
Can Didronel or Fozamax in itself, (along with diet, exercise, etc) improve and retain bone density in a person with a T score at present of -1.9 (age 51)?
How much of an influence is caffeine intake on the prevention of absorption of calcium?
Is it true that coffee with milk will cancel each other out?
If one is to take calcium and magnesium at the approriate doseage of about 1200 to 1500 mgs per day should it be all at night for best absorption, or spread out through the day?
Raloxifine seems a poor brother as treatment with its own risks of blood clotting and potential of increasing hot flushes, is there any other med at this time?
If I decide to take HRT is there a plant based estrogen-progesterone combo with minimal risks? What are these?
What are the known stats on HRT therapy related blood clots, breast cancer?
If one has fibrocystic breast disease along with very dense breasts is there an increased risk of Ca with HRT Rx, or just in difficulty diagnosing?
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Q: I am 36 and have osteoporosis in my spine. My score was -2.8 for my spine, but above normal in my hips. I have never taken steroids or any other drugs, am fairly active, and not underweight at all. I was hospitalized for malnutrition as a 5 year old, and was not cared for by my biological family. Could these factors contribute to never having enough bone in the first place? I have not been diagnosed as early menopausal, but the dr. is testing my hormones, as I have never had regular periods. Are there other causes for osteoporosis? |
| A: The malnutrition and irregular periods may be playing a part here. You would probably do well to see an osteoporosis expert to help determine the origin of the osteoporosis and if there is a more insidious cause, to correct it. 1000 mg of calcium in split doses of no more than 500-600 mg per dose is recommended along with the Vitamin D you mentioned. Many experts feel calcium citrate is better absorbed but this is not universally acknowledged. There may also be a lower incidence of kidney stones with calcium citrate, understanding that the rate of stone formation with any calcium supplement is quite low. Rather than high impact exercises known to increase the risk of fracture, I'm sure your doctor meant weight bearing exercises to build or maintain bone mass. Without other risk factors noted above, medications are not indicated at this time. |
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| Q: I am 37 years old and have just been diagnosed with osteopenia. My doctor has recommended I do more high impact exercises as well as take 1000 mg of calcium and 400iu of vitamin D daily. My question is ...what type of calcium is best? I have heard that calcium citrate is better than calcium carbonate, and how much should I be taking. Should I also look at other medications or should I wait ? What are the risks of other medications, especially at my age. I have not yet entered menopause. I would appreciate any info you can give me on osteopenia. Thank you. |
| A: It's not clear at all why a 37 year old would have even had a bone density done to diagnose osteopenia. Be that as it may, the two theories are bone loss versus bone never gained. At 37, barring long periods of amenorrhea, long term steroid use, thyroid abnormalities (usually not well controlled), malabsorption syndromes and some other possibilities, it's probably of the "never gained" category. 1000 mg of calcium in split doses of no more than 500-600 mg per dose is recommended along with the Vitamin D you mentioned. Many experts feel calcium citrate is better absorbed but this is not universally acknowledged. There may also be a lower incidence of kidney stones with calcium citrate, understanding that the rate of stone formation with any calcium supplement is quite low. Rather than high impact exercises known to increase the risk of fracture, I'm sure your doctor meant weight bearing exercises to build or maintain bone mass. Without other risk factors noted above, medications are not indicated at this time. |
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| Q: After taking Fosamax for 1 1/2 yrs. I developed esophageal/stomach problems. I am reluctant to try it again. When I stopped the Fosamax last July, I haven't taken anything for bone loss since then and the latest bone density scan showed I've lost bone since a year ago. I am taking a diuretic for Meniere's syndrome and I'm wondering if it could be a factor in the loss (even though I was taking it the first year of taking Fosamax and still built bone). (The diuretic I take is 1/2 tablet of Triamterene and Hydrocholorothiazide 75mg/50mg, daily) I cannot take HRT because the estrogen causes the dizziness and vomiting episodes of Meniere's. My doctor has said I could take once-a-week Fosamax but I'm afraid to take it. Could it be that even if I take Fosamax again, that it can become ineffective in its ability to build bone? My doctor is waiting for me to tell him what I'm going to do and I haven't been able to decide. |
| A: The once a week Fosamax 70 mg pill has been shown to have the same gastro-esophageal irritation as placebo. It seems that taking it once a week is totally different than taking it 7 times a week (regardless of the dose of the pill). Other options would be Actonel, a "cousin" of Fosamax, and Didronel, a distant cousin of Fosamax. Miacalcin, although not as "accomplished" as the above noted medications, may also be a good choice. Since you gained bone mass with Fosamax AND the diuretic and then lost once the Fosamax was discontinued, it appears the diuretic is not related to your problem. |
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| Q: I had breast cancer 11 years ago at the age of 36. After chemotherapy I went into menopause. My last period was in 1990 when I was 37. Last year I had a bone density done and they found that I had quite a bit of bone loss. My doctor put me on Fosmax. I have been taking it for about 6 months. I have recently noticed that my hair has become very thin. I think it is due to the fosamax. I am not taking any other medication. What can I do to reverse the hair loss and to prevent it from continuing? |
| A: I have no personal knowledge of hair loss associated with Fosamax. I did a literature search which failed to show any proven or known association. The Physician's Desk Reference does not list alopecia (hair loss) as a side effect or adverse reaction of Fosamax. Given these sources of information, this appears to be either a dermatologic problem or a hormonal one. A dermatologist would be recommended to evaluate your possible options. |
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| Q: I am a 49 year old premenopausal woman just diagnosed in September with osteoporosis. I don't have my numbers, but the dr. said that unless we can stop the bone loss, I'm at risk for spontaneous fractures by the time I'm 60. I tried Fosomax but was unable to take it due to esophogeal problems. I am currently taking Miacalin. I eat well, exercise, don't smoke, did not have a late menarche, but am a thin Caucasian with a family history of osteoporosis. I have just sustained a stress fracture in my hip. I am really curious as to any information on osteoporosis in premenopausal women - everything I read describes it as a postmenopausal problem. I also have a history of calcium kidney stones. We have checked for parathyroid function, which seems to be normal? |
| A: I'm presuming that as a 49 year old, you had a bone density done to diagnose osteoporosis due to the stress fracture you noted. The two theories on osteoporosis are bone loss versus bone never gained. At 49, barring long periods of amenorrhea (sometimes associated with high levels of exercise in thin women - especially in the teen years), long term steroid use, thyroid abnormalities (usually not well controlled), malabsorption syndromes and some other possibilities, it may be of the "never gained" category. Family history certainly can play a big role here as does your body habitus (thin). 1000 mg (if you're on other medications as well for osteoporosis) of calcium in split doses of no more than 500-600 mg per dose is recommended along with the Vitamin D . Many experts feel calcium citrate is better absorbed but this is not universally acknowledged. There may also be a lower incidence of kidney stones with calcium citrate, understanding that the rate of stone formation with any calcium supplement is quite low. Weight bearing exercises to build or maintain bone mass are better than many other high stress exercises. Please see some of the other responses this month regarding this and related topics. A new dose of Fosamax (70 mg) is not any more irritating (once a week dosing) than placebo. You may wish to speak to your doctor about Actonel as well. |
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**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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