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Osteoporosis Ask The Expert |
| Q: Is the treatment for Osteoporosis different for males than females? |
| I am a 67 year old male. Recently by x-rays of my back, it was stated in the report that I have osteoporosis . In a phone conversation with my primary physician's assistant, he stated that I should be on hormones, but that he would have to run it by the primary physician. Since that time, and this was at thanksgiving, I have tried to make contact, by phone to the primary physician. I was told, by office personnel, that I should make an appointment to discuss the situation. My question is, why is it necessary to discuss treatment face to face? Can't he advise me by phone? What is necessary? My schedule is very irregular and also why the extra expense for an office visit just to say here is what you do and if a prescription is necessary, can't he call it in as has been done on other occasions. I would like to know also, isn't it rather uncommon for a male to have this condition? Could you tell me what is the usual treatment in this kind of situation? |
| Answer from Dr. Bianchi |
| Osteoporosis (OP) is much less common in men than in women,
but is on the increase. In many cases male OP is secondary to a cause that must be sought. When possible, curing
the cause means curing the secondary disease. Likely causes are intestinal malabsorption, hypogonadism, chronic
corticosteroid therapy, alcoholism, hyperthyroidism, hyper or hypoparathyroidism, and many more. In general, the
first steps for OP therapy are: high calcium diet (1500mg/day), vitamin D supplement (if required), physical activity
(e.g. brisk walking 30 minutes a day), low alcohol intake, little smoking. It may be necessary to add a drug, but
this should be evaluated by a doctor. Hormones are generally prescribed for OP only in case of hypogonadism (low
testosterone levels). Generally, a phone call is not enough to get complete information and give a therapy. A patient
must be seen and some blood and urine tests may be needed before prescribing a specific drug. Maria Luisa Bianchi OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Question about progesterone for the treatment of Osteoporosis and Osteopenia. |
| I have been recently diagnosed with Osteopenia. I had a vaginal hysterectomy
at age 28 and removal of ovaries due to cyst at age 42 - 10 years ago. I started on Premarin after removal of ovaries.
I now take 0.625 daily, 1500 mg of calcium, 800 mg Vit D and exercise daily. At doctor's recommendation I tried
Fosamax but could not tolerate. I am now continuing with Premarin and also Miacalcin Nasal Spray. I have recently
seen some information on Progesterone cream therapy for osteoporosis and osteopenia treatment. The past research
I have done (plus my OB/GYN doctor) said there was no need for progesterone therapy if the uterus and ovaries are
not intact. Is this progesterone therapy for osteoporosis valid? It concerns me that it is being recommended as
an over-the-counter medication and would want to discuss with my doctor but I would like your opinion before I
do. Thank you Linda |
| Answer from Dr. Bianchi |
| As far as I know there is little evidence of a direct effect of progesterone
on bone. Progesterone therapy is not presently recommended for osteopenia or osteoporosis. Your doctor is correct
to say that there is no need for progesterone after hysterectomy. Estrogens (premarin) are protective for bone,
and you should check if your calcium + vitamin D + premarin keeps your DEXA values stable in time. Only if your
bone mass is still decreasing you may think about changing your therapy. Physical activity is also good for bone. Maria Luisa Bianchi OBGYN.net Osteoporosis, Editorial Advisor |
| Q: What is Osteoporosis? |
| Two high school biology students are seeking information on the definitions, diagnosis and treatments for Osteoporosis. Dr. Bianchi has answered with an informative and educational response for all. |
| Answer from Dr. Bianchi |
| I will try to give you some general info. Osteoporosis (OP) is a disease
of bone tissue which commonly affects women after menopause. There are other causes of osteoporosis, but less common.
The scientifically accepted definition of OP is: "a systemic bone disease characterized by low bone mass and
alterations of the micro-architecture of bone tissue, with a consequent increase in bone fragility and susceptibility
to fracture risk". Bone is a very active tissue during all our life. It is continuously destroyed and rebuilt.
During childhood and adolescence bone formation is predominant over bone resorption, so that our skeleton grows
in length and weight. The maximum value of bone mass (peak bone mass) is reached around 20-25 years of age. Thereafter,
in the adult age, there is a period of equilibrium with little change in bone mass. At a later point, a slow decline
of bone mass begins. This phase starts around menopause in women (because of decrease of estrogen levels) and some
time later, around 60-65 years of age, in men. This may be a limited loss without consequences, but in some people
(currently, about 1 woman in 4, or 1 man in 10) the reduction in bone mass is much more than normal and may reach
the point which is called osteoporosis. People with OP have a greater risk of fractures , even after minimal trauma
(that's why they're called "bone fragility fractures"). Most commonly, these fractures occur in the spine,
wrist or hip. Osteoporosis is diagnosed with a special X-ray method called bone densitometry or DEXA. Regarding
prevention of OP we have two main aspects. The first one is for us all, and should begin as early as possible.
The key points are two: a correct dietary intake of calcium and a regular physical activity (walking, running,
dancing, etc. - everything that's done against gravity). There are recommended levels of calcium for each age (e.g.
1 g/day in the child, 1.5 g/day in the adolescent, 1 g/day in the adult). Calcium is essentially found in dairy
products (milk, yogurt and cheese). People who cannot eat such food (or other calcium enriched food, such as soy
milk or soy cheese) should be given calcium supplements. Vitamin D is important to facilitate calcium absorption
in the intestine. Vitamin D is formed in the skin upon exposure to daylight. In the good season, it's very important
to stay outdoor every day with some skin exposed. Older people should do the same, but they may be given calcium
supplements, or vitamin D supplements, especially if they can't eat enough calcium in the diet, or don't stay too
much outdoor. When a person has developed osteoporosis, this kind of prevention is not enough. Such persons should
prevent the further progression of the disease, and also prevent its compliance, such as fractures. So they should
be very careful in their daily activities to avoid bone trauma (e.g. falls, weight lifting, sudden bone strain).
Beyond calcium, vitamin D, physical activity, most of them will be given some specific drug to help maintain their
bones as strong as possible. I hope to have been helpful. You may also try to contact the National Osteoporosis Foundation (USA) or the National Osteoporosis Society (UK, www.nos.org.uk) to obtain further information. Maria Luisa Bianchi OBGYN.net Osteoporosis, Editorial Advisor |
| Q: What foods will help the fight against osteoporosis? |
| I am currently taking Evista and Fosamax 1 x daily. I am 55 and I do not
have any symptoms, but my bone density test is low. I would like to know if I can eat certain foods to increase
my calcium instead of taking these expensive drugs. I was told soy milk, sardines, tuna, salmon and broccoli would
help. Are there any more foods that might help. Also, will these foods help without having to take the medications
or do I need to take them together and for how long. Doctors seem only to know about medications. I am interested
in food alternatives. I also know exercise is good. I need to do that. Thank you. Diane |
| Answer from Dr. Bianchi |
| 1. if you have osteoporosis, dietary calcium alone is not enough, and a
drug may be required. 2. Evista and Fosamax, although quite different chemicals, have a very similar action on bone (inhibition of bone resorption). You should ask your doctor why he thinks it is necessary to take both of them together. In most cases of post menopausal osteoporosis one drug should be enough. Both Evista and Fosamax have been shown to have positive effects on bone (prevention of fragility fractures). 3. the diet should be high in calcium (at least 1.2-1.5 grams a day). The richest food are dairy products (milk, yogurt, cheese) - even low fat - are very rich in calcium. Soy milk is also OK if calcium-enriched. Sardines, tuna, broccoli, etc. are not as rich as milk. You should easily find a table with the calcium content of most foods. 4. dietary calcium should be high indefinitely. Drugs are probably also to be taken for a long time, checking the results on bone mass with DEXA (at intervals of at least 12 months). Current drugs only block the evolution of osteoporosis, do not heal it. 5. physical activity is also good for bone, e.g. brisk walking 30 minutes a day. Maria Luisa Bianchi OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Question about test results |
| I am 39, premenopausal, and have been on synthroid for 12 years. My DEXA
scan reports the following: L-spine: T score= +2.01 Z score = +2.20 Hip: T score= +0.13 and Z score = +0.28 Radius/ulna
: T score= -0.07 and Z score = +0.26 Should I be worried about my L spine being high or my radius being negative?
Thanks Karen |
| Answer from Dr. Bianchi |
| You should not worry about either. Both values are good. T-score is a statistical
evaluation of the value of bone mass with respect to that of healthy young people. By international agreement,
osteoporosis begins when the T-score is strongly negative (-2.5 or less). Bone mass is generally affected by hyperthyroidism,
not hypothyroidism. Maria Luisa Bianchi OBGYN.net Osteoporosis, Editorial Advisor |
| Q: What can I do to help the pain? |
| I am 35 years old and was diagnosed first with premature menopause at the age of 19. In 1999 I found out that I now have osteoporosis and arthritis of the spine and hip. I am currently taking Fosamax and Vioxx. I live in pain almost every day. Sometimes it is so bad it is hard to walk around or just sit for long periods of time. I do not want to take pain medicine if necessary. What do you suggest for the pain? I have tried creams, rubs, ointments. And about every kind of aspirin you can buy. Thank you for you time. |
| Answer from Dr. Bianchi |
| Fosamax does not immediately or directly reduce bone and joint pain, but
as it strengthens the bone, it may reduce pain with time. When pain is strong, maybe aspirin and aspirin-like drugs
(NSAIDS) alone are not enough, and you may ask your doctor and try aspirin or acetaminophen PLUS codeine or oxycodone.
In the U.S., there are different trade drugs with these formulae. Since you may not be only an occasional user,
do take NSAIDS only in the dosage prescribed by your doctor, as they may have side-effects if taken too often.
If pain is mainly due to inflammation (arthritis), sometimes non drug treatments may be effective: - physical-kinetic therapy - TENS (transcutaneous electrical nerve stimulation) - ultrasound treatment - microwave or shortwave diathermy - acupuncture A rheumathologist should help you to choose the best for you. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Asthma drugs and Osteopenia |
| I'm 22 and last year I had my first BMD test done... result? Osteopenia.
I can't recall the exact numbers, but I know the head of my femur was worse than my spine (I think the numbers
were T -1.8 and T -1.4). At that time I was also experiencing muscle fatigue and as always, my feet hurt... In
the past five years I've been diagnosed with possible stress fractures behind the big toe of both feet. Last year,
some random blood work also showed somewhat low platelet and WBC counts, so I visited a hematologist who monitored
those levels for over a month and determined that there's a cyclical pattern that sometimes drops below "normal".
An ultrasound also showed no evidence of abnormal organs. Since my low BMD could have been contributed to amenorrhoea
when I was a young teen, the muscle fatigue was investigated instead - by a nueromus cellular specialist. A muscle
biopsy, some other tests and crazy amounts of blood work were done, but there wasn't enough for a diagnosis. In
the end, I started taking cretin (1/2 tsp/day) and a multi-vitamin to increase my vit B12, vit D and folic acid.
I should also note that I saw a dietitian 3 times to ensure my diet offered sufficient calcium and started drinking
more soy milk . I have a list of food intolerance and allergies which mean my diet is vegetarian (no animal products
incl. milk and cheese) plus I eat chicken and fish, but no rice or yeast. With 600 mg/day in supplements, my daily
intake of calcium ranged from roughly 1100-1500 mg/d. I also replaced my competitive swimming (injured shoulders)
with biking (a lot!!), low impact aerobics (when my feet could stand it) and walking instead of taking the bus
more often. I thought I was on my way to turning things around! But after this years test, it doesn't look like
I"I've gotten anywhere. With the error involved in BMD testing, the -.3% change in the density of my spine
is negligible. But in my femur, the loss was 1.9%. All of this in a year plus 1 week!! How can this be explained.
When tested last year, my estrogen levels were normal, and since bones weren't the focus I wasn't put on the pill.
But what now? I have had asthma and for 7 years. I took uniphyl until I was getting all of migraines, crazy reactions
to foods, hallucinations and frequent tremors. At that time I started taking pulmicort (4x400/day) and took it
until last spring (2 years) when it was replaced with flovent (4x250mcg/d) since it contains less corticosteroid
and might not be as bad for my bones. It seems like no one knows what's going on, especially me! I would really
appreciate some suggestions for where to look for more information or where to go for help! Sorry this is so long... Lauren |
| Answer from Dr. Bianchi |
| Your picture is not completely clear. What caused your amenorrhoea,
and how long did it last? Long-lasting lack of estrogen may have contributed to your osteopenia, especially during
adolescence (the period of greater bone growth). Chronic therapy with corticosteroid drugs may also have negative
effects on bone, in particular on the spine. Maybe, you should ask your doctor and try some other anti-asthma drugs,
with no corticosteroid. Sometimes, corticosteroid therapy induces a deficit of vitamin D, so you may do a check
for 25-OH vitamin D in your blood. Regular physical activity and a correct calcium intake (1,1-1,5 g/day is OK)
are key requirements in your condition. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Can Fosamax and Tamoxafin be used together? |
| I would like to know if and fosamax can be used together for osteoporosis. I had a breast cancer operation in 1995 and still on Tamoxafin |
| Answer from Dr. Bianchi |
| Livial (tibolone) has complex sex-hormone effects, and you should ask your
cancer specialist if it can be used after your breast cancer. You should also ask your doctor if there are specific
reasons for you to use this drug. Personally, I wouldn't prescribe it in your condition. Fosamax (alendronate)
is currently one of the most widely used drugs for the prevention of osteoporosis fractures. It reduces bone resorption
in a way much similar to estrogen, but is not an estrogen and has no effects on other organs, such as breast. In
general, there is no need to use alendronate together with hormone replacement therapy, although there are no contraindications.
Raloxifen a new drug in the class of Tamoxafin, has been proven to reduce post-menopausal bone loss, and it may
have also an effect in the prevention of breast cancer relapse (there are ongoing studies about this). Moreover,
there is some evidence that Tamoxafin has some effects in reducing bone loss. Maria Luisa Bianchi,M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Decrepititus and the cracking joints. |
| Hi. I am a 46 year old women in good health. I exercise regularly and lift
weights a bit. In the last several years I notice that my neck, back, shoulder area cracks a lot. I don't know
why it does it. A massage therapist told me it was "decrepititus". The term made me laugh, it sounds
like old and decrepid. But could this have to do with loss of bone mass or osteoporosis. No one in my family had
or has this condition. I take calcium and vit D and was a big milk drinker as a child. How can I find out more
about this? It doesn't stop me in any way---it's just strange. Thank you. |
| Answer from Dr. Bianchi |
| Crepitus is a common sign of joint motion, and it generally has little significance.
It is not related to osteoporosis. Regular physical activity and correct calcium intake are the key elements for
prevention of osteoporosis. After menopause, you could ask your doctor if it's better to have a DEXA bone scan
to measure the calcium content of your bones. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: What are best treatments for Osteoporosis? |
| I am a 51 year old white female non smoker. I had a hysterectomy
at the age of 27 and have battled HRT for many years never finding the right therapy for my body. The best HRT
has been with monthly injections of . I have been diagnosed with osteoporosis. I also have Lupus and Hashimoto's.
I am a vegetarian and I am not taking any Rx for the osteoporosis yet. I would like your advice as how to deal
with the above situation. I also have arthrofibrosis and am dealing with it very poorly i.e.. 2 total knee replacements
(same knee) in two years and now facing yet another one. Please help me. Thank you Eileen |
| Answer from Dr. Bianchi |
| I don't know what "testereone" is. I don't believe
it is "testosterone" - a male hormone - because I don't know of any use of it for HRT in women. For osteoporosis
you should eat a lot of calcium (1.2 grams a day; it is found in milk and dairy products). Or take a calcium supplement,
if you can't eat milk. Specific drugs (e.g. alendronate) can be prescribed on the basis of bone mineral density
(measured by DEXA scan). If you take cortisone for the lupus, you should have extra care for your bones. Maybe
your vitamin D levels should be evaluated and, if low, a supplement will be helpful. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Effects on a fetus while taking Fosamax. |
| I'm 36, was diagnosed with Osteoporosis 6 years ago and have been taking
Alendronate sodium for the past five years. I see my doctor for a check up once a year. He's always said that trying
for a baby wouldn't be a problem as long as I came off the medication 3 months before attempting to get pregnant.
But at my most recent check-up he told me that Alendronate sodium has been found to have a much longer half life
in the body than previously thought. He also said that Fosamax was usually only prescribed to post- menopausal
women. He explained that he had been unable to find any research which told him how long this medication stays
in the body after you've come off it. I'm aware that I'm no longer terribly fertile at my age, but does this mean
that I now can't even try for a baby because the accumulation of five years on Fosamax would damage the fetus?
Is there anyone out there who knows anything about this area or who could point me towards the right books, papers,
research institutions or doctors so I could find out more about the possible risks? Thanks, Lore |
| Answer from Dr. Bianchi |
| There are no definitive data on alendronate and pregnancy. It is recommended
not to take alendronate during pregnancy, because it would pass from the mother's blood to the fetus across the
placenta. Alendronate gets sequestered in the bone for a very long time, possibly life time, but it is unlikely
that this "buried" drug has any effect on tissues other than bone. It doesn't circulate in the blood
for long. Alendronate is generally used by post-menopausal women, those most likely to be affected by osteoporosis,
and there's no experience, to my knowledge, of use in young women who got pregnant thereafter. According to pharmacological
studies in animals, alendronate is not teratogenic. Probably coming off alendronate 6 months before getting pregnant will be safe. If I can find other relevant data in the literature I will let you know. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Would you at this point also recommend Fosamax? |
| I am 45, three years post op for a TAH/BSO. Have been taking Estratab, Estratab
hs, and prometrium, from the 6th month post op date. Last year, after reading how much more common osteopenia is,
than previously thought, I asked for and received a DEXA scan. Results revealed osteopenia. (lumbar spine -1.8,
Femoral neck -1.9) This year I had a repeat scan, which showed an additional 10 loss. I have since added chewable
Tums to my regimen, 500 mg twice a day. Though I've read that calcium citrate is absorbed better than carbonate,
I'm much more compliant with the chewables. Any other suggestions? Would you at this point also recommend Fosamax? Joanne |
| Answer from Dr. Bianchi |
| If -1.8 and -1.9 are the T-scores, this means that you have osteopenia,
which is stable. You're already on hormone replacement therapy, so it's not necessary to add other drugs for the
moment. OK for chewable Tums, 500 mg twice a day. Have regular exercise (e.g. brisk walking at least 30 minutes
a day). Have another DEXA next year. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor |
| Q: Does depo-provera have a marked effect on a 39 year old woman who has an osteo problem and has begun to take Fosamax? |
| Does depo-provera have a marked effect on a 39 year old woman who has an osteo problem and has begun to take Fosamax? Is there another chemical birth control available to her or do you feel that she can still be on depo-provera as she has shown improvement on Fosamax in as little as 3 months? |
| Answer from Dr. Bianchi |
| There are no conclusive data about the influence of progestins on bone.
Of course, there are other kinds of contraceptive pills, ask your gynecologist. 3 months are too short a time to
evaluate bone mass changes with Fosamax. Generally 10 to 12 months of therapy are required to have reliable data. Maria Luisa Bianchi, M.D. OBGYN.net Osteoporosis, Editorial Advisor **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. |
