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Osteoporosis Ask The Expert |
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| Q: I am a 62 year old woman diagnosed with osteoporosis since 1992. I have bone density tests every 2 years and it's getting steadily worse. My sister was diagnosed with breast cancer after being on the Climara 50 patch for about one year, and I am terrified of breast cancer. I have been unable to tolerate large doses of calcium because of severe constipation. But now take 1500 Calcium (soluble, fizzy type tablet) and have no problems with constipation. I've been taking Raloxifene for about 3 months and seem OK but have hot flushes. In May 2000 I tried Fosamax, but had severe gastrointestinal problems. When I stopped Fosamax all these symptoms disappeared. Doctor says there is a once a week 70mg Fosamax pill becoming available and I should try this. I have just heard about Tibolone and don't know if this is "the answer". Do you think the Fosamax 70 would be tolerated better and should I continue with Raloxifene? Any other suggestions would be greatly appreciated. |
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| A: The once a week Fosamax does not seem to be associated with the gastrointestinal complaints of the daily dosing and may be very good for you. Similarly, Actonel taken daily has not had the gastrointestinal complaints attributed to daily Fosamax. With your concerns about breast cancer, Evista (Raloxifene which you are already on) is also a good choice and may reduce the risk of breast cancer. Tibolone is not available in the US at this time (expected in the next 2 years) but early reports from Europe say it's the best thing "since sliced bread". |
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| Q: What is the difference in osteoporosis and osteoarthritis? What can one do to slow down the process? What is osteopenia? |
| A:
Osteoporosis is a "thinning" of the bones or lower density of
bones leading to an increased risk of fracture. There are no symptoms
unless a fracture occurs.
Osteoarthritis is the common arthritis we normally speak of and can be
very painful. These two entities are unrelated.
Slowing down osteoporosis involves adequate calcium, adequate Vitamin D,
weight bearing exercises and appropriate medication if necessary.
Osteopenia is less bone loss than osteoporosis.
Feel free to peruse the Osteoporosis section and previous answers for
more complete information on these topics.
Please see the OBGYN.net Osteoporosis Archive of Articles for Woman and Patients. |
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| Q: Is
there any research which shows a correlation between asthma sufferers and
inhaler users and bone loss? |
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| A: If by inhaler you mean corticosteroid drugs (beclomethasone, betamethasone, etc.), there is an increased risk of osteoporosis with prolonged therapy at any age (for example, see Lancet 29 July 2000, there are many papers). Other kinds of inhalers (albuterol, aminophylline etc) are not connected with bone loss. |
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| Q: What do you think about the HRT in patients with breast cancer using tamoxifen, and with vasomotor complaints and osteoporosis? |
| A: HRT should not be prescribed in a woman with breast cancer. You can treat osteoporosis with a bisphosphonate (alendronate or risedronate). During tamoxifen therapy for breast cancer in post-menopausal women, a lesser decrease of bone mass than expected was observed. Such data were the starting point to develop other SERMs with a more potent action on bone, and now we have raloxifen, which is now considered a good therapy for osteoporosis. The studies on the prevention of breast cancer with raloxifen are not concluded, however in treated women the incidence of breast cancer was significantly lower than in placebo women. Raloxifen has a more important effect on bone loss than tamoxifen. Regarding the problem of vasomotor complaints - I suppose you mean "hot flashes" - both tamoxifen and raloxifen may increase this symptom, especially at the beginning of treatment. |
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Q: I am a 5'7" Caucasian with a slim build and very fair skin. After recovering from a decade-long struggle with anorexia, I was told that I had osteopenia at 28. I increased my calcium intake and added weight-bearing exercise, but did nothing else for treatment. My mother has osteoporosis, as did her mother before her (a severe case requiring a permanent back brace to stabilize degenerated vertebrae). At age 32, I had twins, who are still nursing at 13 months. One twin is dairy intolerant to the point that he reacts to my breastmilk if I consume dairy in my diet. As a consequence, I have had no dairy for 9 months. Although I have been careful to take more than 2000mg of calcium citrate per day, a recent bone densomitry test shows I have lost even more bone mass and have a T score of -2. My physician wants to put me on Fosomax. My questions are these: 1) Is Fosomax contraindicated during breastfeeding. 2) If so, why? 3) Breastfeeding is very important to me, because I feel the closeness it engenders helps counteract some of the lack of attention that each twin must necessarily endure due to 'twinship'. I am reluctant to give it up. Even so, do you recommend doing so? 4) I am hoping that they will wean gradually at their own pace over the next few months. Do I have the luxury of that time, or do you feel I should pursue treatment immediately? Thank you for your answers. |
| A: 1. At your age, with your personal and family history, and with your low bone mass at -2 T-score, you must be very careful to avoid further bone loss. Breast feeding means a heavy daily loss of calcium, and 13 months, for two babies, is a very long time. I think you should be active in weaning them, and the sooner the better. It's possible that you will recover some bone mass after weaning. 2. It is not known if Fosamax (alendronate) is excreted in milk, so it should not be used during lactation. You must wean your babies before taking it. |
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| Q: I am 48 years old female using Fosamax for 6 months. I also have Adrenal Exhaustion and am on the supplements Pregnenolone, ACE and DHEA. I have two questions. First, would Fosamax have any adverse effects on my Adrenal exhaustion? And secondly can I use it together with the above supplements? Thank you in advance. |
| A: As far as I know, there is no direct or indirect effect of alendronate on the adrenal gland, nor interactions with the drugs you take. |
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| Q: I have a 75 year old healthy patient with a mild expression of bone Paget disease. Could I propose raloxifen? |
| A: There are no data on the effects of raloxifen in Paget disease. Bisphosphonates (alendronate, clodronate, risedronate) are the first choice. If not tolerated, i.m. calcitonin may be tried. |
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| Q: I am a 62 year old female who was diagnosed with osteoporosis at age 50. Family history: Mother and aunt died with ovarian cancer, three uncles with prostrate or colon cancer. I had my uterus removed at age 32 and my ovaries at age 49 as a precaution after my mother died. My great grandmother, grandmother, and aunt all had osteoporosis. My mother, who died at age 72 had begun to loose height, but did not have the dowager's hump. I am beginning to get one. I began taking a drug for Osteoporosis at age 50 and have taken Fosamax for three years. My condition has improved to Osteopenia. My concern: I have been taking Premarin 0.9 since age 49 and, because there is so much cancer in my family, that continuing with Premarin is dangerous. I tried Evista, but suffered from extreme hot flashes. My doctor took me off Fosamax because he felt I had "peaked" and did not need to continue with it. What is your feeling about continuing to take Premarin? Is there a natural product I can take, Soy? Feel that I'm caught between getting cancer or having osteoporosis again. |
| A: In my opinion (I am not a gynaecologist) 13 years on Premarin should be enough, even if there is no absolute rule. Breast cancer risk is known to increase with the length of estrogen therapy. Having progressed from osteoporosis to osteopenia is a good result. I think that to remain at this level, it's advisable to take Fosamax again, discontinuing Premarin. Of course, calcium-rich diet and physical activity are always important for your bone. Raloxifen (Evista) is a possible alternative: in general the hot flashes are limited to the first months of therapy. The phytoestrogens found in soy are normally taken in a very low dosage, not protective for bone: if you take them in high dosage, the risks are about the same as estrogens like premarin. |
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| Q: I recently heard something about taking fosamax for more than five years will result in my bones no longer making new cells of their own. Is this true, and what should I do? |
| A: You received incorrect information. Fosamax (alendronate) - as all bisphosphonates - is rapidly deposited in the bone, and remains there for a very long time. It reduces the process of bone resorption (destruction of old bone) leaving new bone formation essentially unaltered. Thus net bone loss is reduced. This is why these drugs are used for osteoporosis. But this doesn't mean that bone cells die. Both bone formation and bone resorption continue. There are many studies on the efficacy of long-term therapy with alendronate for more than 5 years without any evidence of inactivity of bone cells. |
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| Q: I am 26 years old and after suffering 2 very painful stress fractures, I got a bone density text and was diagnosed with osteoporosis. I had been fearful that this would be the case as I had not menstruated on my own (without the help of an ocp) for about 6 years. I am by NO means a compulsive exerciser or dieter. I was previously running (jogging) about 3 or 4 times a week for about 45 minutes and that was pretty much it. My eating habits could have been better but now since I have been diagnosed I am doing everything I can to try and reverse this situation which my doctor assures at my age, can happen. I am currently taking ortho-tri-cyclen (but will soon be switching to allesse) b/c I am experiencing a lot of nausea and water retention. I take at least 1000-1500 milligrams of calcium a day and do weight training for about 50 minutes, 2 times a week. My doctor absolutely does not want to put me on fosamax or another drug like that because I do plan on having children within the next 5 years and these drugs are not for women of childbearing age. What do you think? |
| A: The lack of menstruation (amenorrhea) is one of the causes of osteoporosis in young women. I suppose that the cause of your amenorrhea was fully investigated by your doctor. In my opinion your doctor was right to treat you with hormonal therapy, because in a young woman with amenorrhea resolving this problem can reverse the bone loss. So, you don't need other drugs (such as fosamax) for the moment. You have to pay attention to your diet (the amount of calcium that you take is correct) and physical activity (regular but not too much, it's OK to do weights twice a week, you may also take a 30-minutes walk every day). This is all you have to do for your bones at the moment. The use of other drugs may be necessary later in your life (i.e. menopause). |
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| Q: I am now 49 and was diagnosed with primary ovarian failure at age 37. I was put on premarin .9 and provera 5mg at that time. Two years ago after my first bone density test, I was put on fosamax. I just had another bone density and I have progressed in spite of the medication, 1200-1500 mg of calcium and daily walking. Other meds include synthroid. My recent bmd was -2.69 of the fem neck. My internist wants to put me on myacalcin in addition to the fosemax, hrt, synthroid and calcium. I drink about 4-6 ounces of wine daily. Is the alcohol causing my progression? Should I look for other reasons of bone loss. Are all these medications reasonable? |
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A: I think that the problem is to clarify the cause
of your continuing bone loss. If it's only because of menopause or
is there some other reason. Unfortunately the information you give is not
complete. You don't tell if you had osteoporosis when you were first put
on fosamax, and how much you
did lose in the last two years. Moreover, you don't tell if the 2 bone
density tests were made on the same machine at the same bone site (e.g.
femur), which is the only way to have 2 comparable tests. From your words, I understand that you had an early menopause at 37. This was correctly treated by HRT (as you did), but it seems that until 47 you did not have a bone density test. So you can't know if your bone density was stable or not during all those years. After your first test, which I think showed osteoporosis (BMD T-score < -2.5), your doctor added fosamax. In the following 2 years you had an adequate intake of calcium and a regular physical activity (both essential tools in the prevention and therapy of osteoporosis). However, bone loss progressed. In this case, if you don't respond to HRT + fosamax + calcium, I suppose that your doctor should consider other possibilities of secondary osteoporosis (intestinal malabsorption from any cause, hyperparathyroidism, vitamin D deficit...) and exclude them. Moreover, you mention synthroid: you've been given it because you have a low function of the thyroid gland (hypothyroidism)? This is another disease, with low influence of bone density unless the synthroid dosage is too high. In my opinion it will not be useful to add calcitonin (Myacalcin) to estrogens and alendronate (fosamax). First, possible causes of secondary osteoporosis should be excluded. I suggest to continue with your therapy and repeat a BMD test after about 18 months with the same device and on the same skeletal site (femoral neck), to check any change of bone mass with accuracy. |
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| Q: I was told I have Osteoporosis. My sister takes Fosamax, and my Mom takes Actonol. What is the difference, and is Fosamax 70mg better, or would it be better to take Fosamax 10? What is the normal dosage of Actenal? |
| A: Actonel and Fosamax are bisphosphonates, i.e. drugs able to reduce the resorption (destruction) of bone and to reverse bone loss, and both can be used for osteoporosis. Regarding the choice of the appropriate treatment, you should ask your doctor: there are many drugs available against osteoporosis, and it is important to make a choice considering the patient's characteristics (age, sex, clinical history, etc.). Fosamax is available in two dosages for the treatment of osteoporosis: 10 mg once a day, or 70 mg once a week. The first dosage has been available for many years and there are many scientific studies showing an increase in bone mass and a reduction of fragility fractures with it. The second dosage has been introduced more recently, but many data indicate that also this dosage has a good efficacy. Actonel is available only in one dosage (5 mg) and must be taken every day. |
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| Q: I have been taking Actonal for the last three months, two hours after eating waiting another two hours before having another meal. Although I do not have any side effects at the moment, I am not sure of the long term use. I appreciate it if you could give me more information regarding possible long term effects? I am also taking antihypertensive and immuno-suppresants for hepatitis C resulting from an auto-immune disease that has affected my liver. I am currently taking the following medications: Imuran, Vasoretic, Nilstat, Inderal, Calcium + Vitamin D, Tetracycline (occasionally for Rosacea). |
| A: Actonel (risedronate) is a relatively new drug, belonging to the well-known family of bisphosphonates. In general, these drugs are not metabolized (transformed) in the liver or other organs, and they are only active on bone (reducing bone resorption). There are people who have been taking a bisphosphonate for more than 10 years, and did not have any long-term adverse effects. There are no known interactions with the other drugs you are taking. You should take your calcium supplement with your meals, far from the Actonel pill, because calcium reduces the absorption of bisphosphonates. |
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| Q: I am a 39 year old woman just diagnosed with Osteopenia. I am not post menopausal or experiencing any symptoms of perimenopause . The leaflet that comes with Fosamax states that Fosamax is for the treatment or prevention of osteoporosis in women AFTER menopause. Any problem with me taking Fosamax? My doctor did prescribe it. |
| A: In general, Fosamax (and other drugs) are given for the treatment of osteoporosis. Osteopenia is a lesser degree of bone loss, but maybe your doctor thinks that you may be at risk of developing osteoporosis even at your relatively young age. There are no contraindications to take Fosamax even before menopause, but you should avoid a pregnancy because the effects of these drugs on the embryo and fetus are not known. Moreover, you should be aware that a correct calcium intake - in line with the recommended daily allowance, about 1 gram a day at your age - and a moderate but regular physical activity (e.g. walking at least 30 minutes a day) are important in the prevention and treatment of osteoporosis. |
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| Q: Does mild and milk products have acid in them that is bad for the bones? Is acid bad for the bones? Should I stay away from tomatoes, lemonade, vinegar, and a lot of acid? Can you give a diet for healthy bones? A list of things to eat and a list to stay away from? |
| A: There's no problem with ingesting normal quantities of acids with foods. Our stomach is secreting a very high dose of chloridric acid every day to digest foods. Only an excess of acid in the blood (acidosis), which is a pathological condition, may stimulate calcium loss from the bone. In general, a free, varied diet is the best one. All calcium rich foods (in particular, milk, cheese and yogurt) are good for the bone, as they help in taking the recommended daily allowance of calcium (about 1 gram a day in an adult, premenopausal woman). You may prefer skim milk or low-fat yogurt and cheese in order to avoid an excess of fats and calories. However, an excess of protein (e.g. a diet too rich in meat, cheese, eggs, fish) and salt should be avoided because it increases the calcium loss in the urine. And a diet too rich in wheat bran and oxalates (tomatoes) may reduce intestinal absorption of calcium. |
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| Q: I am 50, postmenopausal for 7 years, a breast cancer survivor (7years) with an estrogen negative tumor, no node involv. I have osteoporosis. Scores are hip =n -3.48 and spine = -2.80. I do not drink or smoke and I exercise. Recently started strength training. I cannot take Fosamax due to an ulcer and esophogus problems. Miacalcin spray gave me bad and frequent sinus infections( Swollen nasal turbinates). I need to avoid HRT, Evista isn't safe yet for BC patients and Tamoxifen has tough side effects. What does one due in this situation? I of course have been taking calcium (Citrical) for the past few years. I would greatly appreciate a reply. P.S. Maternal grandmother broke two hips, is over 100 now. Mom has osteoporosis and is doing fine on Fosamax. Thanks! |
| A: Given your family history of osteoporosis, your early menopause and your bone mass scores, a therapy is indicated. You must check with your doctor. Evista (raloxifen) is not contraindicated in breast cancer - and there are ongoing studies to investigate a protective effect similar to that of tamoxifen. Calcitonin is not only available as a nasal spray, but also in an injectable form. Calcium and physical activity are always good for osteoporosis. |
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| Q: I was diagnosed with osteopenia when I was 40, I am now 42 and have osteoporosis. I used miacalicin for 1 1/2 years, and my density got worse. My doc never did check my hormones initially. Isn't osteoporosis preventable? From when I had the 1st test shouldn't I have been given some aggressive treatment? |
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A: You
don't tell me if you're in menopause or not, this obviously changes the
perspective. At your age, if you're not in menopause, you should
thoroughly search for an underlying cause of osteoporosis. It may be a
very low calcium intake, an intestinal malabsorption or some other chronic
condition (hyperthyroidism, hyperparathyroidism, estrogen deficiency,
conditions which require long-term steroid therapy, idiopathic
hypercalciuria, etc.). In my opinion, Miacalcin is not a first-line therapy for osteoporosis. If you are in menopause, hormone replacement therapy (estrogens) should be the first choice. Bisphosphonates (alendronate, risedronate) are an alternative, and can be given even before menopause. The two essential steps of osteoporosis prevention and treatment, to be considered even before any drug, are a correct calcium intake (at your age, at least 1.2 gram a day) and a regular physical activity. |
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| Q: I am 42 years old, and had a hysterectomy (uteris, ovaries,cervix) at age 36 due to endometriosis, adenomyosis, ovarian cysts, fibroids, adhesions. I have taken estogen in different brands/strengths since the surgery. Most recently on estratest. I recently had a dexa scan done and the results show severe osteopenia and osteoporosis. My Dr. prescribed Aconel, calcium supplements and exercise. She told me to have another scan in 2 years. I smoke, am 5 ft tall, white, small frame...all the risks fit me. I have an appointment with a Rheumatologist in 2 weeks. Do I need a rheumatologist or an endocrinologist? I've been reading a lot of confusing and sometimes conflicting info and really don't know where to go from here. |
| A: Your osteoporosis is now being treated (Estratest + Actonel + calcium +physical exercise) and you should await the results of your next DEXA scan. Given your age and your early menopause, the estrogen therapy is the first choice. Your gynecologist added Actonel, so I think this therapy should be enough. Calcium (1.2 grams a day) and physical activity are of course essential. I think that you may ask your doctor about any doubts, rather than seeing another specialist. With smoking, up to 10 cigarettes a day, there is no significant additional risk. |
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| Q: I am a 24 yr. old white menstruating female. I have one child who is 2 yrs. old who I breastfed for 20 months. I went to the doctor with back pain. After x-rays they found a 68 degree curve in my upper back which causes me to hunch forward. This curve has caused me to go from 5' 7 to 5' 5. They also saw that my ribs had to start to calcify. They sent me for a bone density test finding a -2.2 in my spine and a -2.0 in my hips. I have started Fosamax. I am confused since I have always drank milk and taken calcium. Both my mother and grandmother have osteoporosis that started after menopause which for them started around 40 yrs old. What would be the cause for someone my age having it this early and am I at high risk to have more complications once I hit menopause? |
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A: You have a family
history of osteoporosis. You got pregnant and breastfed your child for 20
months, so you gave him a lot of calcium at an age where your own skeleton
was still completing its growth. This may be the main cause of
your osteoporosis. However, at your age, your skeleton will recover the
calcium loss over the next months, provided you have a calcium-rich diet
(at least 1.2 grams of calcium daily). Besides calcium intake, a program
of physical activity (weight-bearing) is essential to stimulate bone mass
recovery.
Fosamax will also help your bones to minimize calcium loss and increase
bone mass. If you are planning to get pregnant again, please ask your
doctor about continuing with Fosamax.
However, it may be advisable to wait at least 2 years, and not to breastfeed your next baby for more than 6 months. As your mother and grandmother had an early menopause, you may be in the same situation. An early menopause, particularly if there was a low bone mass at the start, clearly leaves more time for the skeleton to lose calcium and to enter the zone of high fracture risk. However, things may change over the next 20 years, both with respect to prevention and treatment of postmenopausal osteoporosis, so you should not worry too much now. |
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| Q: Could you please tell me if Actenol is a small, yellow, pointed end football shape, 5mg., and are they to be taken once daily? |
| A: Yes, Actenol (risedronate) pills are like that. The dosage is 5 mg (one pill) daily. To ensure good absorption you must take risedronate on an empty stomach, i.e. in the morning, with a glass of water. Then you should wait at least 45 minutes before having breakfast. Do not lay down after taking the pill. |
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Q:
I was diagnosed with Osteoporosis five years ago. I am a white
female, 53 years old, total hysterectomy at age 23. Had fractured
pelvic bone when osteo was diagnosed. I have been on Fosamax,
calcium, estrogen patches and exercise routine ever since with regular
check ups at the osteo clinic. I still do not understand the dexa scan
results. I was told that all my spinal vertebrae, except one, are at 2 x's
the risk, and one lower spinal vertebrae and both hip joints are at 4 x's
the risk. Even though my risk factors have been reduced tremendously, I don't understand what these risk factors mean. Exactly how bad is this? How careful do I need to be? How much can I lift? I there anything else I can do to gain more bone density? |
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A: You are taking all that
is needed for your osteoporosis: bone-saving drugs (Fosamax and estrogen),
calcium supplements (to get the correct calcium intake), and physical
activity. I think your doctor has estimated that you don't need a vitamin
D supplement. This is all you can do to increase bone mineral density. Regarding the DXA results: the lower the bone mineral density (BMD) of a bone, the higher the fracture risk. A risk of 2x or 4x means that you have 2 (or respectively 4) times the probability to have a fracture with respect to a "normal" person. The "risk factors" are a lot of things that increase the risk of reducing BMD and having a fracture. For example, menopause, low calcium intake, no physical activity, family history, some drugs (e.g. cortisone), being of a small physical frame, past fragility fractures, etc. are all risk factors for osteoporosis. We can reduce some risk factors (e.g. correct calcium intake) but not others (e.g. family history). As a rule, you should lift only light weights and above all you should NOT bend your spine forward then straighten it to take up something from the floor, but you should learn to lower yourself by bending the knees with your spine upright. For your hips, you should not run unless your doctor says it's ok. Walking is always ok, and is very good for your bones. |
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| Q: Six months ago I had a radical hysterectomy due to endometrial cancer that developed in my uterus. I had been on premarin/prempro for about twelve years and felt great while taking it. No radiation was necessary due to good prognosis. I am not taking hrt, due to discomfort during intercourse, I am using estring and taking actenol. Even though my bone density is good I would like to know if I am endangering myself by using estring since it provides me with estrogen which I strongly believe gave me cancer. I also have arthritic knees and hands which seem to be more painful since taking actenol . Any possible connection? |
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A: I am not a
gynecologist. My field is osteoporosis.
Topic estrogens (Estring) are generally used to correct localized
symptoms, but they do not cover systemic problems linked to
menopause, because the dosage is low.
I suppose that you use Estring on prescription of your gynecologist. It is
important that you discuss the problem with your gynecologist, asking
about the long-term use of Estring with respect to your endometrial
cancer. Estring has been shown to have minimal to no absorption, and as
such, should have no effect on anything but the vagina itself.
(Additionally, many studies have shown a lower risk of endometrial cancer
in those on HRT than those on no medication at all.) Regarding Actonel, it can be used also for the prevention of osteoporosis. Actonel (risedronate) acts on bone like the estrogens: both drugs decrease bone destruction (resorption), reducing bone loss due to menopause. Arthritis is also more frequent after menopause. It is possible that the increased pain in your hands and knees is more due to the discontinuation of Premarin than to the use of Actonel. Only in rare cases bisphosphonates (the class of drugs Actonel belongs to) may induce bone - not articular - pain. In these cases, pain rapidly disappears after suspending the drug. You may try to stop taking Actonel for two weeks and see if your pain goes away. |
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| Q: I am requesting a form for questions about myself. At 40 years old, I was told I had osteoporosis and osteopenia. |
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A: Osteopenia is a mild degree of calcium
loss from bone (i.e. a slightly reduced bone mass), osteoporosis is a
severe degree of the same.
I am not sure to understand what you mean
by "form of questions".
If you mean questions to evaluate your risk factors for
osteoporosis, I am enclosing a check-list below, but I strongly
recommend you to consult your doctor. Given your young age (are you in
menopause at 40 years?) you should check with him/her if there
may be an underlying medical condition which has caused your
osteoporosis (such as intestinal malabsorption, hyperthyroidism,
hyperparathyroidism, estrogen deficiency, conditions which require
long-term steroid therapy, idiopathic hypercalciuria, etc.) Main risk factors for osteoporosis:
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| Q: I am 68 years old and have never had HRT therapy. My Mother died of ovarian cancer - her sister also died of cancer (of unknown origin). I have been diagnosed with severe osteoporosis of the lumber region and osteopenia of the hip. Why the difference? I am reluctant to start HRT. I do take extra calcium and am about to add soy products to my diet. Do you recommend once-a-week Fosomax? |
| A: Bone calcium loss, while generally affecting the whole skeleton, is not necessarily uniform everywhere. That's why you can have a greater loss (osteoporosis) at lumbar spine than at hip (osteopenia, which is a lower degree of bone mass loss). To prevent further losses, a correct daily intake of calcium is needed (at your age, about 1.5 grams per day). Outdoor acrivities help in producing vitamin D in your skin.Your doctor may prescribe a vitamin D supplement. Regular physical activity is also essential (e.g. brisk walking 30-40 minutes a day). Soy products may be calcium-enriched and also have a small dose of phytoestrogens (the dose you may take by eating soy products will have only minor effects on bone). In my opinion, given your age and your familiarity for ovarian cancer, HRT is not recommended as an osteoporosis therapy. I think once-a-week Fosamax is the first choice. |
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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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