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Osteoporosis Ask The Expert

 

Osteoporosis Ask The Expert
Questions this month have been answered by:

R. Wayne Whitted, MD, MPh, OBGYN.net Osteoporosis Editorial Advisor

and

Harvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor

and

Paul D. Burstein, MD, FACOG, USA, OBGYN.net Osteoporosis Editorial Advisor

 

Click here to see Previous Ask the Expert Questions and Answers

Q:  I am 57, female,  and after a bone density was confirmed for osteoporosis.  My doctor told me to take calcium, magnesium and Vit. D supplements, exercise daily, and if I didn't want to take fosamax, I could try testosterone cream.  She said she went to a seminar and was told women have benefited from small amts of testosterone cream who have osteoporosis.  Have you heard of this treatment?

A:  I would have to disagree. There are several treatments for osteoporosis and testosterone cream is not one of them. There is little evidence that testosterone except in combination with estrogen has much effect, and testosterone given by skin creams, in many cases, is not even metabolized by humans. I would urge to you to get better advice.
 
Q:  Is there any way to correlate DEXA Scan numbers to per cent of bone loss?  For example:  How much bone loss would a 54 year old woman have with a -1.5 in the spine?
A:  With the numbers you give, the answer is that it is difficult to make such a calculation and would be meaningless. Assuming the value you cite is a T-Score, it would reflect bone density of 1.5 standard deviations below the mean bone density for a young adult. The concept of a standard deviation is like high school grades on a bell shaped curve. This is not osteoporosis. The real question is did you lose bone mass at all or never reach that theoretical peak on the best day of your life. One of the problems with DEXA is that it is a snap shot of bone density on a given day. If there is not excessive risk of fracture, it may be reasonable to maximize calcium, Vitamin D, exercise, avoid smoking, excessive alcohol and excessive caffeine, and repeat the test in two years. It would be a good time to discuss your medical history with your physician and find out if you have any conditions or take any medications that might have an adverse effect on your bone health. Hope this helps.
 
Q:  What is the significance of a T score of the neck of the hip worse than -2.5, if the rest of the hip measurements are better, so that the Total T-scores is better than -1.0? Does the patient have osteoporosis of the most common site of hip fracture, and need to be treated?  Or does she not even have osteopenia?  I have several patients that fall in this category?

A:  Although some osteoporosis experts do look at the total hip measurements, most look at the femoral neck as the site most likely to fracture and therefore the site of most importance when considering therapy in that area. Presuming the DEXA machine has shown consistent results (ruling out instrumentation error of course), we routinely treat the worst area. In this case, we would consider that this indicates osteoporosis and appropriate treatment with a bisphosphonate (most likely) should be instituted. Remember that the bisphosphonate is just, for lack of a better term, a brick layer. Adequate Calcium and Vitamin D (the bricks) need to be taken in for expected response to the therapy.
 
Q:  I have been perscribed actonel for my osteoporosis and I was wondering is it ok to also be taking coversyl and aproxin tablets at the same time?
A:  Coversyl is an ACE inhibitor and goes under the name of Aceon in the US. The are neither major nor minor interactions with Actonel. After searching for "aproxin" and being unable to find it on any search engine in English, I cannot comment on that drug.
 

Q:  Is it possible to experience side effects from the Fosomax 70 although none were experienced while taking the Fosomax 10 daily?  For the last two months I have been having headaches with pain behind my right eye.  Most of the time they are similar to migraine headaches, which I have not had any for some time.  For the last six weeks this has been a daily occurrence.  Sometimes I even wake up in the night from the pain.  My doctor had me get a CT scan, which was normal, and he has me taking Vioxx 50 mg for six days and then 25 mg for eight days, and then I am to see him again.  This has helped the pain, but I still feel the pressure across my forehead.  This morning it occurred to me that I have only been taking the Fosomax 70 for a little over two months, and I was wondering if the headaches and eye pain could be a side effect from the medication. I think I will skip my dose this Saturday and then talk to the doctor.  I would also appreciate your input. Thank you.

A: Common side effects of fosomax are esophagitis, gastritis and bone pain.  Headaches have been associated with fosomax.
 
Q:  What is the difference between taking actenol daily or one weekly tablet. I was prescribed Fosamax for a weekly tablet and my insurance didn't approve it but they did approve actenol daily.  I would rather take one tablet each week and wonder if it is as effective.  Thank you.
A:  Actonel has not been approved for once weekly therapy.
 
Q:  I was diganosed with severe osteoporsis in 1996, I was 52.  I had two fractures - that is how we found out that I had it.  I was put on Fosamax, high calicum and Vit D.  I had been holding my own until this past year.  I now have a fracture in my left foot - since August of 2001.  It is healing - but slow.  I have two fractures in ribs on my left side.  I did not fall - just did small simple things and got them.  I have heard of the new drug by Eli Lilly - Forteo. Has it been approved?

I go to my doctor the day after tomorrow - but I am very concerned.  I have seemed to have gone down hill very fast.

Any suggestions - I am also on Hormone Replacement therapy - since about 1995.  I did everything right - the doctors seem to think that my bones just didn't develop as they should when I was young.

A:  It is important to do secondary evaluations for other causes of bone loss.  also, forteo has not been approved yet.
 
Q:  I am a 56 year old women who had a hysterectomy, removal of the uterus and ovaries, at age 35. I have been taking Premarin for 21 years. My bone density is fine.

I want to stop HRT because of a fear of breast cancer. My mother has osteoporsis. I exercise five days a week, take 1200 mg of calcium daily,  and  drink milk regularly. Would it be wise for me to take Evista?  I also take Synthroid for Hypothyroidism. What else would you recommend to protect my bones?
A:  Evista has been approved for the prevention and treatment of osteoporosis.  It appears to reduce the cholesterols and to offer a reduced risk to breast cancer.
 
Q:  After the studies done by the American Medical Association- would you advise the use of ipriflavones in combination with once a week fosamax as a good supplement in the defense against osteoporosis? Thank you.
A:  Ipriflavones have not shown benefit in osteoporosis management.  They are often used by menopausal women for treatment of perimenopause, such as hot flushes.
 
Q:  I took Fosamax last year & it didn't seem to agree with me. I don't remember exactly what side effects I had, but I went right off it. I happen to have Osteoporosis, pretty bad count (said the doctors, 3 of them). I took Actonel a few weeks ago & again side effects: Nightmares, muscle pain, stomach aches. I have Khrones, Illeitis, cholyotis & IBS. All of the above are not active now. I take Azulfidine & Folic Acid. I started Foxamax again 2 weeks ago.

Everything seemed to be O.K. until yesterday when I took the 3rd pill. (70 mg) My tongue is burning at the tip, my neck started to bother me, my ears are ringing (nothing new) but somewhat magnified. My mother had osteoporosis (never took anything for it, fell in a super market, lived to be 82). To take or not to take the Fosamax? Thank you so much for your concern.

A:  The treatments for osteoporosis are varied.  Fosamax and Actonel improve bone density and reduce fracture risk but have SE such as stomach pain, bone pain, headache, etc.  Evista, a selective estrogen receptor modulator, improves bone desity, reduces fracture risk, improves the cholesterols, and appears to reduce the risk of breast cancer.  It is an oral tablet and generally well tolerated.  Calcitonin nasal spray is approved for the treatment of osteoporosis but has limited benefit in the long term.
 
Q:  I am a 35 year old white female, 5' 6'', 120 lbs with osteoporosis.  I had a child by c-section almost 5 years ago.  After delivery I could not walk for four months due to a compression fracture in my spine.  Osteoporosis was due to prednisone usage for  medication for ulcerative colitis.  I would like to have another child.  My bone density is only slightly better than it was when I had my child.  Will I do any permanent damage to myself if this fracture was to re-occur in my next pregnancy?  I am taking Fosamax and ortho tricyclen currently.
A:  It is always best to prevent fractures.  It is important to stay with fosamax.  It reduces fracture risk by 50%.  The fracture that has occurred is still there and hopefully not bothersome.
 
Q:  A 41 year old female friend of mine, first diagnosed with osteo at 30, just had a bone scan, nuclear imaging, which turned up eight fractures including one in the lower spine - pars, lumbar - was told she has the bone density of a 65 year old.  Any comments or advice I can pass on will be greatly appreciated.
A:  She needs to be evaluated for secondary causes of osteoporosis. These include, but are not limited to: thyroid disease, parathyroid disease, adrenal disease, and a variety of other rare diseases like leukemia, multiple myeloma, paget's disease of the bone, etc.
 
Q:  I am 69 yrs. old and have been unable to take hormone therapy due to fibrocystic breast. I have been diagnosed  with osteoarthritis which is a family trait. I am taking  100mg of Celebrex, which doesn't seem to control it, but does help. I recently had a bone density test done and am now taking Actonal. Will this help to lessen the arthritis pain and stiffness? Thank you for your answer.
A:  Actonel doesn't impact the symptoms of arthritis.
Q:  I am a 54 year old female and I have osteoporosis.  I have been on fosamax for the last two years, 10mg. per day.  I was having back pain and went to my dr.  He says that a bone in my back is compressed, but that it isn't real bad.  He put me on naprasion and an anti-inflammatory.  Will this heal on its own or will it remain the same?  I just don't know if he is doing all that he can and if I should be going to a special back doc.
A:   First Answer from Dr. Marchbein:  Taking the information you have provided from your doctor, if there is indeed a bone causing compression of an area, an anti-inflammatory agent would be highly recommended. This must be differentiated from a compression fracture in the spine caused by osteoporosis. Depending upon the exact location and nature of the compression, the expectation of resolution of your symptoms may vary. If you are concerned that your doctor may not be doing everything necessary or may no be diagnosing the full story, an appropriate choice for another opinion might be a rheumatologist.

As an aside, you may wish to discuss with your doctor the newer dose of Fosamax - 70 mg once a week taken with the same set of rules and precautions. Hope this helps and please write back for more information as the situation presents itself.

Second Answer from Dr. Whitted:  It sounds as if you have osteoporosis and now had a compression fracture.  Fosamax is important because it reduces subsequent fractures  incidence.  There are treatments that can stabilize the existing fracture.  These involve injecting a cement like substance into the vertebra.   Maybe you can ask your physician about this.

Q:  Would it be harmful to take a second hip density scan within a few weeks of the last one.  I just want to make sure there wasn't a mistake in the reading, some results are hard to accept.
A:  Although not dangerous, most experts find this type of re-testing unnecessary. In addition, it is not likely that your insurance would reimburse you for this repeat test.
Q:   I am a 54 year old female that has been diagnosed with osteoporosis.  I had a complete hystorectomy with the doctor leaving me the cervex because she said I had too many adhesions to take it out.  I was put on .9 premarin at the time (1997).  After a year I had a bone density test and it showed osteoporosis so the doctor put me on fosomax.  After being on it for a month I went to the hospital because I thought something was in my throat.  This type of abnormalady had been happening often.  They put a scope down my throat and determined that I had gerd and that the fosomax was making me just "feel" like I was choking.  The doctor took me off from the fosomax and put me on Evista (the hospital doctor).

So I started on the Evista and when I went to my family doctor he told me to get off the Evista because I was already taking premarin and did not want to get too much hormone.  I am totally afraid to take anything if the doctors cannot make up their minds.  I have a gynochologist and a family doctor and my family doctor gets all my results from everything that I have done.  What shoul I do concerning my bone loss and do you think that the weekly dose of fosomax would be better for me?

A:  Since Evisa has anti-estrogenic activity in certain areas of the body and estrogenic activity in other areas, there is no logic in treating with both medications simultaneously. The GERD that you had with Fosamax is not unheard of but was most likely when the dose was 10 mg daily. There is now a 70 mg pill taken weekly that may be better for you. In addition, Actonel, a "cousin" if you will, to Fosamax is available and may be better for you in particular, with respect to the GERD. Actonel is now daily but approval for weekly Actonel is expected this summer.
Q:  I am a 45 year pre-menopausal diabetic female.  I had a hysterectomy over 14 years ago, all was removed with the exception of my ovaries. As far as I know, I have not gone through menopause.  If I have, I have not recognized the signs.

In January 2001, I fractured both my right and left ankle.  In September 2001,  I obtained two stress fractures on the top of my left foot (I was told it was from powerwalking 4 days a week.  I had worked my way up to 4 miles each walk.)  Then recently on January 13, 2002, I fell down my long flight of steps landing abruptly on the sixth step down, fracturing.  Per Dr. George Mathews, my Neurosurgeon and Dr. Clayton Walker, I severely fractured my 11th vertebrae.  My neurosurgeon believes that  the severity of my back fracture came from the osteopenia, he has me wearing a thorasic corset. for my back fracture.  The neurosuegeon has also recommended that I have an injection inserted into my vertebrae to "cement" the vertrabrae and to quicken the healing process.

The week before fracturing my back, I had seen my diabetic doctor.  At that time I requested that she prescribe a bone density test be performed.  Initially, she was very reluctant because she did not believe that I was a candidate for the bone density test.  The reason for her reluctency was because I had not yet reached the post menopausal stage.  At least I did not believed that I had and as of this day, not one of my doctor's has stated that I have.  I do not know the signs of menopause and because nothing "hormonal" has changed since my hysterectomy, I thought I had nothing to worry about.

Upon expressing my deep concerns in regards to wanting this test and after she reevaluated my recent fractures and loss of height, she decided it was in fact the best route to take.  I have also loss 3/4 of an inch since a year ago.  When I told her that, she then agreed that is was the best route to take.  The stress fractures have not healed as of this day and upon falling down my flight of steps I have refractured my left ankle.  

After waiting over three weeks, I decided it was best for me to call both my diabetic doctor and my orthopedic doctor.  The diabetic doctor's nurse explained that it wasn't serious enough to be seen by my diabetic doctor until my visit in April.  My orthopedic doctor said that was something that surely needed to be monitored and that it was on the verge of osteoporosis.  Because I am a diabetic,  I am very concerned as to how osteopenia relates to osteoporosis.  My diabetic doctor's nurse stated that the osteopenia is not serious, however, the orthopedic doctor said it is right on the edge of osteoporosis and that she would like to see me when her office could schedule an appointment for me, the earliest appointment available is scheculed in April.

I have do some research on osteopenia, but have found that I am receiving mixed messages.  How serious is osteopenia?  Is there anything that I should start taking now prior to seeing my physicians that might be helpful in preventing or slowing down the process of osteoporosis?  In all of my research, I have not yet found how diabetes relates to osteopenia or osteoporosis, is there any additional data that I could research?  In some of the research I have done, I have found that estrogen is sometimes an option.  I am also concerned about the use of estrogen especially in how it relates to breast cancer.  My maternal grandmother and aunt were both put on estrogen after menopause and within 10 years both have lost a breast from cancer.  Are there any new estrogen related medications that are not harmful or linked to breast cancer?

A:  Menopause can be defined by doing a blood test called FSH.  In addition an estradiol level can be obtained in correlation. Osteopenia is early bone loss and is defined by the WHO as a T-score of -1.0 to -2.5.  Chronic medical conditions can predispose a person to bone loss in addition to lifestyle issues and menopause.  It is important to sit with your doctor until all areas are fully explained and you are comfortable with the explanations.
Q:  My mother in law is 64 years old and 10 years ago she had an adenoma of the parathyroid removed with a calcium result of 16.0 before the surgery.  She also has had breast carcinoma and has osteoporosis.  My question is:   How is the blood calcium affected when a person has osteoporosis.  She runs a 10.8 /11.3 calcium at this time.  Also, does the blood calcium fluctuate at different times of the day.  Her calcium can run high normal to slightly elevated. Any information you have would be appreciated, thank you.
A:   The blood calcium is not affected by osteoporosis. Rather, blood calcium and the intake of calcium affects osteoporosis. Many of the body's chemicals show fluctuation throughout the day although minerals remain relatively stable.
Q:  I am a 42 year old female, I have been on Actonel for seven months now and seem to be on a steady weight gain, 10 to 15 pounds with no change of eating habits and on the same exercise program. Although I don't see weight gain on any of the info on side affects I have read, I can't help think that this drug seems to have slowed down my metabolism, not just my boneloss, is that possible? And if it is, is there anything I can do about it, short of stopping the prescription.
A:   Bisphosphonates such as Actonel and Fosamax have no known effect on weight, whether loss of gain.
Q:  Is it true that drugs such as Fosamax prevent the old bone from being reabsorbed?  If that is the case would one's T and Z scores look better on the scan, but in actuality, really just be reflecting weak, brittle older bone that should have been replaced?  I read about a study which indicated that bone breaks with people on a placebo compared to those on Fosamax showed 10% increase in breakage whereas those on Fosamax 11%?!  I am asking because I hate to take any medication and was told that with a left hip score of -2.25 I should start taking the 70 mg of Fosamax.  Is there anything that encourages bone (osteoblasts?) growth available?  Is there any chance that new healthy growth is inhibited indirectly by taking something like Fosamax because the body doesn't sense a need or trigger to produce because there is something (older bone) taking the place of where new bone would be sent?
A:   Fosamax has been shown in randomized, blinded trials to raise Bone mineral density significantly and reduce fracture risk significantly.  In addition, Actonel, a similar medication has been shown to do this.  Also, a selective estrogen receptor modulator, Evista, has been shown to reduce fractures significantly.  Calcitonin, a nasal spray has also.  The conclusion, therefore is, that these products allow normal bone to be replaced by inhibiting osteoclastic function (the cells that break bone down).
Q:   I am a 40 year old with a hx of Total hysterectomy in 1995. I have been on Premarin since the surgery /this has increased to .9mg premarin in the last 3 years due to decreased hormonal levels. I also have severe ashtma which lands me in the hospital 3-4 times a year for a regimine of IV antibotics and large doses of  IV steriods. This has unfortunately started leaving me with stress fx's in my lower leg in Oct. 01 and then on the other leg in three places this last month. I have been on Foxamax and 1500 mg Calcium and Vit D since Oct. 2001. My first bone density test revealed that I am osteopenia. My internist and orthopod are at loss to know what to try to help. We all feel that this will probably continue due to the severity of my lung problems. Is there anything else I can do or do you know of anyone close(it would be Indianapolis, IN) that could help. I work in the health field and am on my feet constantly pushing carts and holding patients so I am off for 5 weeks to try and get this under control until or incase I have another flare up of breathing problems.
A:   For osteopenia with a history of stress fractures and steroid use associated with asthma, you are doing everything you can at this time. The estrogen PLUS the calcium (hopefully with Vitamin D to help absorption) PLUS Fosamax are what you need. Your doctors may wish to do a serum NTx to determine bone turnover and confirm that this therapy is working for you. If problems continue, one might suspect problems with calcium absorption and this can be looked into at such time that this may be determined.
Q:  After four months on Fosomax, I am told that my thyroid is "slightly" underactive, and I have been prescribed medication for that. Could there be a cause and effect relationship?  I am Caucausian, 57, had breast cancer four years ago.
A:   There is no relationship between Fosamax therapy and subsequent hypothyroidism.
Q:  I’m 57 and since July I’m taking “Fosamax 10” + Calcium Clorid 500 (twice a day). After six months my T changed from –3,36 to –2,74 for spine. Since February 2002. I’m taking “Fosamax 70” (because it’s easier) and Calcium D3 Stada 1500 (1*3 mg). Since 1996. I’m treating high blood pressure (200/110) with Cilazil 2,5 mg.

Occasionelly I take vitamins C-500, E-200 and minerals SE-50. I’m at menopause since 1997. Now my endocrinologist suggested me Fosamax + Calcium + Kliogest (hormonal drug), because of a better recovery. I made all tests (gynecological, breast tests) and I was told that there are no obstacles for using hormonal drugs. I’m still affraid because nine years ago I had bleeding from a breast, but it happened only ones. Nothing was found.

Should I take hormonal drugs anyway and what would You suggest me? Thank You for your time!

A:  Your gynecologist is the correct person to determine if hormones are right for you. Some studies seem to indicate a synergistic effect with bisphosphonates such as Fosamax and estrogen. Since you have already seen a betterment of the bone density without the estrogen, make sure they explain what benefit they expect from the addition of a new medication.
Q:  I am a Nutritionist/ dietitian in an eating disorders clinic.  We have light exercise for the girls, but we would like to incorporate more lean body mass building exercise into their routines.  I was wondering what exercises would be considered safe for patients with osteopenia.  I will be doing yoga, meditation and breath work, light walking, and?  Suggestions are welcomed.
A:   Presuming the bone "loss" (or "never gained") is limited to
osteopenia, a supervised regime of aerobic exercise to encourage a healthy cardiovascular system AND weight bearing exercise (low weight and higher repetitions to tone rather than build bulky muscle) would be appropriate. The weight bearing exercise has at least two advantages. First, with low weight and high reps, they will not be building large muscles which would be a problem for younger girls with eating disorders and body image problems. Second, the weights will help promote bone growth up until 25-30 years of age and may help reverse some of the osteopenia, presuming adequate calcium AND Vitamin D intake AND adequate estrogen via regular periods (this is obviously a problem in some patients in an eating disorders clinic - some may need oral contraceptives to regain normal estrogenization
while working on weight issues).
Q:  I am a 71 year old female and was diagnosed with osteoporosis two years ago .  My  bone density measurements are: (2000-hip: -2.28 T. score; 2002; -2.79.}  2000-spine: -2.61; 2002: -2.60}   How serious is
this increase?   I use Miacalcin Nasal Spray, Tums, and Caltrate.  I cannot use Fosamax  because of GERD  and have trouble drinking milk because of lactose intolerance,  Any advice that you can give me would be appreciated.
A:   Based upon these results, and in agreement with most studies, Miacalcin is a relatively INEFFECTIVE drug for the treatment of osteoporosis. Despite therapy, the hip has gone from severe osteopenia to mild osteoporosis (a worse state of bone). The spine, already showing mild osteoporosis, remains unchanged after therapy with Miacalcin.
Q:  My first bone density test done five years ago showed osteopenia.  A recent follow up test  showed statistically significant improvement in bone density.  I was very pleased until a friend who knows I have osteoarthritis said the recent test could be showing arthritic deposits on my spine which my physician is reading as improved bone density.   While I will be discussing this with my gynecologist, I wondered if you have heard of this possible "false" reading of a bone densitometry?   Also, is there another type of measurement of bone health which would be more accurate?    Would it help to have an arthritis specialist review the test results?

Thank you from a 63 year old woman who has been on HRT for 10 years, exercises regularly, and takes calcium, although not as much as I should.
A:   It is known that degenerative arthritis can cause a "false" elevation of the bone density. This can be seen in the spine measurements. Some reports will actually note that levels may be elevated by DJD (degenerative joint disease). In such cases, the hip measurement may be more reliable. In this regard, an arthritis specialist may not be able to add anything in this scenario. And, as you mentioned, you may wish to consider increasing your calcium intake to the appropriate amount (1000 mg per day in divided doses) as well as Vitamin D (400 IU) per day.
Q:  I have osteoporosis at 57 yrs old. At my yearly checkup, my doc suggested a bone scan. Well, I thought he was calling me back because my health was perfect ...only to be told that I have osteoporosis, at some level of the 3. Now, I am trying to educate myself on what should a 57yr old women's level be. I have never smoked, I am a light drinker & I am on the mid-active side. My weight until 10 yrs ago has been 110 or lower. My mother's mother had osteoporosis. Is this something that is passed down in the family? My doc has put me on Fosamax once a week + 6 tablets of cal/vit D a day. Does this Fosamax do a good job with just one pill a week? Should I expect to gain some of the bone density back? Should I go to a specialist? And, what questions should I ask my doctor? Thanks for your support.
A:   Standard DEXA values are computer generated and you can get these from your doctor's printout of the bone density report. Osteoporosis is indeed something that seems to follow family lines although it can occur to anyone. The weekly Fosamax appears to be just as effective as the daily Fosamax. If you peruse previous answers on this site, you will get much more information on this topic and the others which you mentioned.
Q:  I am a 31 year old female who had a random bone density scan done at the hospital that I work at.  My findings were very disturbing.  I have severe osteopenia.  My numbers were actually 2.3 on the density scan.  My right hip was even a little worse- 2.5 (osteoporosis).  My doctor has started me on 1800 mg calcium a day and a vit d supplement.  I was re scanned a few months later with no improvement.  He has since started me on fosamax, but 3 weeks later, has stopped the fosamax- stating that there is not enough literature
on 30 year olds on these meds to continue.  He wants to start me on  some kind of progesterone pill once a month.  Can some-one give me their thoughts on this and will it really help me build bone density as well as keep me from losing more?  Also, isn't it uncommon for someone of my age to have such high bone loss?
A:   At age 31, results of bone DEXAs must be interpreted with great care. The fact that your "numbers" were consistent with severe osteopenia and osteoporosis at age 31, this may very well be a "never gained" position with respect to bone rather than "loss". Maximum bone density is usually reached by age 25-30. In that you age is near that, the concept of "never gained" is more likely unless you are severely underweight, have an eating disorder, poor or minimal
Calcium and/or Vitamin D intake or some malabsorption syndrome. Given the information in the last sentence, Fosamax may not be indicated as much as adequate Calcium and Vitamin D. A work-up for malabsorption is indicated as well. With an eating disorder that can cause a lack of periods, some practitioners recommend estrogen and progesterone to
assist in bone production.
Q:  I am a 56 year female.  Within the past year I learned that two vertebrae in the lumbar region of my back have T scores of minus 2.5.  I went thru early menopause in my early 40's and realize that the type of estrogen, and or the quantity of it is related to bone
maintenance. Calcium intake is of course important.  I am trying to walk more and have just started taking Fosamax.  I now consistently take calcium supplements.

Considering that I have also been told to have my blood pressure monitored regularly [in the doctor's office my number's are on the low end of mild hypertension.  I bought a wrist monitor so I could evaluate what is
normal for me at home.  The second number, which indicates pressure between beats, is 50 % of the time still in the low 90's.  The systolic pressure is in the normal range at home.

How much calcium I should be taking? Also, please comment on whether the total amount of calcium a person consumes could affect blood pressure?  I've just begun trying to understand how a "calcium channel blocker" is useful in treating high blood pressure. I drink calcium fortified soy milk at breakfast. I also eat some cheese or frozen yogurt each day.   I take two 500 mg calcium chews or supplements with vitamin D each day. I credit the soy products I use and low meat consumption with healthy cholesterol.

I am optimistic about getting my blood pressure down allowing that I lose some weight and walk more.  The osteoporosis is a major concern as my mother and grandmother had difficulty with it in their late life and did not start menopause until into their 50's. Thank you for your time.  I am hoping my question is of interest to others as well.
A:   The appropriate amount of calcium, once you are on Fosamax, is a total of 1000 to 1200 mg per day. This can either be from food, calcium pills or both. If by pills alone, the body cannot absorb more than a dose of 500-600 mg. That would mean 2 doses per day. Adequate Vitamin D in the diet or in vitamin supplementation aids in calcium absorption.

The concept of calcium channel blockers for hypertension has to do with microscopic calcium chemical reactions at blood vessels and will not interfere with calcium for bone development.
Q:  I am a 45year old female who started taking didrocal two weeks ago. I have recently begun experiencing pain in my leg and hip area. Could this be a side effect from the medication? I have checked with other women on line and a lot of them have also reported having the same problem.
A:   Side effects are usually mild and often do not require discontinuing the medication. These include stomach pain or upset, constipation, diarrhea, muscle ache, and headache. In rare instances, patients with Paget's disease of the bone will experience increased bone pain during treatment with etidronate.
Q:   I'm 27 and have steroid induced osteopena.  I was on 70mg of steroids for ulcerative colitis up a year and a half ago.  since then i had j-pouch surgery and am on the road to recovery.  my doctor recommended evista iv treatments and told me it was my ONLY option. I had one treatment and became ill from the medication.   after considering the risks and since i was facing my final surgery, i opted to not have additional treatments. there was no improvement from the time i had the treatment to my last appointment.  currently, I take 1500 mg of calcium a day, plus a multi.  my last surgery was 6 months ago and my endocrinologist appointment is next month. i really do not like the toxicity of evista or fosomax and don't want to take more medication than i need to.  Is calcitonin my safest option?
A:   Evista is not given intravenously and is not approved for corticosteroid induced osteoporosis. Fosamax and Actonel are approved. Neither is given intravenously. If you are on greater than 7.5 mg of prednisone or equivalent more than 6 months, treatment is appropriate. This is a unique situation and you should be followed by a rheumatologist or endocrinologist, as they are familiar with this situation. At age 27 it is hard to say you have lost bone mass as you have not yet reached your peak. If you have had multiple DEXA exams, they need to be on the same machine, done in a center with known PRECISION data, as the comparison is not an easy one.

Calcitonin (Miacalcin) would be a poor choice. There are people using intravenous Pamidronate for people who cannot tolerate oral drugs like Fosamax. It is experimental, not FDA approved, expensive, but likely to be effective. We may have an even better choice (Zolendronate) in the future and if there is someone near you doing clinical research, it might be a choice. Hope this helps.
Q:  My mother was told by her daughter-in-law that if she had taken her Premarin with a type of fatty food, such as buttered toast, it would have been better absorbed.  She has severe osteoporosis and wonders if she would have been different had she eaten the buttered toast with each dose.  Thank you for your answer.
A:   Premarin is water soluble and readily absorbed. It has been stated that estrogen is better absorbed with food, although it is difficult to find actual evidence of this. It is not necessary to take with a fatty meal. Hope this helps.
Q:  Any available osteoporosis medication that can be utilized as a patch.  Cannot tolerate nasal spray and have great difficulty swallowing the pills.Have a reaction to hormone patch, causes breast cysts.  Any information would be greatly appreciated. Thank You.
A:   Although it is not approved for this use, Pamedronate is a drug in the family of Fosamax that can be used intravenously for treatment of osteoporosis. I am unaware of a patch that would be useful. Sorry.
Q:  Do you recommend assessing bone density and treating osteoporosis in
wheelchair bound women who are unlikely to fall?
A:   In general, yes. Immobility is associated with bone loss. Low bone mass and the tendency to fall is a perfect combination of fractures.
Q:  My T Score is -3.1. I have been told to take evista by a Mayo Clinic Doctor. I am sixty years old. I was diagnosed in 1995. My T Score then was -2.86. I had a compression break in 1993. Does this always get worse? I am afraid to take evista because of the side effects (blood clots). My mother had one in her leg years ago.
I have barrett's esophagus also. What percent of people get blood clots? And could this bone density stay the same? What is the ususal progression of this disease?
A:   You need to compare the raw numbers for bone mineral content and the results need to be done in as standard a fashion as possible: same machine, and ideally the same technicians with known precision data. If you bone mineral density remains the same, there is still a reduction in fracture rate. If you have already had an osteoporotic fracture, your risk of another is greater than someone with worse bone density and no fractures. Not knowing your age and a host of other information, it is hard to advise on treatment.

This risk of blood clots with Evista is increased roughly three times that of someone not taking Evista (same with estrogen and Tamoxifen). Remember that is three times a very small number--still a small number. If your mother has a hereditary condition known to increase the risk of clots, you might too. Has she been tested? Or was the clot a result of surgery, immobilization, or injury?

As far as Barrett's, I would discuss this with your gastroenterologist. If you do not have a swallowing disorder you may still be able to take Fosamax or Actonel.
Q:  This question is with respect to my mother.  She is 74 years of age, and was diagnosed with osteoporosis.  She is small boned and thin.  A blood test recently revealed that she has too much calcium in her blood; this is apparently due, they believe, to parathyroid issues.  Her question is whether she should take Miacalcin, when she already has too much calcium in her blood.  If so, why?  If not, what are the dangers or problems with this treatment? Thank you so much.  Your response would be greatly, greatly appreciated.
A:   If your mother's blood calcium levels are too high, she may have a benign (non-cancerous) tumor of the parathyroid glands. Potential complications of high calcium levels include: osteoporosis, kidney stones, abdominal cramps, and in some cases pancreatitis, and some psychological disorders. It would depend on how high the levels are. In younger women, surgery may be recommended to remove the abnormal gland. This surgery is not without risk and should be done by an experienced endocrine surgeon. In some women, the levels of calcium and parathyroid hormone do not justify doing anything.

There is no reason why she should not take Miacalcin, but as an agent for treating osteoporosis, it is not as effective as others in reducing fractures. Fosamax or Actonel might be better choices. Hope this helps.
Q:  At 55 I had only missed two periods but because of symptoms (sleep problems, palpitations, sudden weight gain) my gynecologist gave me HRT.  I stayed on different
preparations for a year and stopped last April because of lower leg edema.  I have only been off replacement since then.  About 11 months.

I am a 56 year old female.  I try to keep up with the latest health information and incorporate the "right" things to do.  I have been doing aerobics for 25 years.  I have also been lifting weights for several years.  I take a multi and separate vitamins including calcium (1200-1500 over three doses), with magnesium, and vitamin D.  I had a base level bone scan several years ago and everything was normal.  I had another test last year with a traditional dexa machine and it showed an increase in my hip density but a
slight decrease in the spine(osteopenia).  My endocrinologist said she didn't feel the traditional dexa machines were accurate (because it only viewed the spine from one direction) and that she was getting a new one that "arced over the area and also viewed the spine laterally.  Well, I went for my test today and she said I had the hip density of a 30 year old but had osteoporosis of the spine and that the other test must have been picking up the area behind the spine which she felt was osteoarthritis.(no symptoms)  I couldn't believe it and am quite upset because I make such an effort to do all the "right"
things.  I've never smoked hardly drink, and in fact am over weight which should help.(only times it does.)  I do take synthroid and cytomel but get tested at least twice a year.  I'm really upset.  I also don't know whether to believe what she said about this "better machine".  If it is so much better why doesn't anyone else use it.  The nurse said she was the only one in the East with this machine probably because it was so expensive.  They have only had this machine for about five months and watching her "assess" and manipulate the graph lines on the computer makes me think it is very much
determined by the person manipulating the computer.  The doctor seemed to agree.  I don't know how long it takes to be proficient on this type of dexa.  Is there any data about the accuracy of this dexa machine versus the usual dexa machine?  Help!  I'm bewildered and don't know what to do next.
A:   It is hard to argue that the traditional DEXA machines, measuring the lumbar spine and hip are not accurate. The problem is in the concept of bone density, bone loss and trying to compare small changes where the accuracy of the machine is fine, it may be the precision of the people using the machine. Unfortunately, the terms "osteopenia" and "osteoporosis" are made by comparing your bone mass today with the theoretical peak bone mass you would have been predicted by computer model to have reached in your late twenties. The difference of those measurements determining osteopenia (some loss) or osteoporosis (more loss). The problem is that there is no way of knowing if you ever reached your anticipated peak bone mass and lost it, or never had it in the first place, but have not undergone significant loss. The physiological definition of osteoporosis implies a loss of bone quality and strength, that is not just low bone density but deterioration of the microarchitecture of the ! bone. Currently, we have no practical way of measuring this. The problem is compounded by loss of bone with age in spite of all the very sensible things you have done and the overwhelming contribution of the genetic determinant of peak bone mass which is probably the most important aspect, and about which, you can do nothing.

Currently, bone experts recommend using the femoral neck as the site to diagnose osteoporosis and caution against using only one bony area of interest. By this I mean, not overinterpreting one vertebral segment, or using only one of the hip measurements. In the new DEXA machines, there will be enhancements to the ability to "see" structures and hopefully avoid some of the current confusion. The facts remain: different types of bone lose density at different rates and there is often little correlation among the sites commonly measured, such as the spine, forearm, and hip. Second, the precision is everything when comparing two or more studies, and the human element is key. Each technologist should know their own precision. The accuracy of each machine is seldom the issue. Comparison measurements should be done by the same people on the same machine. Third, one must allow enough time between exams to make a meaningful comparison. For the hip, this is generally two years.

Vertebral measurements are confounded by the difficulty of lining up the spine perfectly and consistently. Also, arthritic changes make the bone appear more dense than it is. Perhaps new machinery will help this, but I would be cautious in throwing out the baby with the bath water and blasting the current DEXA technology. There is already a call for better training and certification of technicians so that meaningful results will help clinicians make better decisions. Hope this helps.
 

**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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