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Osteoporosis Ask The Expert |
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Questions
this month have been answered by:
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Q: Can osteopenia be reversed without drugs?
I am interested in knowing if my tests results indicating osteopenia
in my
spine and borderline osteoporosis in my hip can be reversed with 1500
milligrams of calcium, increased soy intake and vitamin D. My Doctor
recommended that I walk with 5 pound weights. |
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| A: Exercise, Calcium, and Vitamin D are the first line therapy
in your setting.
They will assist in retarding further bone loss. Weight bearing
exercise
stimulates bone remodeling. Multiple studies suggest that healthy
living
can minimize bone loss but will not rebuild bone. Second line
therapy
utilizing Hormones or Evista will build some bone and stimulate the
production of quality bone. third line therapy consists of bisphosphonates
such as Fosamax and soon to be released Actonil. There is also a
nasal
spray, calcitonin, which will build some bone. It sounds as if in
your
setting you need to begin thinking of additional therapies. R. Wayne Whitted, M.D., M.P.H OBGYN.net Osteoporosis, Editorial Advisor |
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| Q:
Miacalcin nasal spray vs. Fosamax I am a 57 year old postmenopausal female. After 9 years of HRT, I was taken off and placed on Fosamax due to the results of a bone density test. I could not tolerate the Fosamax due to very bad GI upset. Now I am on Evista and am having hot flashes, night sweats, sleep disturbances, and continuous sinus problems. I have never felt worse in my life. I know I have osteoporosis, but is there a better way to manage it? A friend told me Miacalcin is a nasal spray and does not have these side effects. |
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| A: Osteoporosis is treated in a
multi-tiered fashion.
Firstly one must have all modifiable factors optimized. these in
part include tobacco, caffeine, alcohol cessation, taking appropriate
calcium and vitamin D, exercise and optimizing the health from chronic
diseases. HRT is used for bone stabilizing and a myriad of other
menopausal issues to include symptom control. If osteoporosis occurs
while on HRT than often another
antiresorptive agent is added such as Fosamax or Miacalcin nasal spray.
Evista is not necessarily a replacement for HRT as it does not have as
good of a bone building effect as HRT in clinical studies.
R. Wayne Whitted, M.D., M.P.H
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| Q:
What are the side affects of the Drug Fosamax? I have been diagnosed with osteo and have been taking Fosamax and am wondering what are the side affects of this drug? |
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| A: Side effects of Fosamax over placebo include abdominal
pain, constipation,
diarrhea, flatulence, acid regurgitation, esophageal ulcer, Musculoskeletal
pain, headache. There may be other side effects but are not reported
at
this time.
R. Wayne Whitted, M.D., M.P.H
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| Q:
Do
I need a bone density test now? My general practitioner has said I need to have a bone density test where my spine AND my right hip need to be x-rayed. I am 49, and had a total hysterectomy at age 42. I have never had children. Do I need this test at this time? Why? How often is this test needed? Why? I am taking Estradiol and have taken ERT since three months after the hysterectomy. |
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| A: You do not mention your other risk factors for menopause.
Early menopause
is only 1 risk factor. Since you have been treated with HRT its
importance
decreases. There are no clear guidelines so all doctors have
different
protocols. Since the test involves minimal radiation it is harmless.
My
rule of thumb is to have a BDS 10 years after menopause if treated with HRT.
Recommendations on frequency of the test is based on the findings of the
initial scan.
R. Wayne Whitted, M.D., M.P.H
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| Q:
What side effects can I
expect from Miacalcin nasal spray?
What side effects can be expected with Miacalcin Nasal spray? I have been diagnosed with osteo arthritis and this spray was recommended as treatment for me. |
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| A: Miacalcin nasal spray is used solely for osteoporosis
treatment.
Osteoarthritis is a different disease entity requiring different
treatments.
The main side-effect of the spray is rhinitis (runny nose) which can be
aggravating.
R. Wayne Whitted, M.D., M.P.H
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| Q:
What is advisable for a person with osteoporosis
and arthritis?
My mother (like many people I suspect) has both osteoporosis and osteoarthritis. As a result, the very types of weight-bearing exercise that would help her osteoporosis would unfortunately worsen her arthritis. What is advisable for a person with osteoporosis who also has arthritis, other than obvious measures such as sufficient Vitamin D and calcium intake and possible pharmacological therapy? |
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| A: Unfortunately your mother is in a catch-22 situation.
What kind of
exercises does her rheuma -tologist suggest? Her options include
calcium and
vitamin D. she needs to consider Evista or hormone therapy as an
adjunctive
option. In addition, to improve bone density, she may need to consider
Fosamax or Miacalcin Nasal spray.
R. Wayne Whitted, M.D., M.P.H
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| Q:
Concerned with what medication would be most appropriate.
I was just diagnosed with severe osteoporosis, I've read some information on the medication, Fosamax, but it is not FDA approved. I am 37 and concerned with what medication would be most appropriate for me. I Am very sensitive to most drugs, am taking inhaled Pulmicort and Bricanyl inhalers for breathing problems. I Also get lots of headaches and am trying a weight resistance program, but my neck and shoulders ache this I believe brings on a headache. Also have very poor urine stream and have slight incontinence during night time sleep, maybe not associated with osteoporosis. |
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| A: As I am a gynecologist, I feel a little out of my league in answering
this
question as it appears you are a 37 year old male. Quite honestly, I would
discuss osteoporosis with your physician, and perhaps seek out a doctor
with
an interest in metabolic bone disease, such as an endocrinologist or renal
specialist. Paul D. Burstein, M.D., FACOG OBGYN.net Osteoporosis, Editorial Advisor |
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Thank you Dr. Burstein for giving me a piece of your
valuable time,
especially since this isn't your field. I really mean that. Sometimes its
not
hard to think that Doctors are trained to be as detached as waiters.
You probably get hundreds of messages, so I consider
myself
lucky you answered me, and wish I that I could find a Doctor like yourself. |
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| Could you please give me some information on pubic osteoporosis and how arthritis can complicate this condition. | |||
| A:
I do not have a lot of information specific to the pubic bone. Cases of
"insufficiency fractures" are reported and seem to be related to
known
osteoporosis, use of Corticosteroids, and other risk factors. This is an article which may be of interest: Insufficiency fractures of the pubic ramus. Semin Arthritis Rheum 1996 Jun;25(6):373-82 (ISSN: 0049-0172) Schapira D; Militeanu D; Israel O; Scharf Y Department of Rheumatology, Rambam Medical Center, Haifa, Israel. Seven elderly women with insufficiency fractures of the pubic ramus are described. The pre - disposing factors for this condition were osteoporosis, rheumatoid arthritis, renal failure, prolonged Corticosteroid treatment, pelvic irradiation, and mechanical changes after hip surgery. The clinical presentation included progressive inguinal pain, limping, and inability to walk. Because initial radiographs were diagnostic only in four cases, bone scintigraphy and computed tomography were necessary to confirm the diagnosis and detect additional fractures. In most patients, bed rest, non-weight-bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up showed complete or partial recovery. In one case, no recovery was achieved because of noncompliance with treatment. Insufficiency fracture of the pubic ramus should be suspected in cases of unexplained inguinal or hip-area pain and inability to walk in the elderly. The clinical suspicion should be supplemented by radiological investigation. Bone scintigraphy and computed tomography are useful means for early and accurate diagnosis. The risk factors for this condition should be identified and treated. If therapy is initiated early and pursued, this type of fracture has a benign outcome. Hope this helps. Paul D. Burstein, M.D., FACOG OBGYN.net Osteoporosis, Editorial Advisor |
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| Q:
Where can I find more
information on osteopenia?
I would like more information on osteopenia, but I am having problems finding anything on the web. Do you know of any helpful links? |
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A: Please review these questions that have previously been asked regarding osteopenia: Here are some articles that may be of interest to you: What is osteopenia?
by Susan Ott, M.D., Associate Professor How
Can I Prevent Osteoporosis? Food and Our Bones: The Natural Way to Prevent Osteoporosis by Annemarie Colbin Information
for Women about Osteoporosis and Other Bone Diseases Protect
Your Bones Please visit our Women and Patients Links page for more information. |
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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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