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Osteoporosis Ask The Expert |
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| Q: 55 yr. old female...routine DEXA scan showed 5.0 for lumbar spine, 3.9 for hips. Can't find any info on elevated readings. Any cause for concern? |
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| A: High T-scores from DXA may be due to either artifacts, drifts in calibration of the DXA apparatus, large sized bones (or people), or underlying bone "sclerosis". It is prudent to start with a radiograph of these regions to r/o artifacts such a s degenerative changes leading to false elevations of bone density and also to search for evidence of underlying bone disease. Underlying bone sclerosis can be caused by a variety of diseases, but one that should be kept in mind is hepatitis C which may otherwise be without any symptoms. In summary, high T-scores do require some concern and appropriate further evaluation. |
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| Q: I have just turned 50 and have been on Actonel for about 5-6 months now. I am 5'7" and my weight has remained the same for the past 15 years. Now that I am on Acetenol, my weight has changed by 8-10+ pounds without changing my eating habits. My stomach swells and I am "thick" and it's disturbing. Is this one of the side-effects? I had a hysterectomy 5 1/2 years ago but still have my ovaries; hormone level is normal so I am not on hormones. Actenol and calcium, Vitamin C, Vitamin E are the only other medications. Thank you! |
| A: There is no evidence from clinical trials or general experience that a drug such as Actonel would be the cause of your swelling. Suggest that you discuss this with your physician and look for other reasons. |
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| Q: I do not fit in the standard categories for osteoporosis, although there is some family history of the disease. I am not small, thin, do not smoke, never took steroids, etc. However, my periods began a bit late (14) and were irregular. I never took anything to make the periods more regular. I was diagnosed as post-menopausal last year at age 46 (after the standard blood test). I had a bone density test and scored -2.3 on the hip. Is this because of the irregular periods, and were the irregular periods due to lack of adequate estrogen? I now take Femhrt hormone replacement therapy, but am wondering if I am a candidate for Fosomax, as well. Thank you for your comments. |
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| A: Unfortunately, "risk factors" for developing osteoporosis are only a part of the entire story. There is much we do not understand that leads to an individual having low bone mass and a high risk for future fractures and the postural effects of weaker bones. It is difficult to know whether your irregular periods played an important role in this regard; especially without information as to the levels of your circulating estrogens during those times. It is conceivable, but more likely is your "positive" family history. You might be a candidate for Fosamax or alternatively wait for follow-up bone densities to monitor the effect of the FemHRT- this is something you need to discuss with your physician. Hope this is helpful. |
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| Q: My mother has been asked to take Osteofos (same as Fosamax) 10 mg. per day. Her concern is that since she has Sjogren's which causes dryness etc. Perhaps she may be more prone to the side effects of Osteofos. She is worried about the pill getting stuck somewhere in her system. I have asked her to check with her physician about the once a week dose. Would appreciate any suggestions you may have. She is also taking calcium supplements - 500 mg. per day - I have asked her to increase this to 1000 mg. per day. |
| A: I see no reason to suspect that alendronate (Fosamax) should be a problem merely because of xerostomia (Sjogren's Syndrome). The dry mouth from lacrimal gland dysfunction should not effect the esophogus and place her at higher risk for side-effects or problems. Once a week dosing sounds like an excellent choice, as compared to daily dosing. |
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Q: I would like to stop HRT & alternatively use soy products & flaxseed and a more whole foods eating style. I am 50 yrs old and have had a Hysterectomy with BSO. Is this an appropriate alternative and is it possible to provide similar protection to HRT? Also, what is your view on calcium orotate vs other calcium supplements? Is it better utilized by the body? |
| A: The first part of your question is too complex for a forum of this sort. That being said, no "natural" alternative can do what HRT can do as effectively as HRT in double blind, randomized controlled trials with respect to menopausal symptoms. With respect to heart disease, eating right, exercising and cholesterol lowering medication may even be superior to HRT. The same goes for Alzheimer's disease with respect to eating and exercise in addition to keeping an active mind. Both osteoporosis and colon cancer will benefit from the better lifestyle changes and additional calcium (plus Vitamin D). HRT may still be one of the better ways to reduce macular degeneration however. In a literature search of calcium orotate, no articles came up except for sales pitches. In contrast, there was one article from Hungary about magnesium orotate reducing cardiovascular disease. Since I found no "objective" literature about calcium orotate, I cannot comment on it at this time but look forward to new studies. |
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| Q: I am 50 years old and still getting my period, although irregular. I have some bone loss already and my dr. decided to put me on footman once a week because I have very small bones. He did this so there would be less bone loss and perhaps growth of bone instead. I would like to know the side effects of taking this drug if any? |
| A: Side effects from alendronate (Fosamax), especially when administered in once weekly dosing, are quite rare. In clinical trials, when subjects were unaware whether they were taking alendronate or a placebo pill, the frequency of side-effects was equivalent to the placebo group. No one side-effect was seen more prominently with alendronate as compared to placebo. However, there have been cases of esophageal irritation (esophagitis) subsequently noted after the trials were completed and this drug was released into the market. These cases were usually associated with the patient either taking very little water with the pill or lying down immediately thereafter. This led to the warnings which stress the importance of at least 8 oz. of water and remaining upright. Fortunately these are rare instances, and for the most part, Fosamax is well tolerated and has impressive salutary effects on the skeleton to reduce chances of future fractures. Hope this puts everything in perspective. |
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| Q: Hi. I am a 36 year old white female with a tof -3.2. I had rhabdomyosarcoma as a child, diagnosed at age 7. I had one ovary and my uterus removed at the time. I had 18 months of chemo and radiation directed in my pelvic area. I was not given estrogen replacements. I found out last June, I have gone through menopause, hence the bone density. I tried Fosamax and had severe reactions to it. I currently take Klonopin for post traumatic stress disorder and cannot take antidepressants due to side effects. Any direction would be greatly appreciated. |
| A: It is difficult to assist you in that the reaction to Fosamax was not elaborated. It is conceivable that dosing Fosamax weekly or every other week to start with perhaps lower doses and even antacids (proton pump inhibitors) the evening before the weekly dose might all be considered in strategies to treat your low bone mass. Alternatively, you might be a candidate for Actonel. These are all suggestions to discuss with your physician or local bone expert. Good luck. |
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| Q: I am 55 years old, and am in the low 25 percentile, on my bone density scores. Spine -2.4 Hips -l.7. I have not been able to take Fosomax or Actonel. My doctor wants me to take Evista. I have read that Evista increases the risk of Ovarian Cancer. My doctor said this is not so. Do you think there is an increase in Ovarian Cancer when taking Evista? Can I do weight bearing exercise, and proper diet, and not take medication? I would really appreciate your response. |
| A: I am unaware of any data that suggest Evista increases the incidence of ovarian cancer, and based on its ability to antagonize estrogen effects on reproductive organs (or act neutral), it is unlikely to anticipate a rise in ovarian cancer from Evista use. In terms of exercise and nutritional modifications, these are important and should be helpful, but are unlikely to be sufficient to avoid medication. This may be best discussed with your physicians or a local expert in osteoporosis. Hope this is helpful to you. |
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| Q: I am a 52 year old female with osteopenia as of 1998 discovered thru a bone density test. Prior to that In 1995 had a major leg and foot injury due to a fall in the living room of my house. Leg broken in the joint and foot in 5 places. Immediately went on Fosamax and in 1999 bone density had increased to -2.1. In 2000 due to gastro problems (reflux /GERD) came of Fosamax and went on Evista. Did not have a bone density in 2000. New bone density test as of June 2001 indicates bone density much worse .. now at -2.4. The Evista is awful for night sweats and increased hot flashes. Very uncomfortable but my ob/gyn says best way to go due to reflux. Would you recommend HRT instead of the Evista? Also I understand their is a new time release Fosamax out that you take only once a week. What would be your opinion of taking it with having GERD/Reflux? Another question that I have is concerning Actenol? Would this be another alternative? I currently take 1500 mg of Calcium and try to take 800 iu of Vitamin D. My exercise program is much harder for me due to my past leg and foot injury. Would it be helpful to take a combination of medications? I do not want my next bone density to be full blown Osteo. Your help is appreciated. |
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A: The
underlying condition of GERD is not necessarily a contraindication to
using Fosamax or Actonel. Especially with our recent
understanding that Fosamax may be taken only once a week and still derive
similar effects as with daily use. Many patients with GERD opt to
use a proton-pump inhibitor such as Prilosec or Prevacid the evening
before their once a week dose. If you are losing bone mass while on
Evista, then either weekly Fosamax or alternatively Actonel would seem
like rational alternatives or additions. Conventional hormone
replacement is also a viable option- all these choices must be discussed in detail with your physician or local osteoporosis expert. Hope this is useful information for you. |
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| Q: I have been diagnosed with mild to moderate osteopenia. My physician started me on Actonel nearly a year ago in a 5mg daily dose. Recently I was switched to a 30mg weekly dose. I understand that, like Fosamax, the manufacturers of Actonel are expected to get FDA approval of a once-a-week Actonel later this year, probably a 35mg pill. Am I now getting an adequate amount of the drug to protect me from further bone loss until this new and slightly higher dosage becomes available? |
| A: The data concerning weekly Actonel with a 35 mg dose is currently being submitted to the FDA for analysis. Whether this becomes available depends on the outcome of that analysis and the data from this recently completed clinical trial. The question of whether 30 mg is an adequate substitute cannot be truly answered since this dose wasn't subject to study. Therefore, depending on a number of factors (e.g., the severity of your disease, etc.) a judgement must be made by your health care providers as to whether this is a sufficient dose. Hope this is useful information. |
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| Q: How long prior to conceiving a child would I have to stop taking Fasomax in order to ensure it does not get to the fetus? |
| A: The answer to this is not completely known, but is probably in excess of 12 years. On the other hand, the amount that is released from that contained in the skeleton and actually reaches the fetus is infinitely small and most experts in the field believe that it is unlikely to be harmful. Hope this is helpful. |
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| Q: I am a 38 year old female who has been on long-term steroid (prednisone) therapy for asthma (December 1999 to present), doses ranging from 60-80mg per day. There were also several hospital stays with higher intravenous doses. I am currently at 5mg per day. As a result, a bone density test has shown osteopenia. I recently fractured my left hip requiring surgery. In April of 2000 I had a Nissen-fudliplication for severe GERD. Other surgeries in 2000 include a fistulectomy and sinus (twice.) I have also been treated with multiple antibiotics for all but a few weeks during this period of time for pneumonia and chronic sinusitis. I have high blood pressure and total weight gain of 70 pounds. I have been taking 600 mg of calcium with 200 I.U. of vitamin D twice a day since March of 2000 as well as a multi-vitamin. Other medications I take daily are Diovan, Tiazac, Prilosec, Zyrtec, daily aspirin therapy, Flovent, Serevent discus, Flonase and Combivent. Exercise is limited due to the fracture, however before the fracture I was in aquatic therapy for 45 minutes twice a week and walking. I want to be educated in possible treatments of osteopenia before I meet with my doctor in two weeks to discuss my personal treatment. |
| A: You present some very challenging issues to deal with in terms of the dependency on steroids to control your asthmatic condition, which unfortunately weaken the structure of your skeleton. With the severe GERD, using oral bisphosphonates such as Fosamax (even once weekly) is not without some risk. You did not provide information as to the severity of your osteopenia, which might influence the decision as to whether you require additional therapies. If parathyroid hormone injections are approved by the FDA later this year, this might be an ideal consideration. Alternatively, some bone experts will give bisphosphonates by injection every month or few months avoiding the risk of esophagitis. These are just a few suggestions, assuming that your hormonal status is normal and the osteopenia is severe enough to warrant therapeutic intervention. Hope this is useful for you. |
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| Q: Is Fosamax as effective as Estrogen in promoting bone mass growth? Are there known side effects of Fosamax? |
| A: The gain in bone mass that has been observed with Fosamax is about equivalent to that seen with estrogen in individuals who have not been on either agent previously. The longer term data available with Fosamax indicate about 11-12% increase in bone mass over 7 years- such long term prospective data do not exist with estrogen. The side effect profile of Fosamax is fairly limited to occasional esophageal irritation or esophagitis. |
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| Q: I am 50 years old and have just been diagnosed with significant osteoporosis. I am an RN in an ICU and I frequently have to move and lift very heavy patients in and out of bed. My lower back already feel very weak. Am I at risk for vertebral or hip fracture? |
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A:
The question of risk from daily activities such as
lifting in
individuals with osteoporosis is not an easy one. Certainly, lifting
with proper technique is important (bending from the knees, etc.)- as is
muscle strengthening from qualified physical therapists to reduce the risk
of vertebral compression fractures developing. Your sense that your
back is weak is probably more subjective than anything else, as you cannot
perceive low bone mass (or "weakened bones") unless a fracture
were to occur. Dr. Mary Bouxsein, a scientist at Harvard, has been
trying to study the relationship of everyday activities including lifting
and the stress to specific skeletal sites. You can retrieve some of
her work on the internet. Hope this is useful for you.
Please check-out this article about Dr. Bouxsein which includes a reference of publications. |
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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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