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Q: What can I do about Gastrointestinal side effects from Fosamax. I've been taking Fosamax for about 4 months. At first the gastro symptoms were minor with occasional problems with gas. For the last month and 1/2 I've had increased symptoms. Pain and discomfort occurs in the afternoon. My obgyn suggested Tagamet before going to bed. This helps somewhat but I'm concerned with prolonged use. Is there a source I can use to possibly approach the problem with changes in diet? I've been unable to discern whether certain foods cause more problems or not. I'd appreciate any info you could forward to me. I see this as a long term problem. I'm only 50 and have not gone through menopause as yet. |
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| A: Fosamax (alendronate) and other drugs like it called bisphosphanates can cause gastrointestinal side effects in some patients. When that happens I usually review with my patients the way they take the medication. Fosamax should be taken in the morning after an overnight fast with at least 8-10 oz. of water (and only water!). Also, the pill should be taken in the upright position and the patient should not lie down or eat for at least 30 minutes after ingesting the pill. If this has been tried and has not succeeded in alleviating the symptoms there are a number of other strategies that could be used: 1. Cut the dose in half for a few days and then slowly return to the original dose. 2. My favorite strategy is based on recent published data: Fosamax can be taken once or twice a week as long as the total cumulative amount of medication is taken. For example: if you were prescribed 10 mg. daily you could take 70 mg. once a week or 35 mg twice a week. This intermittent dosing may alleviate the gastrointestinal symptoms. The benefit appears to be the same as taking the drug daily. The only problem is that at present Fosamax pills are marketed only in the 5, 10 and 40 mg strength. You may want to discuss with your doctor trying one 40 mg. pill every 4 days (if the dose recommended is 10 mg daily) or 40 mg every 8 days (if the recommended dose is 5 mg daily). 3. If you have exhausted all your tricks with Fosamax you can try a different bisphosphonate. Two others are available in the market in the U.S.: Actonel (risedronate) or Didronel (etidronate). |
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What are the side affects
of Tibolone? Hi I wonder if you would answer a question for me. I am fifty six years old and Started going through menopause at the age of forty five. My doctor has just put me on Tibolone, after being on Femoston for a few years They have just found out that I have osteo arthritis in my spine and at 11 stone four pounds I need to loose a stone in weight, sorry to get side tracked but my question is will Tibolone make me put weight on, and what is it made from also are there any side effects Hope you can find time to answer. |
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| A:
Tibolone is a synthetic hormomne used in Europe for treatment of menopausal complaints. It has not yet been approved for use in the U.S. Its biochemical properties are similar to those of estrogen, progesterone and androgens (male type hormones normally produced by women as well). At the level of the uterus it behaves a a progesterone like molecule so the lining of the uterus thins out. In bone, the vagina and the central nervous system it works as an estrogen therefore it alleviates hot flashes and insomnia and may improve mood. At bone it delays the accelerated loss seen after the menopause (anti-resorptive activity). In the brain it can also act as an androgen and libido can be improved. Tibolone can also have some beneficial effects in the cardiovascular system. The most common side effects associated with tibolone are: breast tenderness, nausea, edema (fluid accumulation) and breakthrough vaginal bleeding. The edema when severe can cause weight gain. The bleeding can occur in up to 15% of patients however it can be minimized by starting the medication more than 6-12 months after the menopause. I am not aware of any data on breast cancer. |
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What change can I make to
help my bones? I am a 51 year old premenopause woman. I recently had a bone density test that showed that my spine was very strong ("spine of a 20 year old"); but my hip bones were very weak. I am very active, (I do weight-bearing exercise 5 days a week), have never smoked, drink infrequently, eat a healthy diet and have been taking a multiple vitamin and a Calcium with Vit D supplement for a year and a half. My doctor also ran a series of blood work test, they showed hormonal levels were all normal. Why would the hip bones be so different from the spine bones? Can you recommend any changes I can make, or further testing my doctor should consider? |
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| A: The first thought that comes to my mind after reading your question is to make sure that your spine measurement is correct. An analogy to this is the following: you ring your neighbor's door bell and there is no answer. You assume your neighbor is not home but another possibility is that the electricity is out, the door bell is not working or that your neighbor is using headphones to listen to Vivaldi's "Four Seasons" and cannot hear the door bell ringing. Similarly, while your spine measurement is reported to be comparable to "the spine of a 20 year old" there are other reasons why the reading may be falsely optimistic. Bone density machines read the amount of mineral content between a source of energy and a device capable to measure the energy transmitted. In front of your spine are other structures such as big blood vessels that can accumulate calcifications. The machine cannot tell what is mineral from the spine and mineral from the vessels. It just reads more mineral than what is truly present in the spine. Also, if there is a vertebral fracture in the spine the concentration of mineral around the fracture will be falsely increased. Spine fractures are usually painful and can be diagnosed more accurately with spinal X-rays. One additional factor is the observation that different bones can loose density at different rates in different conditions. The spine is a more sensitive site to decreases in hormones such as estrogen. |
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Side effects of Fosamax for
osteoporosis. Have been reading and hearing that taking Fosomax has serious side effects. Am a female, age 74 , 105 lbs, 5'1. have read that taking this product can produce an ulcerated esophagus. , even if you do not lie down after taking the Fosomax. Also heard that any bone mass additions is on the outside of the bone and makes the bone more likely to fracture! Has anyone any knowledge of this? It seems that there is always mucous to discharge, (which I can't) and I am developing a cough. Any info would be appreciated. |
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| A: The PDR (Physicians Desk Reference, usually available at your local library) has detailed information that has been evaluated by the American Food and Drug Administration with regards to adverse events that have been demonstrated to occur when taking all approved drugs marketed in the U.S. Some of the most common side effects with any medication are in the gastrointestinal tract, usually nausea. The following is information that was published in the PDR about Fosamax (alendronate): ADVERSE REACTIONS Clinical Studies In clinical studies of up to five years in duration adverse experiences associated with FOSAMAX usually were mild, and generally did not require discontinuation of therapy. FOSAMAX has been evaluated for safety in approximately 6000 postmenopausal women in clinical studies. Treatment of osteoporosis In two identically designed, three-year, placebo-controlled, double-blind, multicenter studies (United States and Multinational; n=994), discontinuation of therapy due to any clinical adverse experience occurred in 4.1% of 196 patients treated with FOSAMAX 10 mg/day and 6.0% of 397 patients treated with placebo. In the Fracture Intervention Trial (n=6459), discontinuation of therapy due to any clinical adverse experience occurred in 9.1% of 3236 patients treated with FOSAMAX 5 mg/day for 2 years and 10 mg/day for either one or two additional years and 10.1% of 3223 patients treated with placebo. Discontinuations due to upper gastrointestinal adverse experiences were: FOSAMAX, 3.2% placebo, 2.7%. In these study populations, 49-54% had a history of gastrointestinal disorders at baseline and 54-89% used nonsteroidal anti-inflammatory drugs or aspirin at some time during the studies. Rarely, rash and erythema have occurred. One patient treated with FOSAMAX (10 mg/day), who had a history of peptic ulcer disease and gastrectomy and who was taking concomitant aspirin developed an anastomotic ulcer with mild hemorrhage, which was considered drug related. Aspirin and FOSAMAX were discontinued and the patient recovered. The adverse experience profile was similar for the 401 patients treated with either 5 or 20 mg doses of FOSAMAX in the United States and Multinational studies. The adverse experience profile for the 296 patients who received continued treatment with either 5 or 10 mg doses of FOSAMAX in the two-year extension of these studies (treatment years 4 and 5) was similar to that observed during the three-year placebo-controlled period. During the extension period, of the 151 patients treated with FOSAMAX 10 mg/day, the proportion of patients who discontinued therapy due to any clinical adverse experience was similar to that during the first three years of the study. |
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Q:
Will Evista cause weight gain? |
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A: In a study where Evista (raloxifene) was used for the treatment of osteoporosis weight gain was measured during treatment in a group of 2,557 women using the medication and compared, during the same interval with the weight in 2,576 women receiving placebo. Weight gain in both groups was not different. In another study the weight in 581 women receiving Evista for the prevention of osteoporosis was compared to the weight of 584 women receivingf placebo during the same interval. In the former group 8.8% of women experienced weight gain compared to 6.8% of women in the latter group. This difference was not considered to be statistically significant. |
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Q:
Will you please comment on
what these scores indicate? Thank you for this website. I am a small-boned, 103-lb, 5'4", Caucasian female, age 52, ten years post menopausal, history of daily Corticosteroid use for past 16 years (10 mg/day with 40 mg bursts when needed). I have just learned that my T score is --3.24 and my Z score is --2.20. I have a 32% lumbar rotated scoliosis. I understand you cannot diagnose or treat, but will you please comment on what these scores indicate? I understand the scores indicate severe osteoporosis -- but does this realistically mean spontaneous fractures, use of a cane and/or wheelchair within a few years? I still work and am limber, but I am seeing and feeling these problems and, of course, have a zero lifting tolerance. I don't know what to plan for. Thank you for any comments you may have. |
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A: A T-score of -3.24 indicates that your bone mineral density is 3.24 standard deviations below the mean when compared to people similar to you who are at peak bone mass. Usually peak bone mass occurs between 30 and 40 years of age. A Z-score of -2.2 indicated that your bone mineral density is 2.2 standard deviations below the mean when compared to people similar to you in age. A T-score of -2.5 or lower is diagnostic for osteoporosis. This means that there is microarchitectural deterioration in your bone that leads to fragility. In real terms this means that compared to a person whose T score is exactly at the mean your bones would require a substantially smaller amount of trauma to break. Trauma is any force applied to bones which beyond a certain level could precipitate a fracture. For example: a fall. It is hard to predict what could happen to you. If you incur no trauma you may not develop a fracture. Spontaneous fractures are rare in osteoporosis. A force must exert its physical effect on bone for it to break. You need to discuss this issue carefully with your health care practitioner to determine which course of action you may need to take. There are medications and preventive measures that you could adopt to decrease your risk of fracture. |
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| Q: Where can I find more information on osteopenia? | |
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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. Click here to see Previous Ask the Expert Questions and Answers |
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