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Osteoporosis Ask The Expert |
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Questions
this month have been answered by:
Click here to see Previous Ask the Expert Questions and Answers |
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| Q:
I have been reading up on Fosamax and one of the sites I've encountered
said this: "Fosamax is in the same chemical class (phosphonate) that is used in the cleaners used to remove soap scum from your bath tub. This is a metabolic poison that actually kills the osteoclasts. These are the cells that remove your bone so your osteoblasts can actually rebuild your bone. It is quite clear that if you kill these cells your bone will get denser. What these studies do not show is that four years later the bone actually becomes weaker even though it is more dense. This is because bone is a dynamic structure and requires the removal and REPLACEMENT of new bone to stay strong. Fosamax does NOT build ANY new bone." Would you please comment on this and also tell me if you have any feelings about Fosamax versus Didronal? |
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| A: There is no evidence that Fosamax acts as a poison to bone while it works to inhibit osteoclast activity. Stong medical evidence supports the use of Fosamax to increase bone density and reduce fractures. Didronal does the same thing but to a lesser extent than Fosamax. | ||||
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| Q: I'm 37 with 3 children and suffering from premenopausal osteosporosis. On a recent bone density test, I was told that I only have 77% normal density on my lower backbone and 81% on my left hip. I am concerned because my OBGYN wants to prescribe 2000mg calcium, Fosomax and birth control pills. How severe is the condition I'm describing above? The % lost seems like a lot, but I am not educated in osteosporosis so I don't know how to interpret these results. Does the above treatment sound reasonable? Is Actonel better than Fosomax? A book I just bought references Ipriflavone. What is this and is it as effective and safe as the other treatments mentioned? No other tests have been performed at this time but I do have family history of this condition. Thanks! | ||||
| A:
Based on the bone density test report
you sent, it is difficult to tell the extent of your osteoporosis since we
read ours differently. The treatment your physician has prescribed
sounds reasonable. The daily dose of calcium usually recommended is 1500
mg/day with 400-800units of Vitamin D. Both Actonel and Fosamax are effective in increasing bone density and decreasing fractures. There is some information available that Ipriflavone may help prevent bone loss, but probably not to the extent of bisphosphonates. There are no studies that have compared the 2 agents directly. Since you developed osteoporosis at a young age, you should discuss with your physician doing metabolic tests that could cause this condition. Most often no underlying conditions are found for the early bone loss, but it important to rule out other causes. |
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| Q: What is the right thing to be doing if you are not in menopause and have very mild osteopenia? | ||||
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| A:
I think that your PCP was right. Before menopause,
if your bone mass is within normal range at spine and only -1,2 T-score at
the hip I think that for the moment you only need a correct diet (calcium
intake of 1200 mg daily), adequate vitamin D, and regular exercise (as you
do). I suppose that you don't have risk factors for osteoporosis (i.e.
malabsorption, hyperthyroidism, chronic use of steroids, abuse of alchool,
smoking). If so, you should re-evaluate your bone mass after menopause and
the decide if you need a therapy. Actonel, as all bisphosphonates, can interfere with the development of fetal bones and therefore must not be used before menopause if there's a chance of getting pregnant. |
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| Q:
I was 74 when diagnosed with osteopenia, my first bone density test.
Going off the HRT in July 2002, my doctor ordered the test. I do not
want to go on medication and will be trying an exercise program. I
will be 75 in March, excellent health, am on NO MEDICATIONS, thankfully. My new doctor states that my left hip has bone loss with a score of BMD/0.808; T-SCORE/-1.1 AND Z SCORE 0.7. Do you have a chart showing the normal scores and is it ok if I postpone medications for several months? |
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| A:
You have mild osteopenia (or bone thinning)
which is normal for your age. In other words, the findings on your bone
density (your z-score) are showing only age related loss. At this time it would be reasonable to postpone treatment. I would recommend regular exercise, 1200-1500mg/day of calcium with 400-800 units of Vitamin D, and trying to avoid activities that could lead to falls. You should discuss this with your doctor and plan to have a follow up bone density in one year. |
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Q: I
am a 50-year-old woman who has been paraplegic due to Landry-Guillain
Barre syndrome since age 14. I use a wheelchair and cannot stand or
walk. I know that I am especially susceptible to osteoporosis
because of the long years of paraplegia. I am active, however, and
do weight training for upper body strength. I do have curvature of
the spine, which I am monitoring with an orthopedic spine surgeon. I
had a blood clot when I was 15, so I don't think I am a candidate for HRT
(plus my circulation is impaired) and am wondering how menopause will
affect my bone density. |
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A:
In order to assess your current bone density it is
recommended that you have a baseline bone density. It may be difficult to
assess the spine due to your curvature, but the hip could be checked. A
bone density would tell you whether or not you have any significant bone
loss. Preventative measures include weight bearing exercise/strength training, regular calcium intake of 1200mg/day (1500mg/day if you are post-menopausal and not on hormones) with 400-800 units of Vitamin D, avoid excess alcohol intake, and tobacco use. If you did develop osteoporosis or significant bone loss requiring treatment, there are other agents available besides hormones, such as bisphosphonates. |
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| Q:
I am a 41 year old women. I have been having approximately
four periods a year for about 3 or 4 years now, before that in my mid
thirties they became very light and further apart. About three years
ago I went to my doctors as I thought I may be starting menopause they
assured me I was not, my bloods came back within normal range. They
did not offer to do further bloods at a later date. A year ago I
returned to the doctor as I was still feeling very unwell, aching muscles,
exhaustion etc. This time the results came back post meno.
Oestrogen 65 FSH 95. At that time I was 40. My doctor has said that as I am still getting occasional periods that my bones are not a risk. She has diagnosed peri menopause. I have since found out that with POF you still get periods even though you are in the post menopause range and that this is not the case with older women. The point I am making is as I have low oestrogen (it has been tested again, no significant change) and in older women this would cause my periods to stop, is it correct that my bones are not a risk. What level of oestrogen should we have to protect our bones. One doctor said she could not understand why I was still getting periods as in her view I shouldn't be. My doctor has advised me to wait a year without a period, from what I have read about POF this could go on for years. Also is it the case that we loose bone in the years leading up to menopause? |
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A: Premature ovarian
failure may have a several year course of waxing and waning ovarian
function before the ovaries completely stop making estrogen. Estrogen
levels over at least 50pg/ml all the time would be considered
adequate to preserve bone. Levels of estrogen can vary throughout the
month even in normal cycling women and may be over 100pg/ml. In order to assess your bones at this time, you should discuss with your doctor getting a baseline bone mineral scan by a dexa scan that evaluates the hip and spine bone density. To maintain bone health you should get 1200-1500mg/day of calcium with 400-800units of Vitamin D along with regular weight bearing exercise and avoidance of tobacco use and excessive alcohol intake. You should also discuss with your doctor whether you require any hormone replacement therapy. If your doctor thinks you are having periods when she thinks you shouldn't be, then you should discuss with her an evaluation for abnormal uterine bleeding. |
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| Q: I am 39 and my DEXA T scores indicate moderate osteopenia in the Hip (neck) -1.5 and lower spine -1.7 and mild osteopenia in the upper spine. I suffered a premature menopause at 31, am petite and small boned and have been taking anticonvulsants for over 20 years. I am on HRT, calcium and take plenty of exercise. Given my history, please could you advise whether you think these T scores merit going on to a biphosphonate now? | ||||
| A: It sounds like you are getting appropriate treatment at this time. In order to decide whether you need additional therapy or just close follow-up with repeat bone densities, it would be helpful to know your Z-score. The Z-score compares your bone density to age matched controls. If the value is less than -1.0, then consideration would be given to checking a marker of bone resorption (such as urinary N-telopeptides) and if it is elevated possibly adding another agent for treatment. You should discuss this further with your doctor. | ||||
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| Q:
Literally by accident (as a result of x-rays for a car
accident, no fractures) I found out I have what I believe to be a rather
severe case of Osteoporosis, I am 43 years old with a 6 month old
daughter I am nursing. I am very concerned about the diagnosis because I want to be able to do the things that other moms do with their daughters for many years to come. My z-scores were -3.6 for the AP Spine L2-L4, -2.7 for the right femur and 2.2 for the left. I have gone to doctors and have not been satisfied with their experience with osteoporosis for someone in my situation. I have not been satisfied that we understand the cause, I had a milk allergy as a child and did not have a lot of calcium intake, I have asthma and I am taking an inhaled Steroid but only for 3 years, I am very small framed, and as I said I am currently nursing. My thyroid test and Calcium test were both normal. One doctor proscribed Actonel to begin taking after I finish nursing. My questions are: What type of specialist should I be seeing? Is it possible that I will have some bone mass gain after I finish nursing? Actonel seems to be for post menopausal woman. In your opinion, should I be taking that? I am hoping you will take the time to provide a response, I am very desperate at this point for information. I want to be able to take care of my daughter. |
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A:
You have valid concerns. You should be fine to
continue taking care of your baby and future child. I would recommend you
consult either a medical endocrinologist, internal medicine, or
reproductive endocrinologist for treatment and further follow-up. You will regain some bone density usually about 6 months or more after you stop breastfeeding. You should have another bone density 6-12 months after completion of breast feeding. At present make sure you are getting 1200-1500mg/day of calcium with vitamin D 400-800 units. Actonel is usually used for post-menopausal osteoporosis, but has been used in reproductive age women with osteoporosis. You should discuss this further with your physician. |
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Q:
When I was 48 years old, I was diagnosed with Metastasis Breast Cancer. I
am now 53 years of age. I have been receiving chemotherapy since 1998. The
drug is Taxotere, and is administered to me every 21 days. So far I have
had 83 treatments, and am doing quite well. I recently have a bone
scan and was diagnosed with mild osteopenia. My doctor wants to start a
drug called Zometa. Zometa is administered every 4 weeks by I.V.
injections. It is a bisphophonates drug.It is used to treat Hypercalcemia
of Malignancy-HCM high calcium levels. My blood calcium levels
are in the normal range. My doctor told me that Zometa and
Fosomax are the same type of drug. I'm not that convinced they are.
I was wondering if I could take Fosomax 70 mg. once weekly for my
Osteopenia? Would the Zometa be better for me? Could I take both
drugs?
If someone is taking chemotherapy drugs can they take Fosomax? I was wondering if I could take Fosomax 70 mg. once weekly instead of the Zometa? Or perhaps I could take both drugs? |
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| A: It sounds like you are in good hands with your doctor. The Zometa would likely be beneficial for you to improve your bone density as well as being indicated due to your history of bone metastasis. Fosamax and Zometa should not be used together. Also, Fosamax will improve bone density but has no indication for treatment of women with bone metastasis. It would be fine to use Zometa with other chemotherapy agents. You could discuss it further with your doctor. | ||||
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| Q: I have a 27 degree curve in my spine from scoliosis. At 41 I now am developing a "hump" around the top of my spine where my neck connects and I know that is directly related. Does this mean I also have osteoporosis and how should this be treated? | ||||
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A:
The "hump" in your spine may reflect
changes from your scoliosis rather than osteoporosis with vertebral compressions. Perhaps the best way to determine whether low bone mass or osteoporosis is the cause is to obtain both x-rays and bone density measurements and review these with your primary care physician or orthopedist. |
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Q:
I am 57 yeas old female and have been on didrocal for the
past year for osteoperosis. I have noticed that since I have been on
this drug I have gained an unusual amount of weight while keeping on the same diet that I have always followed. I have also lost quite a bit of hair and have been told that I have alepecia. I have now read that this could be due to the medication which I am taking. If I discontinue the medication is there any chance of my hair regrowing. I really feel I am a little young to have such hair loss and am now concerned that it will get worse and it is definitely now becoming visible to everyone. Previous to my taking this medication there was absolutely no hair loss visible as I visit the hairdresser once a month and she started to notice it about six months ago. I had been on this medication for about six months at that point but did not realize that this was a possible side effect of the drug. Is there anything else I can take for the osteo that does not have this side effect? Other than fosamax which does not agree with my stomach. Your advice would be appreciated. |
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| A: You provide few details as to the severity of your condition. The relationship of your hair loss to your medication, which is a combination of etidronate and calcium, remains puzzling. Although post-marketing experiences have been reported by individuals which include alopecia, double-blind clinical trials and years of experience have not substantiated that this adverse event is more common than the placebo arm. Nonetheless, since you are experiencing this perhaps an alternative should be contemplated. You do not mention that anyone tried Actonel which would be a consideration and most recently Forteo, an injectable anabolic agent, has been approved by the FDA. These might be products to consider as well as a selective estrogen modulator such as Evista. You might be best served to discuss these options with a specialist. | ||||
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| Q: I took a bone density screening test since it was free. I am a 45 year old premenopausal woman. I have had 4 children, the last a set of twins, four years ago. I nursed all my children for at least 2 years. I have always depended on diet to serve my calcium needs. Before having children I had irregular periods and required clomid to become pregnant. My mother who is now 88 suffers from osteoperosis and has had many fracutures due to this condition. My screening test resulted in a -1.5 T score. My doctor has perscribed actenol and 1500 mg of calcium along with Vitamin D and exercise. I will also have an upcoming DEXA scan. In answers to other questions you mention that osteoperosis in premenstraul women has an underlying cause. With my history does this mean that I have a disease underlying my problem and that it is not a result of my family history and other factors? Do I have osteoperosis or am I jsut on my way? | ||||
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A: The DEXA results indicate
low bone mass, or osteopenia, rather than osteoporosis. Nonetheless
, the causes may range from your genetically programmed peak bone mass
which you may have acquired by age 25 (and not lost much since then) or an
underlying disorder that obviously is not causing other symptoms (such as
thyroid disease or parathyroid disease). A simple medical work-up with certain blood and urine tests could be done to exclude these possibilities. Consult with your physician. |
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| Q: I am 48 1/2 years old and have been on long term prednisone for 3 years straight. Should I have other harmones tested? Am I going through menopause or having altered harmones from prednisone and shut down adrenal gland? If I'm low in DHEA would taking supplements help estrogen and possibly regulate periods? I don't want to go through menopause any earlier than I have to because of bone loss! | ||||
| A: Asked to address the interaction with prednisone as far as osteoporosis, there is no question that steroids for longer than 3 months can lead to bone loss. If the need is temporary, so much the better. If the need is recurrent or long term, adequate anti-resorptive therapy such as Actonel or Fosamax is needed AS WELL AS adequate Calcium and Vitamin D. The fact that osteoporosis is not present yet is good. Keeping up with the above noted therapies will help stave off further bone loss. If not, Forteo, a new medication may be of some use. You may need to discuss this with your doctor if deemed appropriate. | ||||
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Q: I
just completed a health screening at my place of employment. I had my
blood pressure, cholesterol, glucose and bone density screened. All the
results were great except for my bone density which I scored -1.3. Which
would indicated I have osteopenia. The bone density test was performed on
my right foot. I inserted my right foot into a device and received a
reading of -1.3. I am in very good health. I do cardio 5 -6 times a week
for 40-60 minutes a day. I also do weightlifting exercise 3 times a week
which includes all my major muscles groups. How can I have such a
low bone density score if I am in such great shape? Can you make any
recommendations for someone with my score? Is it too late to rebuild
the bone mass I have lost? Thank you. |
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A: The world health
organization has defined osteoporosis as a t-score less than minus 2.5. It is important to remember that bmd is distributed along a bell curve. This means that on any given bone density 50% of the population is above the mean and 50% is below the mean. A t-score at minus 1.3 is not a "bad" bone density. The best thing you can do is healthy living, vit d, exercise, calcium intake. I would follow the National Osteoporosis Foundations guidelines for having a bone mineral density especially a follow-up one. This area is very controversial at this time. |
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| Q: When I was 25 I was diagnosed as osteopenic. My mum has osteoporosis, I am a small built woman, an asthmatic, I have been on prednisone intermittently for the past 15 years, and inhaled steroids for about 13-14 years. I went off the preventer medication so as not to damage my bones further. I have been on the combined contraceptive pill for the past 11-12 years. When I was first diagnosed, I took up yoga to remain flexible, I have since also begun Tai Chi. I walk up and down the stairs a lot at work, and my job involves some lifting. I eat a lot of dairy foods, and take calcium supplements. I was on Caltrate 600 + Vit. D for about a year and now I take Super Calcium Complete, with calc citrate 1190mg, magnesium oxide, manganese, zinc, Vits K4 and D3 and hydroxyapatite. Would you please tell me of any treatment options that may be open to me as a pre-menopausal woma?. Any help you can give will be greatly appreciated. Thank you. | ||||
| A: You have a very complex situation. Their is a lot of controversy in performing bone mineral densities on women premenopausally. I would recommend seeing a reputable endocrinologist who specializes in bone who can clarify these issues for you. | ||||
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Q:
I am 49 and was diagnosed with osteoporosis of the left hip three years ago and osteopenia of the spine and elbow as well. My doctor immediately put me on Fosomax (30 mg/day) and told me to increase my calcium intake up to 1200-1500 mg per day. My first follow-up bone density test after two years showed improvement in my hip, spine and my elbow is now out of range of osteopenia. I have been in peri-menopause for about 2 years with hot flashes, lots of tears(!), lack of energy, etc. My periods are much heavier and last much longer, but once in a while they are extremely light or just a few days. I have had two months where I had it twice. My best friend was recently diagnosed with osteoporosis and osteopenia and mentioned that her doctor refused to put her on Fosomax (or anything for that matter) because it is now contraindicated before menopause. That scared me, so I asked my doctor about it. She stated that it was a similar concern like the prem-pro issue. But because I am in PERI and not pre-menopause, I was safe. And with the marked improvement in my scores, I should stay on Fosomax. What IS the new concern about Fosomax before menopause? I am not in danger of becoming pregnant because I had my tubes tied 15 years ago after my last pregnancy. Do I have reason to be concerned? |
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| A: The bisphosphonates such as fosamax are FDA approved for the prevention and treatment of osteoporosis in the postmenopausal patient. There is much controversy with the utilization of these medications in the years prior to the menopause. It is always wise to adjust lifestyle and make sure a secondary evaluation for osteoporosis is done as this is unusual in a women who is not menopausal. Certainly hormonal treatment for the management of menopause symptoms is a consideration with the added benefit of bone density protection. | ||||
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| Q: I have been on Depo-Provera for ten years, with no unpleasant side effects. However, recently I had a screening for bone density, a heel scan, and it indicated I am in early osteopenia. I'm 44 years old, take calcium supplements, do weight and aerobic exercise, eat foods with calcium, no family history of osteoporosis, occasional drinker. In other words, I do everything I'm supposed to with no risk factors except my Depo shot. I need reliable birth control. What are my options? | ||||
| A: You can continue taking depoprovera and living very healthy. Other forms of birth control include the IUD (10 years), birth control pills, the patch, and now the vaginal ring. All are reliable with low failure rates. | ||||
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| Q: I have been diagnosed with Osteopenia and very close to osteoperosis. First I must tell you that I have reflux which is barely being controlled by Nexim. I have tried Evista with side effects like breast soreness, tingling headache and I woke up each night at the same time twice a night and just became too tired. This went on for4-5 weeks. So, I am now trying Micalcin. After3 weeks I have developed diarrhea, bloating , gas and I generally feel lousy. I stopped it and after 2 days couldn't believe how much better I feel. Now my question is: Can I try it every other day and expect to get some benefit from the medication? I was told by a drug rep. that only 1% of the drug gets into the bones, which makes me wonder if every other day is worth a try. | ||||
| A: This medication needs to be taken daily to receive benefit. Generally speaking the side effects of Evista resolve over time. Most women do not experience breast tenderness from this medication as it is an estrogen antagonist in the breast tissue. The good news is their are other options being studied. Hopefully a bone agent that is easily tolerable will come out of the new research. | ||||
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| Q: I am 48 1/2 years old and have been on long term prednisone for 3 years straight, for an autoimmune lung disease (2 years at average of 25mg/day and 1 year at average 15mg/day). I have been told my adrenal gland is completely suppressed and will probably stay that way until/unless I can get below 7.5mg/day for a long time. I have also been low in thyroid since I was in my 20's and have controlled this easily with tests and taking synthroid. I have experienced many side affects from the steroids. I have read that when the adrenal gland is shut down, that it may affect DHEA harmone which controls estrogen? Should I have other harmones tested? Am I going through menopause or having altered harmones from prednisone and shut down adrenal gland? If I'm low in DHEA would taking supplements help estrogen and possibly regulate periods? | ||||
| A: Prednisone, unfortunately, has many side effects with long term use. These include muscle weakness, osteoporosis, diabetes, adrenal insufficiency, etc. | ||||
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Q:
I am a 47 yr. old, premenopausal woman. My doctor prescribed Fosomax about
one year ago for osteopenia. I am 4"10" and under 100 lbs.
Osteosporisis runs in my family. When I first began the Fosomax, I experienced severe tightness in my leg muscles (particularly my hamstrings), and in my arms, sometimes in my hips, accompanied by an ache or pain. I do weight training and yoga several times a week, which became difficult with this pain and stiffness. After a couple of months, it went away. However it has reoccured and I have been experiencing it for almost 2 months. I am trying to maintain my regular exercise routine, but again it has become difficult. Do you think this could be related to the Fosomax? I have read that Fosomax is actually for postmenopausal women and so wonder if this is actually something that is making a positive difference for me at this time. And if it is not, what do you recommend? Thank you for your assistance and advice. |
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| A: Fosamax is FDA approved for postmenopause prevention and treatment of osteoporosis. Its use in a premenopausal person has not been documented. In addition, the National Osteoporosis Foundation guidelines help to determine who should be on treatment. T-score <-1.5 with other risk factors or t-scores <-2.0. Muscles problems and bone achiness are common complaints with fosamax. | ||||
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| Q: Are there any contraindications to taking both Fosomax and Evista. I am 2 years post menopausal and am not taking HRT. What about Actonel and Fosomax, or Evista and Actonel? | ||||
| A: Combination therapy generally is not recommended. Although the bone mineral density seems to improve slightly more than if one agent is used the fracture risk reduction has not been identified. | ||||
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| Q: I'm 43 years old. I went through menopause when I was 37. My doctor told me I have a mild case of spinal arthritis and I also have osteopenia. I never took any hormones, fear of cancer. Should I start now? I feel like I'm falling apart. I also was considering taking estrogen vitamins - over the counter. Any information would be helpful. | ||||
| A: There are many issues that would make one decide to choose hormone therapy and this is beyond the scope of this service. Other bone protecting agents are Evista and the bisphosphonates such as actonel and fosomax. Careful evaluation of your menopausal risks are needed to help direct therapeutic decision making. | ||||
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| Q: I am 35 and have severe osteoporosis. I have 2 younger sisters with it worse than I do. My sister 33 has a -3.3 on DEXA of the hip area. We have all had many blood tests run to find out what is causing this (tests are all normal). I am currently on calcium plus D 3 times a day and Actonel 1x/week and exercise and stay active. Where can we go from here? What specialists, tests, or genetic testing are available to find the root of the problem? | ||||
| A: I would seek out the advice of an endocrinologist that specializes in bone diseases. | ||||
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| Q: I am a 29 year old women who is very concerned with my dexa score results. My hip was -.4 and my spine was a -.3. I suffered from agoraphobia from the age of 17- 23, and did not go outside into the sunlight at all. I am very concerned that during these years I may have caused my bones to become weakened. Now I am not sure what I should do and what kind of damage I may have done to my bones. I have recently noticed alot of changes in my posture and spine and after noticing a loss in height I had an X-ray done which revealed that my spine was somewhat curved. I'm wondering whether this could be due to my bone density? A doctor recently prescibed the drug Actonel, which I took for a month. Unfortunately I suffered some intolerable side effects like calf muscle tightness, dizziness, and headaches. I stopped taking Actonel and now take 4 Citracal tablets a day with Vitamin D and do weight bearing exercises 3 times a week. Is there anything I can do to improve my bone density, so I won't develop osteopenia at an early age? And with my history of agoraphobia am I at much greater risk of developing osteoporosis at an early age? | ||||
| A: Women make bone until the age of 35. from 35 to 45 bone content is nearly stable and after 45 mild bone loss begins. Your bone desnity sounds normal and I would not do anything about it. Healthy living, calcium, vitamin d and avoiding bone losing activities. | ||||
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Q:
I am a 51 year old pre-menopausal woman who still has regular
periods. I have consistently weighed between 88-94 lbs. since I am 19
years old and have exercised on a stationary bike 3-5 times weekly for the
last 16 years. Both my mother and grandmother had severe osteoporosis with pronounced humps. In the past, I have had occasional bouts with acid reflux. My gynecologist recommends either fosomax or evista, letting me make the decision. The more I read, the more uncertain I become as to the best treatment for my situation. What do you recommend? |
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A:
The problem here is multifactorial. You have a
strong family history of osteoporosis. In addition to that, you are,
presuming average height, very underweight. These are both risk factors for
your osteoporosis. In that this is your first DEXA, we have no way of
knowing if there has been a change in the past few years. You may very well
have had these numbers for the past 10 or 20 years. The spine is at the
normal cutoff. The hips show a consistent low level at the cutoff of
osteoporosis. In pre-menopausal women, the use of bisphosphonates such as
Fosamax and Actonel have not been adequately tested. Evista, at this point
in time, does not seem to have the data to support it's use in
pre-menopausal women, especially lacking data related to the hip. Although treatment with any of the above agents is not contraindicated, one may first get a baseline serum NTX to evaluate bone turnover. If your serum NTX is good, your bone turnover is low and the agents noted above may be of little advantage. Whether the NTX is good or not, adequate calcium and Vitamin intake is necessary. The medications we've already discussed don't work without the calcium and D. Think or calcium as the bricks, Vitamin D as the delivery truck and the medications we've discussed as the brick layer. Without the bricks brought by the delivery truck, the brick layer will be idle and no work will get done. |
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Q: I
am a thirty year old woman and at my last regular physical my doctor
quoted my height at 5'3 1/4". I have always been 5'5", so
to humor me my doctor did a bone density scan. Sure enough, she said
I have osteopenia (my results were -1.4). I have absolutely no symptoms, exercise 4-5 times a week (treadmill & weights) and have always drank a lot of milk and ate a lot of dairy products. My daughter (only child) was born on 12-29-01 and I exclusively breastfed her for the first year of life. She is now 16 months old and still breastfeeds 4-5 times a day, but also drinks whole milk. I cut out dairy in my diet for 5 months when she was little (due to stomach issues with the dairy for my daughter), but I have been taking prenatal vitamins all along plus an additional dose of calcium, magnesium and zinc. (Total supplementation of calcium is 1200mg per day.) I do have a family history of osteoporosis in my family on my father's side. Basically, my family physician said she is absolutely stunned at my bone density results. She said due to my diet, exercise and calcium supplementation, ( plus the fact that I never took steriods or any medications containing steroids in my lifetime)I should not have these low bone density results. I am going to a rheumatologist in a few weeks, but was wondering if you know of any research related to such drastic bone loss due to breastfeeding? (By the way, she did a full blood work-up on me and found no thyroid or other problems that could be causing bone loss, so that is also why she is additionally perplexed. Since I have already lost 1 1/4 inches in height in less than a year and a half, we're both trying to scramble for some research on possible links to breastfeeding.) If you could point me to some research on this topic or offer other suggestions that I can take to my appointment with my rheumatologist, I would greatly appreciate it. |
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| A: It is well known that hypoestrogenic states such as menopause, GnRH therapy and breastfeeding can lead to temporary or long term bone loss associated with this low estrogen state which will be less likely to help incorporate Calcium into new bone development. In osteopenia associated with breastfeeding, it has been shown to reverse with the return of menses along with adequate calcium and Vitamin D intake, presuming no malabsorption syndrome. | ||||
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| Q: I am on a blind study of actoneland fosamax. I'm on the 8th week, of once weekly meds. I am not comfortable reading these meds cause the osteoblasts to die, unabl;ing the bones to remoldand four yres dow the road, I may have denser bones, but may be more at risk for fracture due to osteclast dead. I'm also starting to experience alot of weakness in my back, causing extreme fatigue there. Is this a side affect? I also have joint pain in ankles, kness, knucklesand wrists. Is this a side effect? what are my options other than taking Lime-A-Way? I am agonizing bad over this. I don't expect you to tell me what to do, more like what theses meds due in the longrun and if are safe and what my side effects are, what it could mean? | ||||
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A: Lot’s to discuss.
Let’s clear up one thing. I am unaware of Premarin being associated with
an increased likelihood of Lupus. Next, if you really felt that
Premarin was making you sick for the 14 years you were taking it you should
have asked your doctor to prescribe something else. There are some
circumstances where the benefits of the medicine so far outweigh the
side-effects that the patient is asked to put up with the side-effects. One
such example might be chemotherapy. I can’t think of too many others. If
the medicine prescribed to make you “better” actually makes you
“worse” – something’s wrong with that picture. |
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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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