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Osteoporosis Ask The Expert |
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| Q: Are internal organs being damaged due to a shortened and curved posture? | ||||||
| My grandmother has had osteoporosis for many years now and she is much shorter than she used to be (5'1'' to 4'9''); is there any chance that her internal organs are being damaged due to her shortened and curved posture? Will she be experiencing more pain due to this damage? Thank you. | ||||||
| Answer from Dr. Marchbein: | ||||||
| It's certainly possible that her internal organs are being compressed and that breathing
may be more difficult, but it would be impossible to say whether or not the organs are being damaged. It is statistically
unlikely. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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| Q: Is there a relationship between osteoporosis and periodontitis? | ||||||
| Is there a relationship between osteoporosis and periodontitis? | ||||||
| Answer from Dr. Marchbein: | ||||||
| Osteoporosis is loss of bone in a variety of areas. If one such area were to be the
mandible or maxilla, oral cavity disease might be a consequence. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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| Q: deoxipiridinoline bone marker to detect loss bone | ||||||
| I've heard about deoxipiridinoline bone marker to detect loss bone. Could you tell me something about it? Thank you | ||||||
| Answer from Dr. Marchbein: | ||||||
| The bone marker we use is cross-linked N-telopeptide (NTx) in urinary sampling and
now in blood sampling. It is used to determine bone turnover in many situations. It is frequently used to evaluate
effectiveness of therapy instituted following a bone density but prior to a repeat bone density (usually 2 years
apart). the NTx can be done before therapy and 3 months later. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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| Q: Will taking fosamax improve condition and increase bone mass? | ||||||
| My grandmother is 80 years old and was operated for a femoral neck fracture resulting
from a fall about 1 1/2 years ago. Her hands and lower extremities are a little deformed but functional with occasional
pains. She works a lot around the house and lately she has been experiencing joint aches and pain at the middle 3rd of her right thigh, on the side where a steel prosthesis was inserted for the fracture. She has been taking Fosamax irregularly since after the operation. Will this still improve her condition and increase her bone mass? She is not taking any estrogen because even with .3 mg, she's having severe dizziness. |
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| Answer from Dr. Marchbein: | ||||||
| Fosamax will be helpful but with continued pain, consultation with the orthopedist
who did the surgery is recommended. Osteoporosis is asymptomatic (no symptoms) therefore pain is associated with
fractures, osteoarthritis, bursitis and other orthopedic problems. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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| Q: Any advice, for a premenopausal woman with osteoporosis? | ||||||
| I was diagnosed with osteoporosis at the age of 36. I am now 37. My diagnosis was
almost accidental. I participated in a 10K walk with a friend; by the end of this walk, I began developing severe
lower back & bilateral hip pain. The pain was so severe that for several days I was unable to walk upright,
but had to remain bent at waist &knees. I worried about joint damage, so I made an appointment with an orthopedic
specialist. He saw me, took x-rays, and told me there was nothing wrong. I was taking rather large doses of NSAIDS
& ASA for pain. His advice was to continue this if it helped the pain. I am an RN and felt there must be something
more to it. At a loss of what to do, I decided to see a chiropractor. She saw me, took x-rays, and told me my bones
looked "much older than my stated age". She recommended bone density testing. The scan was Hologic. My
L-spine T scores ranged from -1.62 to -3.19, Z scores -1.53 to -3.07 from L1 to L4 respectively. My left hip scores
for neck, troch, inter, & total were: T scores, -2.23, -2.21, -2.37, & -2.61; Z scores, -2.02, -2.17, -2.35,
& -2.51. I began seeing an endocrinologist. My workup has been uneventful, with all my blood work results normal. (Part of my workup included an EGD, due to c/o heartburn-precautionary prior to starting Fosamax - I have multiple erosions in my stomach secondary to NSAID use, as well as evidence of reflux - therefore I was placed on Didronel instead.) I work in oncology research and started searching for data on osteoporosis. I can find no data for premenopausal women with osteoporosis included in research protocols. Is no research being done in this population? Also, my doctor has done no further testing since my blood work came back normal. Should I have any further workup done regarding secondary osteoporosis? I am small framed. Height 5' 2.75". Until age 32, my weight was always less than 110 lbs. My current weight is 118-122lbs. My paternal grandmother and my maternal great grandmother both had "dowager's humps". Ca+ intake in infancy and childhood less than optimal r/t intolerance for formula (finally placed on 1/2 strength simalac) and dislike of milk products (no diagnosis of lactose intolerance). Also, since my diagnosis a few months ago, my menstrual cycles have gone from "clockwork" of 28 days to about 31 days, and the active bleeding has dropped from 7 days in my teens and 20's to 4-5 days in my early 30's to less than 3 days (my last cycle lasted 2 days). My MD has mentioned HRT with low dose estrogen, but I worry about increased cancer risk. (I know it isn't supposed to be that bad, but I still worry). I have also seen some info that long-term side effects of bisphosphonates remain unknown and may not be safe for younger women to take long term. I am currently taking my 2nd cycle of Didronel (which leaves me tired and causes bone pain -an unusual side effect?) I am taking Ca+ supplements of 1500mg qd & exercise with weights. Any advice? What should I do at this point? I've read enough to confuse, but not enlighten. I've tried talking to my MD, but would greatly appreciate another view point. Thank you very much for your time. Sincerely, Bonni |
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| Answer from Dr. Marchbein: | ||||||
| This is all very unusual....interesting for a case presentation but not when it's
you. You've had the "million dollar workup" and have pursued the correct avenues. A few points to make: Osteoporosis, prior to fractures, is a painless disease. Very little research is being done on premenopausal osteoporosis and little is truly known about appropriate treatment. The most effective treatment for osteoporosis, in general, is estrogen. If one is premenopausal, birth control pills might be the appropriate choice. Meta-analysis of multiple studies looking at oral contraceptives and the incidence of breast cancer shows no correlation. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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| Q: What will be the effect of taking Etidronate instead of fosamax? | ||||||
| I am 54 years old and was diagnosed as having Osteoporosis 2.5 years ago. I am taking
Fosamax and had since then gained about 5% in bone mass. I do not take Estrogen since I am at high risk (my mother
died from Cancer of the breast). The Ministry of Health instructed the Doctor to prescribe Etidronate instead of
Fosamax. Would you please comment on this and let me know what will be the effect of this change? Thank you very much Techiya |
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| Answer from Dr. Barentsen: | ||||||
| Etidronate and alendronate (Fosamax) are both bisphosphonates and they have a comparable
effect on bone. In established osteoporosis Fosamax has the best proof in large trials. The quality of the investigations
with Etidronate are not so good, but good enough for your Minister. In osteoporosis without fractures only Fosamax
can be advised, because of lack of information on Etidronate. Ronald Barentsen Editorial Advisor for Osteoporosis Section, OBGYN.net |
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| Q: Can I stop taking the Premarin and go back to the Evista and get the osteoporosis protection that I need and not be at any other risks from not taking the Premarin? | ||||||
| I am 54 years old, began menopause when I was about 45. I have gone up to this point
with no "HRT". I did have some symptoms, (hot flashes, crying spells, mood swings), but none unbearable
and a very understanding husband. This year I had a bone density test, at my request. I was told I was in the beginning
stages of "Osteopenia". In the same time frame I had a pap and breast exam. My primary physician put
me on "Evista" for the osteopenia and my obgyn put me on Premarin -- in advising both physicians of the
medications, I was taken off of the "Evista" Because "Premarin also treats the osteopenia I have
not noticed any difference, physically or mentally since taking the Premarin for the last 5 months, and really
didn't want to begin "HRT" in the first place, but agreed to try it. My question is, can I stop taking
the Premarin and go back to the Evista and get the osteoporosis protection that I need and not be at any other
risks from not taking the Premarin? Thank you |
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| Answer from Dr. Barentsen: | ||||||
| Why Evista and not Premarin? Evista has some advantages over Premarin for women at
high risk for breast cancer and even that is not certain yet. For bone mass, estrogen's are better than Evista.
What is important anyhow is the need for prevention of osteoporosis. What is beginning osteopenia? And also important:
when was your last period (the menopause)? Ronald Barentsen Editorial Advisor for Osteoporosis Section, OBGYN.net |
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| Answer from Dr. Marchbein: | ||||||
| By saying you were on Premarin, we must presume you had a hysterectomy. Otherwise
you would have been put on progesterone too (to protect the uterus from constant estrogen). Be that as it may,
ERT (whether Premarin or other estrogens on the market) has been shown to be superior to Evista in bone "maintenance".
In addition, estrogen has been shown to reduce the overall risk of heart disease, Alzheimer's, colon cancer, macular
degeneration and possibly other medical problems not yet delineated. Evista has not yet been shown to have these
"advantages" (with the exception of minor reduction in cholesterol). Evista, however, has no negative
effect on the breast and may even reduce the risk of breast cancer. ERT may slightly increase the incidence of
breast cancer by stimulating already present cancer cells. Harvey S. Marchbein, M.D. FACOG, FACS Chair, Osteoporosis Section, OBGYN.net |
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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 |
