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Osteoporosis Ask The Expert |
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| This month's questions answered by: | ||||||||
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| Q: I was found to have osteoporosis in my hip and osteopenia in my spine. Should I try for combination Fosomax and ERT or keep up with the progesterone only? | ||||||||
| I am a 55-year old post menopausal women who is slight in frame (5'2'' and 120 lbs.). I have read material by John R. Lee about natural progesterone increasing osteoblast production and have heard testimonials of doctors whose patients have gained as much as 15% bone density over a 1-year period. I have been using the progesterone cream for a year and have recently had a hip bone density performed. I was found to have osteoporosis in my hip and osteopenia in my spine. Should I try for combination Fosomax and ERT or keep up with the progesterone only? I am too young to be in this group. | ||||||||
| Answer from Dr. Burstein: | ||||||||
| I am not a fan of the work by Dr. Lee which I know quite well. His work
relies on testimonials but is not rigorous science. Progesterone may be very good but one could not draw that conclusion
from Dr. Lee's work. At 55 you are not too young to be in this group. Age is not the only important factor in determining
your risk of osteoporosis. It depends very much on how many years have past since your last period or menopause.
What is important is that you have been diagnosed with osteoporosis and should begin specific treatment to drastically
reduce your risk of fracture later in life. (Osteoporosis won't cause you any problems unless it is complicated
by a fracture.) ERT is one very good approach as is Fosamax and Miacalcin. There is also a new drug (Actonal) reported
in the medical literature (Journal of the American Medical Association) and on CNN this week that should be available
here within a few months. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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| Answer from Dr. Kleerekoper: | ||||||||
| I would be very careful in paying attention to the writings of Dr. Lee.
His philosophy is out of step with essentially every scientific study. The use of progesterone cream is yet to
be validated as far as effects in humans. Some progesterone creams are not even able to be metabolized by humans.
I would consult your physician as far as what strategy would be best for you. Michael Kleerekoper, M.B., B.S., OBGYN.net Editorial Advisor |
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| Q: My question: is Miacalcin ok for Pre-menopausal women? | ||||||||
| I have been using Miacalcin for osteopenia. I have been on prednisone and
methotrexate for over 2 years. My question: is Miacalcin ok for Pre-menopausal women? Thank you. |
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| Answer from Dr. Kleerekoper: | ||||||||
| Of the various drugs available for pre-menopausal women with osteopenia
or osteoporosis as a result of prednisone treatment, Miacalcin is probably the safest one to use. Fosamax is probably
more effective but the safety in women before menopause is not yet certain. It isn't really your safety that is
a concern, but that of your baby if you happen to get pregnant while you are taking Fosamax or a few years after
taking Fosamax. It is likely to be quite safe but in the absence of good information about this it is best not
to take any chances. Are you still having regular periods on prednisone and methotrexate? If not you might have
your doctor check your hormone levels and consider estrogen treatment if they are low. Are you getting 1500 mg
a day of calcium? Are you taking 800 units a day of vitamin D? These are a must for you. Michael Kleerekoper, M.B., B.S., OBGYN.net Editorial Advisor |
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| Answer from Dr. Barentsen: | ||||||||
| Most therapies for osteoporosis have been evaluated in post menopausal women.
Steroid induced osteoporosis is an appropriate use for these agents. There is concern about use in women who might
be or become pregnant. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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| Q: Questions about back ache and osteoporosis | ||||||||
| I am 39 years old and I have just been diagnosed with osteoporosis. I had a total hysterectomy at the age of 27 for severe pid, I have taken oral estrogen since I was 28. After breaking my fibia in 1992, I asked for a bone density scan and was told that I did not need one at my age, (then 32), as I was taking HRT and that would make things alright. What went wrong? I had an x-ray of my lumbar spine 2 weeks ago as I had been suffering with severe back ache, this showed signs of osteoporosis and I was referred for a bone density scan. To say I am devastated is an under statement. Why me? I keep asking myself, what can I do to make things right? | ||||||||
| Answer from Dr. Kleerekoper: | ||||||||
| Indeed a tale of woe but not yet one for despair. Before concluding that
you have osteoporosis and have failed to respond well to oral estrogen I would need to know much more about you.
How did you break your tibia? Osteoporosis DOES NOT CAUSE BACKACHE unless you have a fracture of the spine (vertebrae)
as a result of osteoporosis. If you don't have a spine fracture on x-ray something other than osteoporosis is causing
your backache. Let's wait and see what the bone density scan shows. Even if it confirms osteoporosis with a low
bone density result there are some very good drugs available that will really minimize your future risk of fracture. Michael Kleerekoper, M.B., B.S., OBGYN.net Editorial Advisor |
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| Q: I know that the phytoestrogens are not as effective as the animal based estrogens, but don't they have some benefits? Are soy products as good as they are publicized to be for post menopausal health? | ||||||||
| I had thrombo-phlebitis when I delivered my fifth child 40 years ago. I had a hysterectomy 34 years ago, leaving the ovaries. I had no symptoms of menopause, no hot flashes., etc. I am now 70 years old. Two years ago my gyn prescribed Premarin, which I am reluctant to take because of the phlebitis. Till that point I had no HRT at all. I have no symptoms of heart disease or osteoporosis, (my bone density test was good). I know that the phytoestrogens are not as effective as the animal based estrogens, but don't they have some benefits? Are soy products as good as they are publicized to be for post menopausal health? | ||||||||
| Answer from Dr. Kleerekoper: | ||||||||
| I agree that Premarin or other estrogen tablets may not be appropriate because
of your previous phlebitis but estrogen patches would be safe for you. Phytoestrogens and soy products are not
well enough studied to give you a complete answer. From what we do know they are not as potent or effective as
prescription estrogens but are probably very safe. The same is true for soy products that really are also a form
of phytoestrogen. You are wise to be cautious about all the hype out there for natural products such as soy and
phytoestrogen Michael Kleerekoper, M.B., B.S., OBGYN.net Editorial Advisor |
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| Answer from Dr. Barentsen: | ||||||||
| What is the indication for Premarin in this case. No complaints, normal
bone mass, not increased cardiovascular risk. I will suggest not to use estrogen's at all. And if you want them
anyhow, Soy will be excellent Ronald Barentsen, MD, PhD OBGYN.net Editorial Advisor |
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| Q: Proper use of Fosamax | ||||||||
| After three months on Fosamax I've developed muscle spasms and irritated nerve endings. I've been off the drug for a week and the problems have diminished, not gone away. If I discontinue use of the drug will these complaints eventually go away? If so, a guestimate when? If not have permanent damage been done to my nerves? If not permanent damage, are these complaints enough to discontinue the drug permanently? Naomi | ||||||||
| Answer from Dr. Marchbein: | ||||||||
| This is an idiosyncratic reaction - that is to say, one that is not expected and
may not be repeated on further therapy. Unfortuntely, another factor in idiosyncratic reactions is the unpredictable
nature of their timing - both starting and resolving. Have your doctor contact Merck and see if this has been described before. They have excellent followup of all complaints and should be able to answer the questions you've asked. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: I am wondering, should I let this bone density issue prevent me from having another child? I'm concerned that bearing and breast feeding a second child may further decrease my bone density and accelerate the onset of osteoporosis. | ||||||||
| In May I had a bone density test on my wrist (DEXA) performed at Long Drugs. My T-Score was -1.85, which is considered osteopenia. My primary care physician recommended that I increase my calcium intake and weight-bearing exercise and have the hip/spine bone density test at menopause. Last month, based on my suggestion, my Ob-gyn approved a type I collagen test. I just got a call from her office saying that my level was 5.3, which is "good" and indicates that I'm not losing bone at an alarming rate. I haven't had a chance to talk to my Ob-gyn yet, but I'm thoroughly confused by these results. Should I insist on having a hip and spine bone density test, which is what the technician who administered the bone density test recommended? How do you interpret these results? I am 42, Asian American and of slim build -- putting me at high-risk. My grandmother (who was from China and was a chain-smoker) had osteoporosis. My mother has never had a bone density test, but is on HRT. My sister, who is going through menopause, had a hip and spine test and was fine. I'm also wondering if I should let this bone density issue prevent me from having another child? I'm concerned that bearing and Breastfeeding a second child may further decrease my bone density and accelerate the onset of osteoporosis. thank you. | ||||||||
| Answer from Dr. Marchbein : | ||||||||
| Osteopenia is just that.... osteopenia - a decrease in bone mass below that normally
expected from a 20-30 year old. This may be what your bone density has been for years. Not all women reach their
bone density potential. With a bone turnover test result being low as you noted above, it appears this (osteopenia)
is long standing and not high current loss. Most experts would say to have a bone density at menopause or near menopause. This would not stop people from having children. Adequate calcium and Vitammin D intake is the key, along with weight bearing exercise and reduction is bone loss activities, including caffeine intake, cigarette smoking and a sendentary life. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: I was was wondering if it was possible for me to have osteopenia at the age of 24. | ||||||||
| I was wondering if it was possible for me to have osteopenia at the age
of 24. My bone density test showed that my bone density of my lower lumbar was normal for a 70 year old but my
dad said the test must be wrong because it is impossible. His friend told him that there is no way for a 24 year
old to get an accurate report because a bone density test is not made for people under 35 because their peak bone
mass has not been reached. Is that true? Here is my whole history - I just want to know if the bone density test
can be accurate for a 24 year old female. I did not begin to menstruate until I was almost 18 years old. After the first time I got my period, I went 6 months before getting it again and then I would get it about every three to four months until my sophomore year of college. After a year of not getting my period, I went to a Gynecologist for the first time. He put me on Triphasal which regulated my period. I began running a lot during my senior year in college but was never involved in rigorous or continuous exercise prior to that. I have not run for the past three months due to back pain. I have had stress fractures on my pelvic bone in February of 1997, on my femur in 1998 and on my tibia in 1998. When I went to an Orthopedist, she was concerned with my bone density due to my history of stress fractures andmy irregular menstruation. She prescribed a bone density test. The test results showed normal bone mineral density in the femoral neck region but revealed osteopenia in the lumbar region. My T-score wawas -1.54 and my Z-score was -1.44. The test was done on a Norland machince. My doctor showed me the graph and pointed out the dot which represented my bone density in my spine and then proceeded to show me that mine was much lower than the normatl range for my age. She explained that my bone density of my lower back would be the NORMAL score of a woman in her 70's. She said she was concerned because my periods have never been normal. I am aware that runner's may have a problem with this, but I did not start running until my senior year of college and my problems with my periods were existent prior to that. In addition, an x-ray of my spine showed deterioration in my lower lumbar region. Also, my doctor said that my running should help fight against bone loss and that she felt that my bone density test would probably have been worse if I was sedentary. Her recommendation was for me to have my hormone levels tested. I went to the gynecologist and he said that I would have to be off Triphasal for three months before my hormone levels would accurately be reflected in blood tests. It has now been a week and a half since I had the blood work done which revealed high cholesterol, normal hormone levels, low white blood cell and platelet counts and my total lymphocytes were high. I am worried and anxious to know what all this means and why I have been having lower back pain which has prevented me from running for the past three months and why my bone density is low despite my involvement in weight bearing exercise, normal calcium intake and good health habits. Sincerely, Heather |
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| Answer from Dr. Marchbein: | ||||||||
| So many questions, so little space. Here go random answers to questions asked. Running may help the femoral neck but should have little effect on the lumbar vertebrae. Anyone at any age can have a bone density measurement.Lack of periods, late first period and heavy exercise can lead to hypoestrogenism leading to osteopenia (prime example are teenagegymnasts). A T score of -1.54 doesn't mandate stress fractures, it just increases the overall risk, especially when there's stress to fracture them. Don't worry about a 70 year old looking spine. Have an NTx done (blood or urine) to determine present rate of bone turnover (breakdown). With late periods and irregular cycles and with "normal hormones", I'm a little confused. An endocrinologist may be the way to go. Alternatively, going on the pill will cover up the problem and give a constant level of estrogen which will certainly help bone growth. By the way, there may still be time for new bone growth - maybe til age 30. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: Preferred Treatment | ||||||||
| I am 55 years old an post-menopausal. I've tried taking hormones twice before
- the first time it put me in emotional imbalance and I experienced some sort of menstrual discharge most of the
time. The second attempt with another brand of hormones did not affect my emotional balance but still caused the
same bleeding/spotting problem. My recent bone density test showed that I have osteoporosis. They couldn't see the 4th lumbar and said that the 2nd and 3rd were affected. I'm trying to decide whether I should take a medicine for the osteoporosis or try hormones again. I have a history of osteoporosis in my family, but none of breast or uterine cancer. I weigh 115# and have fibrocystic disease. |
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| Answer from Dr. Burstein: | ||||||||
| Estrogen (and progestin if needed), is the first drug of choice for many
women with post- menopausal osteoporosis. If you are concerned about tolerating hormone therapy, Fosamax would
be a reasonable choice. Of course, this is a generic answer as I do not know your complete medical history. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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| Q: Is it possible to undertake more than one type of treatment concurrently provided that their side effects are tolerable | ||||||||
| I am 52 years old and recently diagnosed through a bone density scan with
osteoporosis. Due to a significant family history of death through cancer (mother-breast, father prostate, mother's
twin sister - bowel) I am inclined to avoid HRT. I have just begun to take Fosamax but wonder about the benefits
of ERT and also of Miacalcin. I believe that all three have different benefits and that it is difficult to assess
whether Fosamax, in promoting bone thickening does in fact discourage fracture which is I think where the real
problem lies. My question is: is it possible to undertake more than one type of treatment concurrently provided
that their side effects are tolerable Robyn |
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| Answer from Dr. Marchbein: | ||||||||
| Yes, it's possible to take more than one mediction at a time. There is actually a study showing Fosamax and HRT
being additive in their benefits (together being better than each one alone). I am aware of physicians trying Evista
and Fosamax or Evista and Miacalcin. There are no numbers out yet. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: Is there any chance of internal organs being damaged due to 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, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: MCHC | ||||||||
| I am a 40 year old woman and have recently been diagnosed with osteoporosis.
Mostly due to a lack of calcium and have a small build. I keep hearing about the treatment of MCHC. What are your
feelings toward the effectiveness of this and can it be used rather than Fosamax? I have real concerns about the
use of Fosamax regarding gastrointestinal problems. I am fairly sensitive in this area but no real health risks
have been found. Also, are there any side effects with the use of MCHC? Thank you, Tare |
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| Answer from Dr. Burstein: | ||||||||
| I do not recognize the term MCHC - please give me a description. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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| Q: Drugs used for osteoporosis for someone with acid reflux? | ||||||||
| I am 59 and just found out I have osteoporosis. Is there a drug I can take since I have acid reflux with benign growths in the esophagus? I also take .15 mg. Klonopin and 150 mg. of Zoloft for a neuro-chemical adrenaline-panic disorder. I am seeing my internist this week but I want to be knowledgable on the subject. I also have IBS which is under control. | ||||||||
| Answer from Dr. Burstein: | ||||||||
| Gastroesophageal reflux might present a problem with Fosamax. A new drug,
not yet released, Actenol, might be better but I have no data yet. Estrogen therapy, Evista and calcium would have
no effect on the reflux. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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| Q: Should I be worried about osteoporosis? | ||||||||
| Hello, Thank you for your time. I am 41 yr. old, I have lost 1 3/4 in.in
height, that's alot when at my tallest I was only 5 ft. Should I be worried about osteoporosis? Should I ask my
Dr. for some kind of test?(bone density?) Thank you again, Sheree |
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| Answer from Dr. Marchbein: | ||||||||
| I presume from your age that you're still menstrating. With that assumption, the only treatment for loss of bone
(?leading to loss of height) would be something on the order of birth control pills for a more constant level of
estrogen to reduce loss. A bone density test can be done but the treatment in the premenopausal period is basically
limited to the pill (with rare exceptions). There may also be loss of height from loss of hydration of the vertebral
discs - this can be checked out by an orthopedist but, unfortuntely, there is no treatment for that. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
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| Q: Depo-Provera | ||||||||
| I have been on birth control for the past 1 1\2 years. I want to switch to depo-provera, but I heard it can lead to osteoporosis. Do you have any information on this. | ||||||||
| Answer from Dr. Burstein: | ||||||||
| There is some association with bone loss while on Depo-Provera. Especially
in very thin women. Would exercise, have adequate calcium and appropriate amount of Vitamin D. Paul D. Burstein, M.D., FACOG OBGYN.net Editorial Advisor |
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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. |
