Articles
Register for
Osteoporosis Ask The Expert |
| Q: A request for Information about Premenopause osteoporosis. |
| I am a 31 year old woman and after the birth of my second child 4 months ago have had back pain. After an x-ray that showed a collapse in one part of my spine, I was sent for a bone density test. At the test they took my height and I was 2 inches shorter. I'm looking for information on pre menopause osteoporosis and can find very little. I would like to be informed on what can be done to help me before I go over my test results with my doctor and to better understand my options. Can you help? |
| Answer from Dr. Marchbein: |
| The origin of premenopausal osteoporosis should be thoroughly investigated
by a physician competent in such testing. This may be an internist, a gynecologist or more appropriately, due to
your age, a rheumatologist. It may be as simple as no periods during the teenage years (for a variety of reasons)
and/or lack of calcium intake OR as complex as malabsorption of calcium due to gastrointestinal disorders (either
the calcium itself or through inadequate Vitamin D, which is required for absorption of calcium). If this is a
medical problem, the solutions are somewhat easier. As of this point in time, no studies have been published for medical therapy specifically for premenopausal osteoporosis. Many experts use high dose estrogen, as in birth control pills (as opposed to lower estrogen in HRT). Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
| Q: A request for Information about a research study of Simvastatin, Lovastatin or Pravastatin in connection with osteoporosis. |
| I'm studying Pharmacy on Silesiian Medical Academy in Katowice- Poland.
I'm looking for some information about research study of Simvastatin, Lovastatin or Pravastatin in connection with
osteoporosis; I would appreciate your helping me. Best regards Margaret |
| Answer from Dr. Marchbein: |
| I am personally indebted to and would like to thank Dr. Barry Gruber and
Dr. Michael Kleerekoper, both world renowned members of the
OBGYN.net Osteoporosis Editorial Advisory Board, for their responses
below and their unceasing attention and devotion to medical research and the education of professionals and patients
alike. Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
| Answer from Dr. Barry Gruber |
| "Yes, there is an interesting story here. In short- The cholesterol pathway forms some intermediates which are critical for osteoclast function. The bisphosphonates have been found recently to block a few critical steps in this pathway and stations do have potent effects on osteoclasts to prevent bone resumption in vitro. Bisphosphonates are probably much more effective in vivo however because of their selective targeting and localization to bone resorbing surfaces- it is doubtful that statins can get there in sufficient quantity. Nonetheless, the data from the FIT trial has been reanalyzed and patients taking statins do appear to have lower fracture rates. A good review of this appeared in a supplement to J Bone Min Res last month (Russell, RGG, Rogers MJ, Frith JC, Luckman SP, et al. Pharmacology of bisphosphonates and new insights into their mechanisms of action. J Bone Min Res 14:53-65, 1999). Hope this is useful." |
| Answer from Dr. Michael Kleerekoper |
| "Bisphosphonates work further down the mevaonic acid pathway than HMG
coA reductase inhibitors (statins). Cerevastin (Baycol) has been formally tested for inhibition of bone resorption
and it works but not well. The statins the questioner mentioned have not (to my knowledge) been formally tested
but should work, although not well. The drug companies are pursuing this vigorously. Watch this space. On a related note an article last month reported inhibition of bone resorption in the lab with Rezulin. Watch that space also." |
| Q: Question about experiencing soreness in my right foot and then outright pain. |
| I am a 40-year-old woman who had a full hysterectomy a year ago because
of endometriosis. I am taking HRT. I do not smoke or drink. I'm a long-term vegetarian and regular milk drinker.
I am thin and briskly walk 3 miles a day 3-5 times a week. I did have anorexia as a teenager and dieted into my
20s. Have been on Synthroid 0.1 for 10 years. A bone density test a year ago revealed osteopenia. Now, the weird
stuff. A month ago, I began experiencing soreness in my right foot and then outright pain. My shoes had felt tight
for a week or two before. I went to an orthopedic surgeon who said it was probably a stress fracture, although
x-rays were negative. Two weeks later, the x-rays were again negative, but by this time, despite being on crutches
the entire time, my right foot was throbbing, swollen and purple as if engorged with blood. A second orthopod was
also perplexed and gave me pain pills. A vascular surgeon I consulted out of frustration found no gout, phlebitis
or other vascular problems, but sent me for tests. Venus doppler
was negative. Bone scan could not find the bones in my right foot after two tries because of excessive fluid in
the area. Bone scan on my left foot, which had begun to hurt several days before, showed fracture. Meanwhile, right
foot continues to be painful and engorged. I am very frustrated and looking for answers. I'm meeting with the vascular
surgeon in a few days. He's been very helpful, but admits he's out of his league on this one. Nobody else seems
concerned or ready to treat me. Do you have any advice? Thanks. |
| Answer from Dr. Marchbein: |
| I am truly sorry for your medical problems and doubly sorry that we cannot
help you. In addition to the fact that osteoporosis plays no part in this, it is obviously a complex problem. I
sense your immense frustration and wonder as to whether or not a multidisciplinary approach (orthopedic, vascular,
neurology, rheumatology) at a University Hospital might yield some answers. Best wishes for your future recovery, Harvey S. Marchbein, MD, Chairman, OBGYN.net Osteoporosis, Editorial Advisory Board |
|
**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 |
