Osteoporosis Ask The Expert

Transcription

Published on Diagnostic Imaging (http://www.diagnosticimaging.com)
July 14, 2007
By R. Wayne Whitted, MD, MPh [1]
Questions this month have been answered by: R. Wayne Whitted, MD, MPh, OBGYN.net
Osteoporosis Editorial Advisor Harvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman
and Editorial Advisor
Q: I am confused about the difference between osteopenia and osteoporosis. Can you help me?
A: Osteopenia is defined by the WHO as a T score of -1 to -2.49 and osteoporosis as -2.5 or less.
These values are based on bell curve distributions in a healthy population of 30 year old women.
Q: I am a 47 year old woman who has been on Levothyroxin for 30 years. A recent bone scan
showed that I was just "this side" of osteoporotic. My doctor strongly suggested that I start to take
Fosomax. I hate to take any drug and I am worried about the possible reaction between the two.
What do you think?
A: Fosomax is an osteoclastic inhibitor that will protect against bone loss and fracture related to
osteoporosis. It can be difficult to take, and as a result disrupt the oral intake of levothyroxin.
Otherwise their are no other interactions between the two medicines.
Q: I am a 52 year old female, and have recently been told I have Osteoporosis. The test results
reported a -2.5 in my left hip and 3.4 in my spine. I am, of course, very concerned about this
especially since I am only 52. I can't seem to get an answer on how bad this test result actually is,
and what it means to my life style. Would my hip result of -3.4 be considered severe osteoporosis,
and would the test results show my increased risk of fracture? The only risk factors I seem to have is
being a Caucasian female, who has low body weight, small boned, and menopause. I exercise daily
(walk, run and lift weights) and have a family healthy diet.
Also, I need to decide about which treatment I should go with. I have always refused to take estrogen
because of my families history of breast caner. I may now reconsider if I feel the benefits outweigh
the risk. Can you tell me if Evista and Proprem are equally effective in the treatment of osteoporosis?
Do I need to make any changes in my activities, and can I expect treatment to slow this down
enough that I can expect a healthy future? I understand the difference between a T and Z score, but
are they both reported with the same numbers, such as the -3.4? If so, would the Z scores still
diagnose a person with osteoporosis? If the 2.5 in my hip and -3.4 in my spine are correct, wouldn't I
be feeling a lot of pain?
A: The World health Organization defines osteoporosis in the setting of Bone Density Scanning as a
T score of -2.5 or less. This is measured as a standard bell curve and in terms of standard deviations
from the average person. The T score population statistical test compares anyone to a healthy
population around age 30. the Z test compares a person to people of the same age. If you are older
than 30 than the T test is the most appropriate test to define osteoporosis. In general, each standard
deviation below 0 represents 2x the risk of fracture. This means that at -1
a person has double the risk to fracture; -2 has 4x the risk to fracture; -3 has 8x the risk to fracture;
-3.4 approximately 12x the risk to fracture. A T score of -3.4 approaches severe osteoporosis and at
52 is concerning. It is important to look for secondary causes of this other than menopause.
Q: I am 31years old and recently was diagnosed with osteopenia (-1.89 hip,-1.75 spine). I had a
(benign) tumor in the pituitary region removed at age 15 and have always been on replacement
estrogen and progesterone. I never started menstruating on my own. All other hormone function
tests have been normal, except for a slightly low growth hormone and testosterone level several
years ago. I work as a registered dietitian, and am cognizant of getting adequate dietary calcium (at
least 3 dairy foods per day as well as calcium-fortified juice and cereal every day). I avoid caffeine
and phosphoric acid-containing foods. I also take 800 mg of supplemental calcium (with vit D). I do
weight-bearing exercise 3 times a week in addition to running. Since this is my first DEXA, my
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physician wants to use this as a baseline and redo it in 6 months before deciding about starting me
on any medications. This makes sense, although I am nervous that I will continue to lose density
since I feel that I'm already doing all that I can from a lifestyle point of view--I'm also nervous
because a minor bike fall left me with a fractured wrist last fall and I fear more fractures in my
future. I'm wondering if you know of any studies in people like myself who have always been
dependent on replacement estrogen and bone density? Would long-term dependence on synthetic
estrogen put me at higher risk? Would a mildly diminished growth hormone or testosterone level
increase my risk? Thanks!
A: You have a very complex situation. We unfortunately don't have long term information about the
impact of HRT on bones. Since you are 31 we know you have reached your peak bone mass.
Unfortunately, bone density doesn't change dramatically from a 6 month period to the next. In
general, bone densities should be done in 1-2 year intervals leaning more often to 2 year intervals.
You are living a healthy lifestyle and doing all you can to support your bones. I would recommend
seeking out an endocrinologist who specializes in bone management to manage your special case.
Q:
I am a thirty year old female that has recently been diagnosed with severe osteoporosis. My T score
is -2.96 in the neck of my left hip. My vitamin levels are on the low side and have had intestinal
problems in the past. I have seen several endocrinologists, who just say to ignore the result as they
do not think I have osteoporosis. Who do I turn to for medication or treatment. Desperate, please
help?
A: When someone of your age and hormonal status develops osteoporosis, one must consider
etiologies out of the norm. With adequate calcium intake and exercise as well as adequate
estrogenization, the possibility of lack of Vitamin D or lack of absorption of calcium and/or Vitamin D
comes to mind. This can be from a variety of gastrointestinal problems, among them sprue and
some inflammatory disorders. Another reason may, in others, be steroid use for extended periods of
time. The appropriate specialist in your area may be an osteoporosis specialist. Sometimes they are
rheumatologists, sometimes endocrinologists. A gastroenterologist may need to become involved.
Q: I am 61, in excellent health, but have osteo (diagnosed in '97). Is much better now, but slipped
back due to cutting out Fosamax for a yr. Also, had a test last mo. on a different machine & I know
they vary as was tested at 2 different facilities in '97. Have exercised since I was 28 daily (ran for 13
yrs, 43 mi. wk!). I now walk 4 mi. daily; stretch/exercise 40 min daily; lift 10 lb. weights every other
day; play 18 holes of golf 4/5 times wk & hit further than 99% of women. I have severe osteo: T
scores 3.5 & 4.3. Can one go thru life without fracturing? Also can one go to 5 in a T score or higher?
Thx. for your response.
A: The meaning of bone densities relates to "fracture risk". With worsening of bone densities, the
"risk" of fracture increases. One can certainly go through life with "high fracture risk" T scores and
never fracture anything. By the same token, one can have an excellent bone density and sustain a
fracture. It's all about relative risk.
Q: I have fracture three different bones in less than 8 months in my right foot. My doctor said they
were stress fractures and then asked me if I was ever bulemic or anorexic. I told him "no" and then
he told me that people my age don't have this happen unless they are professional dancers, distance
runners, professional football players, etc. I am only 28 years old, but my grandmother had terrible
osteoperosis. He is now sending me for a bone desity test. If for some reason my bone density is
fine, is there anything else it could be? I am tired of fracturing my bones! I do not wear heels and I
don't do any exercise more weight baring then biking.
A: Based upon the bone density, there are many possibilities. If the bone density shows
osteoporosis, this needs to be evaluated and the cause found. If the bone density is indeed normal,
you will need to be evaluated by an orthopedist and/or rheumatologist to discern the reason for the
fractures.
Q: I am 62 and started taking fosamax two years ago. Since then I have gained considerable bone
mass -my osteoporosis has been reclassified osteopenia. Do I need to take fosamax forever? Will I
suffer side effects from taking this for too long?
A: Fosamax is intended to improve bone density and quality of bone so that you reduce your risk to
fracture. When you are osteopenic you still have 2-4x the risk of fracture depending on your T-score.
I generally recommend taking fosamax until the t-score is between 0 and -1.0. This is my opinion.
Q: I am a 72 tear old female and I take 1200 units of calcium
(over-the-counter) per day. A recent bone density test revealed the following:
Lumbar 0.953
Total left neck .860
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Ward triangle 0.510
It was prescribed that I now take one Fosamax in the morning, in
ADDITION to the 1200 units of calcium. How do I interpret the above results? What was the reason
for adding Fosamax?
A: Most people would add treatment if the t-score from the Bone Density Test is -2.5 or less. Some
would add treatment between -1 and -2.5 also in order to prevent osteoporosis.
Q: Approximately 1-1/2 years ago I was diagnosed with osteopenia of hip (-2.1), was 47, diagnosed
with early menopause in perimenopausal stage. My doctor put me on progest. Also, lifestyle includes
exercise (moderate) 3 x week, good diet, no alcohol, light coffee, light smoking. I went and had my
hip and spine reexamined (bone density) and my spine was improved (there had been no problem
with this area and I had been taking between 1000-1500 mg. calcium w/boron, etc. during this
period of time). My hip, however, remained unchanged. My doctor put me on fosamax (10 mg. in
am) and told me to continue calcium. How long do you think it will take for my hip to show
improvement? Will this improvement ever go back to the normal stage of bone mass?
A: Fosamax generally will improve bone density about 3-5% per year. It will decrease fracture risk
by approximately 50%.
Q: Can excessive use of aspirin and aspirin related medicines
such as Excedrin, have a detrimental effect on bones? Can they accelerate bone loss?
A: It is the caffeine in Excedrin that might cause bone loss. Otherwise to my knowlegde salicylic
acid does not cause bone loss.
Q: I was given fosomax - the once a week pill after two weeks I developed serious diarrhea, was
diagnosed with microscopic colitis - also had two ulcers and reflux. It took me three months to
recover, and I was down to 100 pounds from 124 pounds before the disease was arrested with
asacol. Even now I have only gained six pounds back, but expect a slow weight gain. I am convinced
that there is a connection between this time release drug and my health problems. I want to at least
report this reaction to someone, and also find out if anyone else has had this extreme reaction. How
long has the time release pill been on the market? Any information would be helpful.
A: I have not seen this reaction thus far. The weekly dose was released 11/16/00 but had extensive
testing for a few years prior to that. Serious reactions include esophagitis and gastritis, not colitis.
Common reactions include other gastrointestinal complaints but the weekly Fosamax has
comparable complaints to placebo, including the serious reactions. If this is related to Fosamax, it
should be considered, at this time, an idiosyncratic reaction, one that is severe, unusual and
unexpected.
Q: I am a 52 yr. old female. I have been diagnosed with mild osteopenia with a BMD of 1.025 in my
spine. I have been menopausal for 2 years and do not take conventional HRT, but do use natural
progesterone cream 2xday. I also take 1500 calcium daily with magnesium and Vit. D. and try to
exercise and do weight work 3-4 times a week. Do you feel that Traditional HRT would be beneficial
and do you think bone builders such as Fosamax would be best?
A: Osteopenia is diagnosed as a BMD of less than -1.0. At -1.025, you are just over the cusp. The hip
measurement is not listed and may help determine therapy. There are no double-blind, randomized
controlled trials on any progesterone cream and absorption has not been documented in any
pharmacologic doses. Traditional HRT may or may not make a difference in bone mass. It is not
approved for treatment of osteopenia or osteoporosis but may help prevent it in many women.
Fosamax is reserved for women with at least severe osteopenia unless there is moderate osteopenia
with other risks factors. This therapy must, of course, be individualized.
Q: I am 45 years old. I have had a history of thyroid problems where first I had a hyperthyroid and
now I have hypothyroid. I have been using medications for the last 4 years. I have asked my
physician for a bone scan since I have heard that having this medical condition can affect my bone
density. To add to the situation I believe that I am highly at risk for osteoporosis. My mother and her
mother both have this condition. My Brother who is just 1 year older than has been had a bone
density test and he is in the advanced stages. I do not believe that I am at that stage (he has
fibromyalgia). But I believe that my bones have deteriorated. I have read the book Strong Women
Strong Bones. How can I get my physician to recommend a bone density scan? I believe I am not too
young and that I am at higher risk than the 75% or more of the population. My physician has told me
that I am too young and that I will not be at risk until I am going through menopause.
A: The information you present is compelling to get at least a baseline evaluation with a DEXA
bone density. With a strong family history and thyroid irregularities, you have two strong risk factors.
If your physician does not agree, consider seeing an osteoporosis specialist for a second opinion.
Q: I am 36 years old and have 3 children. I have a thin build and I am a triathlete. I recently had a
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dexa scan of the hip and spine and the hip. It showed ostepenia involving the left hip which
measures one standard deviation below the age related mean. I have been taking 1000mg of a
calcium with ipraflavorne(citrate malate) for about a year . I thought the
test results would be better? I would appreciate any advice you could recommend. I thought the
exercise would help the bones? Should I be taking more calcium?
A: It's unusual for a 36 year old to have a DEXA without adequate risk factors. The hip result was
-1.0. From your note, you indicate this is based upon age related mean. This is referred to as a Z
score. We also use the T score to see how the DEXA compares to a 25-30 year old, considered peak
bone density. At 35, the T score and Z score should be similar. Osteopenia can have a hereditary
component as well as the very important factor that many don't consider ..... whether or not you got
to maximum bone density in your teen years and what your exercise and calcium intake were until
age 25, the approximate point when you stop building new bone. With the calcium, 1000-1200 mg
per day is required and some need 1500 mg. This should be in divided doses, with a maximum of
500-600 mg per dose. Adequate vitamin D is also needed to aid in absorption of calcium.
Q: I am 65 years old and am developing a hump by my neck. My bone density tests are normal. I
am on Fosamax. What causes this humping by the neck? I have been told that it may be due to high
levels of steroid hormones. If this is true, what can one do?
A: If your bone densities are normal, it's not clear why you are on Fosamax. On the point of the
"hump", there are a few possibilities. One would be upper thoracic vertebral compression fractures.
Another would be Cushing's Syndrome, the one referred to with a problem in steroid metabolism.
Another possibility is a lipoma of the area, a benign fatty tumor that can occur anywhere on the
body. This needs to be evaluated by your physician to determine the origin.
Q: Two years ago, I was diagnosed with hypopituitarism after a 9 year search to find a reason for
all the symptoms I was having. Over the last several years (since about 1998), I have been getting
shorter in stature. In the last 2 yrs., I shrank from 5 ft., 5 in. to 5 ft., 3.5 in. I was given a bone scan in
June that showed that I have osteopenia even though I've been on estrogen since 1990
(hysterectomy). I have been told to take lots of calcium and to try to be as active as possible.
Unfortunately, I have had to slowly begin to limit physical activity in last couple of years, because of
severe hip and leg pain which I was told must be fibromyalgia. In addition, even the smallest amount
of physical activity makes me perspire terribly and to ultimately feel faint. The doctors I have seen
have no idea why I perspire so much, but it is getting more and more debilitating. I would like to
know if the sweating is linked in any way to the osteopenia, and also does osteopenia ever cause
pain to occur in the hips?
A: Estrogen does not prevent all osteopenia and it is possible that you had osteopenia prior to the
hysterectomy as many women have, but are unaware of. Estrogen is presently not approved for
increasing bone mass although it may do just that in some women. Sweating has not been shown to
be related to osteopenia. Osteopenia should not be related to bone pain. This may very well be
osteoarthritis.
Q: I am a 48 year old white female. I had a complete hysterectomy at age 38. I have taken
premarin 1.25mg since that time. Osteopenia was diagnosed two years ago by a bone density. I
began taking fossamax and developed skeletal pain. I was switched to miacalcin and had no side
effects. A follow up bone density showed a T score of 2.4. I was put on Fossamx, one weekly. I
developed inflammation of the esophagus. I then was switched to Actonel and the inflammation
worsened. (No testing was done.) I have now been placed on Evista. Dr. recommends I stay on
premarin in conjunction with the Evista for one month, if I do well with Evista he will stop the
premarin. This concerns me. Will the Evista do the job when the premarin did not help in the past?
I've read about taking prevocid etc. the evening before fosamax or actonel and wonder if this should
be tried. I am concerned as I am very young and want to take the most effective medication. Any
information you can give me would be greatly appreciated. Thank you for your time.
A: The underlying condition of GERD is not necessarily a contraindication to using Fosamax or
Actonel. Especially with our recent understanding that Fosamax may be taken only once a week and
still derive similar effects as with daily use. Many patients with GERD opt to use a proton-pump
inhibitor such as Prilosec or Prevacid the evening before their once a week dose. If you are losing
bone mass while on Evista, then either weekly Fosamax or alternatively Actonel would seem like
rational alternatives or additions. Conventional hormone replacement is
also a viable option- all these choices must be discussed in detail with your physician or local
osteoporosis expert. Hope this is useful information for you.
This question answered by Barry Gruber, MD, OBGYN.net Osteoporosis Editorial Advisor.
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Q: I am a 36 year old women and I had a dexa test that showed mild osteopenia . I was
wondering if the product CalAbsorb is any good. It can be purchased on the TV and is not in stores
yet. I was wondering if it was just a hoax. The product is calcium citrate and magnesium and vit d all
together in a powdered form .I am taking a pill form of calcium citrate and mag and vit d and wanted
to know which one is better?
A: Any calcium that dissolves in a glass of vinegar within 30 minutes will be absorbed. No study
has shown that taking Magnesium with Calcium aids in absorption or action. In your bloodstream,
there is an intimate relation between the two elements but that does not mean they must be taken
together. As far as the Vitamin D, it can be gotten in regular vitamins and need not be combined
with the calcium. Whatever will be absorbed (see above) is fine. Vitamin D sometime during the day
is all that is required for all but the most extreme exceptions. If you have no complaints from the
least expensive supplementation, that's OK. Hope this helps.
Q: Recently received test results on bone density scan stating my spine T-score = -2.8 & my total
hip T-score = -3.3 which is statistically consistent with osteoporosis. Evaluating doctor recommended
0.625mg of premarin as I have not had hysterectomy. I am 58 yrs old & am postmenopausal. My
concern in starting to take HRT now is that I am a cancer patient. Had melanoma tumor removed
from inside lower eyelid in 1999 & "trace" cells removed in 2000. Underwent proton beam radiation
& then Interferon treatment for 6 weeks. Had to stop chemo due to adverse side effects-primarily
shortness of breath problem. I am concerned about taking HRT with my history of cancer - do I have
reason for concern?
A: There are several parts of the history that are not clear. "Evaluating doctor recommended
0.625mg of premarin as I have not had hysterectomy". If you had a hysterectomy, estrogen alone
might be fine, but as a point of information, with a uterus, the recommendation for HRT is estrogen
AND progesterone. Estrogen with or without progesterone should have no effect on melanoma in
that melanoma is not an estrogen dependent tumor. That being said, the bisphosphonates, Fosamax
or Actonel, are better at bone conservation or in some, bone re-building, than HRT. Hope this helps.
Q: I am a caucasion female aged 43, have just been told I have severe osteopenia (dexscan). I had
a hysterectomy at age 27 leaving only one ovary. Ruling out any other causes for this diagnosis i.e.
hyperparathyroid etc. would I be a candidate for E.R.T.? My physician has suggested Fosamax once a
week but has not yet decided how much per week. Any guidance would be appreciated.
A: ERT may be appropriate for women who have documented menopause. After a hysterectomy,
an estradiol level is needed to confirm this. ERT is not considered appropriate therapy for severe
osteopenia - it's approved for prevention, not treatment. Severe osteopenia, presuming no other
metabolic or hormonal problems, may do very well with adequate calcium, adequate vitamin D and
an anti-resorptive medications, such as Fosamax or Actonel. Depending upon the T score, the
dosage of Fosamax recommended may vary. Some experts feel that if it's worth treating a patient
for severe osteopenia or worse, it's appropriate to use 70 mg weekly dosing. Others feel that the 35
mg dose before osteoporosis is the appropriate dose. I personally favor the former.
Q: My wife is a 36 year old with Lupus and takes approx. 10mg. of Prednisone a day. She has
done so for 10 years. She recently had a thyroidectomy and hysterectomy. She has T-scores of -2.7
for AP Spine and -3.7 for Lateral Spine. A -1.5 for Hip Lt. Total. Nobody can seem to tell us how bad
this is, how likely it is to get worse, or whether she can reverse it through drug therapy. We would
just like to know average T-scores for patients with OS in order to have some kind of scale to
understand the numbers?
A: With Steroid Induced Osteoporosis (SIO), the recommended therapy is Fosamax. Both long term
steroids and abnormalities of the thyroid are predisposing factors here. One can presume based
upon the history and the DEXA scores provided that 1) this is considerably worse than one might
expect from a 36 year old without the predisposing factors; 2) it is likely to get worse (without
therapy) because of the steroids and their effect on the bone; 3) this should be somewhat reversible
through drug therapy. The main idea is to reduce the fracture risk. The T scores may be improved
with a bisphosphonate such as Fosamax, along with adequate Calcium and Vitamin D. The cutoff for
the diagnosis of osteoporosis (NOF) is a T score of -2.5 or less.
Q: My mother has osteoporosis and has the "hump" which developed about 5 yrs. ago. She is 87
yrs. old and has always been very active. She takes Fosomax etc. About 2 mo. ago she had severe
pain in her back and we have been eliminating other causes, to find the reason for this pain. She has
very gradually been getting better but still suffers pain. Her orthopedic Dr. has her on Celebrex and a
mild pain medication which helps. Today, after having a full body scan, we got the news that she had
a small fracture of the vertabrae. Her Dr. also mentioned that there is a relatively new procedure
being done that "cements" the fracture. The Dr. did not know anyone in our area that does this
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medical procedure. I would like to know about this procedure and what it entails. What is it called?
We would appreciate any more info you could give us on this. Please advise.
A: For a compression fracture, there is a new procedure call kyphoplasty, whereby a surgical
"balloon" is inserted in the compressed vertebra and expanded with the "balloon". A cement-like
substance in injected into the balloon and allowed to harden. This expands the previously
compressed vertebra and reduces or eliminates the pain associated with the fracture.
Q: I have been diagnosed with osteoporosis and told to take an ntx urine test. What does this test
show? What conditions is it likely to turn up?
A: The NTx, both blood test and urine test is specifically to determine the bone turnover rate
based upon the chemical "cross linked N-telopeptide". A high level indicates a greater degree of
bone turnover and a comparison after 3 months of therapy may be able to indicate reduced bone
turnover and effectiveness of therapy.
Q: I was just diagnosed with osteopenia after a bone density scan. (Spine was normal, slight bone
loss in the hip.) I am 43 years old. I have a family history of osteoporosis. I am an asthma patient
taking both daily inhaled steroids, and oral steroids as needed to control flares. I have a milk allergy
and consume few dairy products.
My problem: my GP says treatment for the osteopenia is a daily supplement of Calcium
(1200mg)with vitamin D daily, plus weight bearing exercise. My asthma Doc says I need to be
treating the osteopenia, and recommended Actonel, in addition to the calcium supplements.
Are there any established guidelines for the treatment of osteopenia? When is the right time to start
treating the bone loss...now? Any info would be appreciated, since the doctors do not seem to be in
agreement over this issue. Thanks.
A: Individual therapy must be tailored to the specific patient needs. There is no doubt that a
family history of osteoporosis, history of inhaled and oral steroids along with inadequate calcium
intake makes for several risk factors for osteoporosis development. Based upon the exact bone
density result, milder forms of osteopenia may be treated with adequate calcium and Vitamin D
along with weight bearing exercises. For more advanced osteopenia, bisphosphonates such as
Actonel and Fosamax may need to be added. Without the specific numbers (slight bone loss in the
hip needs quantification), exact recommendations cannot be given but a consultation with an
osteoporosis specialist in your area should be helpful.
Q: I was diagnosed with osteoporosis recently. I am a 31 year old female who has a family HX of
Osteo & Rhemetoid. My mother is 64 and in a nursing home due to her condition. My question is if I
take 1500 mg. of calcium magnesium a day (as per Dr. orders) will my possibilities of acceleration
decrease? What else should I do?
A: Due to your age, you should be evaluated by an osteoporosis specialist. There may be some
predisposing factor (other than family history) or absorption problem that needs to be addressed to
reverse the osteoporosis if possible.
Q: I have had a bone density scan which shows that I have Osteopenia in my spine. I am 38 years
old and have had irregular periods since having my daughter four years ago. (This is currently being
looked into by a gynecologist and I am currently receiving no treatment for it).
My GP has suggested that I may have to take calcium and vitamin D supplements, or Fosomax, but
is reluctant to start either (so am I) because I have Irritable Bowel Syndrome. Many drugs do upset
my bowel and Fosomax and similar are known to cause gastrointestinal symptoms.
I do drink plenty of milk and my blood level of calcium is normal. At my age, would weight bearing
exercise be enough to prevent any further deterioration of my spine? Do soy products give any
benefits? Or any herbal remedies?
Also, would any other bones in my body be affected by Osteopenia? The bone density scan showed
that my hips fell in the average range, but other bones in the body are not scanned.
A: The reason for doing a bone density on a 38 year old is not clear. Your osteopenia may be a
situation of "never having gained the bone" rather than "bone loss." With one DEXA, you cannot tell
which it may be. The irregular cycles may or may not be related. Since there can be mild osteopenia
(T score -1.0 to -1.5), moderate osteopenia (-1.5 to -2.0) and severe osteopenia (-2.0 to -2.5), the
level of osteopenia most commonly treated is severe osteopenia. With or without osteopenia,
adequate calcium and Vitamin D are a must.
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With respect to Fosamax, the most common gastrointestinal complaint with the daily dosing was
irritation of the esophagus. With the newer weekly dosing, we don't seem to see this. IBS should not
be involved with any increased complaints. Weight bearing exercises are helpful in all ages, some to
build bone and older patients to improve balance and reduce the risk of falling. Soy products have
estrogen like activity but should not be expected to have any major effect on bone loss. Herbal
remedies have not been studied sufficiently to recommend.
Osteopenia and osteoporosis may affect different bones differently but must be considered a full
body disease.
Q: I have osteoporosis and I have been taking Didrocal for the past 5 years and Evista for the past
3 years. I have a bone imaging done each year. I started just taking Didrocal which helped my spine
but was not helping my hip so my doctor suggested that I take Evista also. When I got my bone
imaging done this year I was a little up on one and a little down on the other one. I can't remember
which he said was up a little my spine or my hip. Is this unusual? I am 66 years of age and I am
about 5 ft 6in. and I weigh 141 pounds. Even although I take the calcium in Didrocal what I read on
the internet it seems to show that I should still be taking a supplement of Calcium and I'm not sure
why. Also the (2) weeks when I take the white pills in Didrocal should I be taking a calcium
supplement? Any suggestions that you can given me would be much appreciated.
A: Didrocal is 14 days of Didronel and 76 days of the equivalent of 500 mg of elemental calcium
giving a 90 day supply of therapy. You need 1000 mg of calcium per day in divided doses of no
greater than 500-600 mg per day in addition to adequate Vitamin D. Improvement may not occur
every year on anti-resorptive therapy . In fact, many experts recommend DEXAs every 2-3 years
because in that time frame, increased bone density is more likely to be seen. At this time, there is no
study on the use of Didronel and Evista but there are studies due on Actonel and Evista in the next
several months.
Q: I am taking fosamax for osteoarthritis and have developed a very pudgy stomach and upper
chest. I am 57 and have never been heavy, now even though I exercise 45 minutes 5 times a week
on an exercise machine and really watch what I eat I cannot lose the weight (35 lbs). I am very
tempted to just stop taking the fosamax. I have been searching the internet and have also realized
that the soreness I have experienced is common. What alternatives do I have?
A: Fosamax is approved for the treatment of osteoporosis at this time, not osteoarthritis. That
being said, Fosamax is not related to any of your complaints except for possible muscle soreness
(myalgia). Some weight gain is age related or genetic in origin, some based upon calorie intake and
others with thyroid problems. An alternative to Fosamax is Actonel.
Q: Is there any benefit for an 80 year old to take both hormones and Fosamax for osteoporosis?
A: Some studies have shown additive benefit from HRT and Fosamax with respect to increasing
bone density. There is some question as to whether the bone is considered "frozen" where there is
little build up and breakdown as in normal bone metabolism. This needs to be further delineated in
the literature but the answer to your question is that the effects of the 2 medications are additive.
Q: I am a 47 year old perimenopausal woman who just got the results of my bone density. -1.5
spine and -1.8 for hip. My doctor calls it osteopenia and wants me to take Fosomax and Ca
supplements. Where do I fall on the scale and what are your recommendations. Thanks.
A: There is mild osteopenia (T score -1.0 to -1.5), moderate osteopenia (-1.5 to -2.0) and severe
osteopenia (-2.0 to -2.5). Your spine is on the cusp of mild to moderate and your hip is moderate. In
the perimenopause, adequate calcium and Vitamin D are essential. With no other risk factors at your
age, the use of Fosamax with your values (better than -2.0) is controversial.
Q: I am 40 years old, not menopausal, 5'1'', 95 lbs., with very small bones. I'm in very good
physical shape, hike mountains weekly, as well as do yoga daily, rock climb, x-country ski in winter,
walk daily, and dance a lot. In other words I'm doing tons of exercise! I've also been doing some
weight exercises with free weights for about 6-12 months a couple of times a week.
For almost ten years I've suspected problems with bone loss. I requested a bone scan and the results
came back as osteopenia in my spine, but not my hip. The numbers were 1.038 grams per cm
squared, which is 86% or 1/4 standard deviations.
I've begun to think that perhaps the problem is inadequate absorption of calcium and/or other
minerals. I've had frequent, sometimes chronic diarrhea since I was 11, and have had parasites a
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few times. What further diagnostics or therapy would you recommend?
A: With your activity level and normal hips, AND with a very minor "loss" in the spine, many
would recommend no further testing. There is a discrepancy in bone densities that can actually
make shorter bone "measure" out with less density than they actually have. Similarly, tall people
may look "better" on a DEXA than they really are. If you wish to investigate your chronic diarrhea, a
gastroenterologist is where you need to start. A serum NTx will also help determine the rate of bone
turnover to confirm whether bone loss is greater than expected.
Q: I am 37 years old. I had my uterus and one ovary removed in July 2001. I do not understand
what I should or should not be concerned about. I do not take any medication because of the ovary I
still have. But, what about bone density? Should I be taking Calcium? My blood count is always under
10. What about iron supplements? I am concerned. My grandmother passed away with breast
cancer. I do not want to take anything I do not really need. I know that I am overweight. I am about
6'2'' and I weight 236 lb. I am not getting any younger, and I want to take care of what I have left.
A: If you still have one ovary, you should be making all the female hormones your body needs.
Some experts actually say that you only need one eighth of one ovary to do all you need. As far as
calcium and Vitamin D, everyone should be taking adequate amounts of both and this has been
covered many times in our Ask the Expert answers as well as other information on our site.
Q: My bone density test showed a 1.9. The doctor wrote a prescription for 10 mg of Fosamax daily.
Is this really necessary? I am 71 in very good health, drink 3 glasses of milk a day and eat cheese
etc. Also I take Citrical +D, one tablet a day, am active in our vegetable and flower garden. I take
occasional one mile walks and swim about 3 times a week. We have a 2 story house and basement,
so I do steps during the day. Is there any damage if I took fosamax every other day? I have had no
allergies to Fosamax and have taken it for three months now .Once you start this medicine must you
take it all of your life ?And do I really need it?
A: Osteoporosis is defined as a T score of -2.5 or worse. Most experts agree treatment should be
initiated at -2.0 and worse. At -1.9, you are quite close to the -2.0. You may have other risk factors I
am not aware of. Although 10 mg per day is a standard dose, the other options are 35 mg per week
in a single dose and just observation if there are no other risk factors. With other risk factors, some
recommend treatment with as high a value -1.5. You need to discuss your risk factors with your
doctor to see if you really fit into the treatment group or if this is precautionary. As far as how long to
take this medication, it depends upon how well you do in a subsequent bone density test.
Q: Is there a connection between osteoarthritis (in the fingers and one knee) and osteoporosis? I
am 52 and through menopause. I am undecided as to whether or not to take HRT. Will taking HRT
help the osteoarthritis? Thanks for your response.
A: There is no obvious connection between osteoarthritis and osteoporosis. You can have either one
without the other or both. There is some scant evidence that HRT may reduce the symptoms of
osteoarthritis but this is not sufficient to recommend it on that basis. Once your doctor discusses all
of the risks, benefits and alternatives to HRT, you can then make an informed decision.
Q: I have been diagnosed with osteopenia with borderline osteoporosis. I am currently on
fosamax. What I neglected to ask my doctor is what should I not do? I know weight bearing exercises
are recommended but I was wondering if there are daily activities or food I should avoid My hips are
in good condition, it is in my spine.
A: When you discuss this with your doctor, s/he will no doubt recommend medication to prevent this
situation from progressing. Adequate Calcium and Vitamin D are essential. Weight bearing exercise
is also important. Excessive protein and, believe it or not, excessive dairy products, can lead to
calcium loss. Most activities should be fine.
Q: My mother took the drug fosamax for her osteoporosis for the first time and she had a terrible
reaction to the drug. The left side of her head swelled up along with her ear and she broke out in
blisters all over her jaw line and neck. She keeps complaining about it burning like fire. She went to
the Dr. and he gave her a shot that was supposed to counteract the reaction and there has been no
progress yet. Have you heard of this before related to this drug ? If so do you have any suggestions
on what to do with the burning. Need less to say she will never take the drug again. Thank you for
your time.
A: I have never personally seen this reaction. It may be some sort of allergic reaction besides being
quite severe. Another thought is that it may actually be coincidental herpes zoster (shingles) in the
affected areas. Her symptoms actually do seem more consistent with shingles than a bizarre
reaction to Fosamax because they are relatively localized. This should be discussed further with her
doctor.
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References: **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.
Source URL: http://www.diagnosticimaging.com/osteoporosis/osteoporosis-ask-expert-12
Links:
[1] http://www.diagnosticimaging.com/authors/r-wayne-whitted-md-mph
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Osteoporosis Ask The Expert

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