Osteoporosis Ask The Expert

Transcription

Published on OBGYN.Net (http://www.obgyn.net)
July 14, 2007 | Osteoporosis [1], Integrative Medicine [2], Contraception [3], Pregnancy and Birth [4]
By Paul D. Burstein, MD, FACOG [5] and Michael Kleerekoper, MBBS, FACP, FACE [6]
Questions this month have been answered by: Paul D. Burstein, MD, FACOG, USA, OBGYN.net
Osteoporosis Editorial Advisor Michael Kleerekoper, MB, BS, FACP, FACE, OBGYN.net Editorial Advisor
Harvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor
Q: I have been on Actonel for six months and have been having hip joint pain. I read the literature
and know I should stop taking it. Does Fosomax have similar side effects? What is the difference in
the two drugs? What does this side effect indicate?
A: Joint pain or arthralgia is a common side effect and not really a serious adverse reaction.
Fosamax has the same list of adverse reactions and side effects and works in a similar fashion. It
might be worth trying Fosamax to see if can tolerate it better. I am not sure that joint pain unless
severe would be a reason to discontinue the drug. I would check in with the physician who
prescribed it.
Q: I have been on Actonel for six months and have been having hip joint pain. I read the literature
and know I should stop taking it. Does Fosomax have similar side effects? What is the difference in
the two drugs? What does this side effect indicate?
A: Joint pain or arthralgia is a common side effect and not really a serious adverse reaction.
Fosamax has the same list of adverse reactions and side effects and works in a similar fashion. It
might be worth trying Fosamax to see if can tolerate it better. I am not sure that joint pain unless
severe would be a reason to discontinue the drug. I would check in with the physician who
prescribed it.
Q: I had breast cancer four years ago and have one more year to go on Tamoxifen. I am
post-menopausal, age 54, and feeling great. I am short and have a small frame so I wonder if
Raloxifen would be a good choice to take after I finish the Tamoxifen since I am not a candidate for
HRT.
A:
This is becoming a fairly common question. The question should be posed to your oncologist. If
the issue is preservation of bone mass, raloxifene is a reasonable choice. The question is: what data
do we have concerning raloxifene in those women with estrogen receptor positive breast cancer and
can we assume that it is a good choice? Interestingly, one can ask is there truly danger in
considering estrogen? This question is being asked more and more. I do not know of a simple
answer. In the case of osteoporosis, the use of drugs like alendronate or risedronate might be better
choices. Hope this helps a little bit.
Q: Is there any relationship between osteoporosis and Vitamin A?
A:
None that I can find in searching the literature. Obviously, Vitamin D is important and there is
some data suggesting that Vitamin K may be useful. In fact, Viactiv Calcium Chews contain Vitamin
D and Vitamin K.
Q:
I am 29 and have recently been diagnosed with osteopenia. A friend urged me to have my bone
mineral density tested because I broke my left wrist twice last year - once from a slip and fall
accident in the hallway and the next while mountain biking. The T-rating for my spine was -2.3, while
my hip was -0.1. Until I started university, I drank milk regularly and have always loved cheese, I
should have had a more than adequate Calcium intake. I have a small to medium frame - 5'4", and
weigh 125 lbs. I have always been reasonably fit, and am currently training to do a triathlon. I have
been taking birth control pills since the age of 15 - which was taken to help regulate my heavy flow
since I had developed anaemia, so there was also no lack of estrogen either. My doctor has tested
my calcium levels, as well as my thyroid for any irregularities and found none. No one in my
immediate family has ever suffered from an irregular break - neither of my parents have ever broken
any bones. Unfortunately, my mother was adopted, so I do not know of her family's medical history.
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Since being diagnosed, I have seen an endocrinologist who is sending me for more detailed blood
work. My GP has prescribed Actonel, but it has not been approved by my health insurance company.
It will only be approved if there is no improvement in my condition after taking etidronate for 2
years. My last break was 6 months ago, and I've read that etidronate should not be taken if there
was a recent break, is this correct?
What typically happens to women with premenopausal osteoperosis when they hit menopause? Am I
still young enough that these drugs will be able to
return my bones to the density that they should be so that reaching menopause won't be a concern?
I am very worried about what lies in my
future.
A: At age 29 you are just reaching your peak bone mass. It is not clear if your fractures were
osteoporotic in nature, that is, low impact. The problem is that a bone density at age 29 most likely
reflects failure to reach the theoretical peak calculated by the DEXA software, and not having
reached and mysteriously lost it. This may be a case of low bone mass but not low bone quality.
Indeed seeing an endocrinologist with the intent of ruling out secondary osteoporosis or other
metabolic bone disease is a good idea. Except in the event of Paget's Disease or
corticosteroid-induced osteoporosis, treatment with bisphosphonates would not be a good idea.
Etidrionate is not approved in the United States for osteoporosis. Actonel is approved for
postmenopausal osteoporosis and corticosteroid-induced osteoporosis. Hope this helps.
Q: I have been taking Lipitor for the last 7 years and have been managing to keep my cholesterol
level below 160. Two months ago, I started Evista due to a DEXA scan showing osteopenia. A recent
blood test now has my cholesterol at 223. I have been trying to find information on the interaction of
Evista with Lipitor and have been unsuccessful. Can you help?
A: It is hard to find data suggesting that Evista would adversely affect cholesterol. In fact, it seems
to help total cholesterol. There is the possibility of an idiosyncratic or unique reaction to the
medication. I would look beyond the total cholesterol and would want to know your triglyceride and
HDL levels. If they are reassuring, I would not be too concerned and would follow up in the next three
to six months on both medications.
Q: I tried taking Fosamax, but it really upset my digestive system. I have osteopenia, and osteoritis,
plus R.A. Now , the Dr. wants me to "try Actonel". I don't like the fact that it is so new, and who
knows what it will cause on down the road. Are we guienea pigs? Are we the pioneers to sample the
new drugs, to later find they cause worse problems? Please answer. One o OBGYN suggested Evista,
but my primary suggested the new Actonel! What do you suggest? I am 65 5'4'', 145 lbs., I take
vitamins and calcium 600mg. Thank you very much for your input. Where can I find ''side effects'' for
actonal?
A: The serious side effects of Actonel are similar to Fosamax: stomach and esophageal ulcers.
These are rare and may be less common with Actonel than Fosamax. If you did not like Fosamax, it is
worth a try to use Actonel. Actonel is newer but by no means an untested experimental drug. There
is data on safety and fracture reduction. Evista does not have data on reduction of hip fractures, but
would avoid some of the problems of Fosamax or Actonel, while perhaps creating others.
Your total calcium intake (diet plus any supplements) should be 1500 mg each day. Vitamin D should
be 400 to 800 units per day, especially if you do not get regular sunlight.
Q: I am 54 years old and have been diagnosed with osteopenia. What exercises can I do to
strengthen and tone my abdominal muscles (since crunches, etc. are not recommended)? Thank
you!
A: I would not eliminate crunches from my workout as they will help abdominal tone. Osteopenia is
not a reason to avoid them. The forms of exercise I would recommend would be a combination of
walking, biking and swimming. This will help with weight-bearing, upper body, and will be aerobic. I
would suggest 30 minutes per day every day or at least most days. The exercise can be divided into
several sessions. Making an effort to use stairs instead of elevators, and walking rather than driving
may be painless ways of getting exercise. Weight-bearing exercise can include not just walking, but
also tennis, golf (walking not using a cart), dancing, etc. Using light free weights may help maintain
upper body strength.
I would suggest a total of 1200 mgs of calcium each day. If your diet is deficient, add a supplement.
Vitamin D may help reduce falls, as well as being essential to calcium absorption and utilization.
Almost all multi vitamins contain 400 I.U.
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Avoid smoking like the plague, hope this helps.
Q: 40 year old woman, Hx of prolonged bleeding, Ultrasound: intrauterine polyp, hysteroscopy polyp removed+Curetage, pathology: adeno-squamous ca., radical hysterectomy - no cancer cells
found neither in uterus nor cervix nor lymph nodes. Can you assume the patient is clear of cancer?
What about HRT? Would Livial (Tibolone) be an option? Unfortunately it is not my patient but myself.
Opinions of my collegues are devided. Thanks.
A: Not aware of a contraindication for estrogen. Tibolone reasonable choice except in the USA
where it remains unavailable. Will need long-term follow up, but seems to have good prognosis
based on no residual tumor and negative nodes.
Q: Thank goodness for this site. I'm a 66 year old woman, post menapausal, and have been
recently been diagnosed with osteoporosis. This came a quite a shock to me as I have been very
active most of my life. I have participated in body building, I ran for many years, biked and walked. I
have not led a sedentary life! At this point in my life I hike and work out on a Bow Flex.
I have been taking estrogen (.0625) since I was 48 and for the past 10 years or so have been taking
natural progesterone (200mg) as I still have my uterus and still have periods. I have been taking
1200 mg of calcium with vit D for many many years.
My numbers for this recent diagnosis are: Z matched--1.5 and T matched---2.9 for my hip. My spine
seems to be within normal limits. My dr put me on Actonel, 30 mg, once weekly. I have been taking
this for
about a month and have experienced no side effects.
I am at a loss to understand the loss of bone with respect to my active
life. What else could I have done...what can I do now other than take the
Actonel?
Also, I have been experiencing hair loss in the last year or so. Is there
any data to establish a parallel with the diagnosis of osteoporosis? No
treatments recommended by dermatologists have made any difference. My
mother at 93 has a full head of hair. Any ideas? Thanks.
A: While you have done everything possible to reach your peak bone mass and keep it, the bone
density measurement may reflect never having reached the peak predicted as a theoretical number
by the bone density software. That peak may be affected by many things, genetics being the most
important. Your loss was probably slowed by estrogen taken soon after menopause, but even that
effect seems to wane with time. Actonel is a reasonable choice. One must caution that the 30 mg
weekly dose is not FDA approved as of yet, and although many physicians are using it, the
recommended dose may change in the future. To date, only Fosamax is FDA approved for weekly
dosing.
You should be applauded for your life long exercise and for many good lifestyle choices. Your low
bone density may not reflect weakened bone and bone density alone is only one factor in predicting
fractures. I would encourage you to continue your calcium intake, in fact, 1500 mg has been
recommended after age 65, best by diet, with supplements for the balance. Hope this helps.
Q: I am a 57 year old woman that was diagnosed with a Perilunate dislocation of the right wrist.
Just recently an x ray showed no evidence of avascular necrosis in the wrist. There is a diffuse
osteopenia complicating the injury and surgery. My question to you is, can you defined the above
statement in laymen's terms, so I can understand my conditions. Thanks.
A: Good question. I would discuss the avascular necrosis with your orthopedist. Plain films of
bone show loss very late and a better way to measure bone density is a technique called dual energy
x-ray absorptiometry or DEXA. This generally will measure bone density at the hip and spine,
sometimes forearm. Osteopenia represents bone density less than the predicted level, but not low
enough to be considered osteoporosis.
Q: I take 6mg of prednisone / 15 mg thalitone a day. I also get 1150mg of calcium through diet
and, supplements. In your opinion, do I need any vitamin D and, if so, how much? My docs don't
seem to know. My concern is: while I know prednisone depletes both calcium and,
vitamin D; thalitone can do some screwy things to both.
A: In general, you would want 400 IU of Vitamin D. That is the amount contained in a multivitamin
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pill. Your requirement is 600 to 800 IU if you are over 65 years of age. If you get sunlight, the
requirements are less. In many northern cities, the amount of effective sunlight is limited especially
in the winters, which are long.
Q: What information does a urine test provide when suffering from osteoporosis. What are the
doctors looking for in the urine and why?
A: One would need to know what tests were being done. There are tests done on urine that look for
markers of bone metabolism. They work well in large studies with data from many patients pooled
but are not helpful on an individual basis. The other urine test would be a 24 hour collection to see it
there is over excretion of calcium.
Q: I am a young (27) woman with a history of running-related stress fractures. I have slight
Osteopenia, my bone density is in the 75th percentile for my age, I am not anorexic, and I get my
period regularly. I take birth-control pills, 1500 mg. of calcium daily, and work hard to get adequate
amounts of calcium, Vitamin D, and protein in my diet. A recent iliac crest bone biopsy found that I
have over-active osteoclasts and hence I have just been placed on Fosamax for a year by my
physician. She and I are both approaching this treatment conservatively given the relative lack of
information about the impact of Fosamax on pre-menopausal women. My two questions are: (1)
What will happen once I stop (after a year) taking Fosamax -- will its results be long-lasting or will I
go back to being at risk for stress fractures and hence have to curb my running? (2) What else might
I be doing/should I know about to stay healthy and ! avoid future stress fractures? Many thanks.
A: You ask some great questions and I do not have all the answers. You are doing everything you
should be doing. You have not yet reached you peak bone mass and unless there are most unusual
circumstances, doing bone mineral density testing is not warranted. The relationship of your bone
density now to peak bone density is unknown: which side of the curve are you on? Fosamax is
approved for steroid-induced osteoporosis, postmenopausal osteoporosis, treatment of Paget's
Disease, and the treatment of osteoporosis in men. There is very little experience in someone like
you, and I have some real concerns: what effect on potential children? Are you really having
excessive resorption of bone? I would consult an expert in metabolic bone disease.
As far as stress fractures, I do not believe these are really regarded as low impact fractures. They are
a problem, but I am not sure they are osteoporotic in nature.
Your question about stopping Fosamax. It appears in older women, at least, that there is no further
bone loss for two years after stopping. Hope this helps.
Q: I have been on fosomax for only three weeks - the once a week dose, and for the three to
four days after I suffer flu like symptoms and have difficulty sleeping, after the four days I feel fine.
Would Actonel be more easily tolerated - any feedback on this?
A: This is a new one for me. I suggest that you take neither Fosamax nor Actonel for 4-6 weeks and
then try Actonel. Don't worry about not being on therapy for this short time. No harm will befall you.
Q: I'm 49, 5'10, 132lbs, and my bone density last summer showed 80% in my hips (everything
else normal). I've never had broken bones or fractures, and am good health. My doctor gave me a
script for weekly fosamax 70mg. I have been taking calcium supplements more seriously since the
bone scan (1200-1300mg daily), drink milk, and walk 3 miles every other day. I am questioning the
need for fosamax....It is a relatively new drug. I wonder about its' long term effects. It is also very
expensive (even though I get a discount through AARP). Considering my good health, and
compliance with calcium supplements, as well as walking regime, do you think it necessary to
continue the supplement?
A: I am assuming that this question comes from a 49 year old woman, not a 49 year old man. You
don't give enough information to give you a clear answer. Are still having periods? If so you probably
don't need anything for your bones just yet. If you have gone through menopause, how long ago was
that and are you taking estrogen? No matter what, in "osteoporosis speak" we don't make treatment
decisions on percent values but on T scores, medical history, and physical examination. Please drop
us another line and I'll try a more specific response.
Q: I am 33 years old and my mother and paternal grandmother have osteoporosis. My mother is
56 and recently broke her ankle in 3 places due to fragile bones. Her T-score is -3. Her doctor
recommended that her daughter have a bone density test. My T-score is -1.8. My osteo doctor is
very concerned with my scores and recommended weight bearing exercise and increased calcium,
1000 to 1500mg day, and in two years come back for another density and see where I am then. I do
not want to be like my mother, it has been 8 months and she is just now walking. ,Is there a
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medication safe for a person of my age? My doctors main concern that when I need the medications
they will not work as efficiently as they would if I started them later in life (at menopause). My
concern is what if in the next two years I lose more bone? What are my chances of recovering from
what I lose and is 2 years an appropriate time frame for me to return for testing?
A: Tough questions given your mother's recent fracture and grandmother's history of osteoporosis.
Believe or not, a T score of -1.8 at age 33 may be perfectly normal. It depends on your overall
medical history and your family history. Look at it this way - if mother and grandmother were both
5'7" tall and you were only 5'3" tall you might have reason to be concerned. However if you are only
5'3" because mother and grandmother had that height you wouldn't worry. At age 33 with a T score
of -1.8 your risk of fracture from osteoporosis in the next 10-20 years is close to zero. (That doesn't
count of course if you are in an unfortunate car accident, etc,). I wouldn't worry about taking
medications for osteoporosis until you get much closer to menopause. By that time much of what we
use today will be old-hat.
Q: I am a 62 year old male. A year ago I was diagnosed as having osteopenia in my left hip and
osteophorosis in my lumbar region. DPX of lumbar region results were T-score to be -3.4 and Z-score
-2.9. The bone density decreased on this year's DPX scan to -3.6 and -3.1. This triggered my family
doctor to start me off on Actenol which I am taking now with 1,200mg of Calcium and 800mg of
Vitamin d.
1. Is there something else I can take or do to possibly retrieve some of the loss?
2. I walk about 3 miles a day, carry groceries, and do the weights to a point. What else?
3. From the time I started taking Actenol (10 days ago), I am having some pain in the muscles
between the ribs of my chest. My heart condition was tested as OK. If this is some kind of reaction?
What to do?
4. 4 years back I had a total of about 10 shots of cortisone (spread over a years time). Could this be
what started my osteoporosis?
Thank you in advance.
A: An otherwise healthy 62 year old man should not have the bone density you report. ALL
secondary causes of accelerated bone loss MUST be systematically excluded before simply starting
Actonel. This is particularly true if you have lost as much bone density as you say you did, in just one
year. Did you really lose any bone density in that year? Were the measurements made on the same
instrument. Were the two results critically compared in all aspects and not just the T score? Lot's
more work needed here before we can really tell you what's going on.
Q: I am 47 years old, have been taking anticonvulsants since age 16 and recently broke my hip at
the femoral head. Had surgery, 3 screws and now awaiting the time I can walk. I have been put on
Fosamax, however, I am pre-menopausal. My bone density test for lumbar and hip were T scores
were -2.3 and Z score was also -2.4. Should I be taking fosamax?
A: Yes, you should be taking Fosamax or other potent osteoporosis drug. However, I am not
convinced that 31 years of anticonvulsants is sufficient reason to have a broken hip at age 47, and
pre-menopause. There might be many other factors contributing and these should all be carefully
looked for and excluded before simply blaming the anticonvulsants.
Q: I was diagnosed last year at age 46 with osteoporosis. I've been on Ortho Cept for a least 15
years and continue taking that at present. I was given a script for Fosamax, had a salivary hormone
test and my testosterone and progesterone were extremely low. I'm now on both topically ( and feel
better!) but have been advised by my doctor to go off the ortho cept and start on another lower dose
form of estrogen. However, the choices are so confusing! The ratio of estriol/estradiol/estone - the
patch/pill/cream - conjugated and esterified estrogens - ...Any advice about estrogen replacement for
a premenopausal woman who want to continue to protect her bones? Thanks
A: Premenopausal women do not get osteoporosis unless some secondary cause such as disease,
surgery, or medication is involved. Make sure that the diagnosis is correct before you start Fosamax.
If the diagnosis is correct you should have a thorough evaluation looking for secondary causes of
bone loss.
Q: I recently switched from taking fosamax once a week (began June 2001), to taking actonel
(30 mg) once a week(April 2002), for osteoporosis prevention, as recommended by my doctor. In
May 2001, I had my first bone density scan which indicated that I needed some form of medication
for osteoporosis prevention. The fosamax gave me joint pain and muscle tightness the first day or 2
after taking each week. I am 55 years old, and have recently been diagnosed with osteoarthritis in
one of my knees, and felt the side effects of the fosamax did not alleviate that condition. Anyway,
the actonel is gentler for me, and does not cause any unusual or uncomfortable symptoms. When I
began taking it, the pharmacist said that it very recently was approved for weekly use as an
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osteoporosis medication. Do you know the study that has been done on this drug, and where it can
be obtained? I do not seem to be able to find information about its weekly use for osteoporosis on
the internet. Can you help me? Thanks.
A: The study has been completed and presented to the FDA for approval of the once weekly dose of
Actonel. I have seen results in preliminary form and they look good, but I cannot give you a specific
reference, nor has this yet been approved by the FDA. Theoretically once weekly Actonel should be
as good and as safe as once weekly Fosamax, but that remains theory for a few more weeks.
FDA Approves Actonel for once-a-week use, read the Aventis press release.
Q: I am 54 years old, of small stature (5'1", 105 pounds) and a smoker. Last year, I was put on
HRT because of entering menopause with some hot flashes--I am still menstruating but not every
month. I have been exercising regularly for the past 8 months. I just had a bone density on a Hologic
which was interpreted as moderate to severe osteopenia in the femoral neck. This was compared to
a bone density done four years ago on a Lunar. The converted results and comparison were:
1998 2002
Lunar Hologic
Femoral
Neck 0.710 (sBMD) 0.65 (sBMD) -8%
Total Spine
Aver 1.055 (sBMD) 1.056 (sBMD) No change
My internist feels that I do not need additional therapy at this time as long as I stop smoking. My
ob-gyn has prescribed once-weekly Fosamax.
My questions:
(1) Is there suppposed to be some correction in the results of small stature? What if the osteopenia is
the result of having achieved a low peak bone density during development?
(2) What does it mean that I have osteopenia in the hip but not the spine? The %Age Matched were
82% for the femoral neck and 105% in the spine.
(3) Since I have been taking HRT and exercising only in the past year, would it be prudent to wait
before starting Fosamax (especially if I stop smoking!) to see if these are sufficient? (especially since
there was no measurement done last year)
(4) What effect would Fosamax have on my spine, which apparently is okay?
(5) What specialty of medicine is best equipped to handle these issues?
I am so confused and am reluctant to start a medication which can have serious side effects. Thank
you for your help!
A: Lots of questions, lots of answers. You cannot compare a study done on a Lunar instrument with
one on a Hologic instrument without a great deal of difficulty and mathematical manipulation.
You must stop smoking!! Smoker's may need higher than usual doses of estrogen which may
increase side effects from estrogen.
You must stop smoking!!! Your osteopenia results from your small stature, your low peak bone mass
during development, and your smoking.
You must stop smoking!!!! Because of the way bone density is measured the results are not uniform
throughout the skeleton. Too complicated to more fully explain why one site is normal and one site
has osteopenia. No need to start Fosamax.
You must stop smoking!!!!! As an endocrinologist I would say endocrinologists are best equipped to
handle osteoporosis. Other specialists would disagree with that of course.
Q: I am a postmenopausal woman of 8 years who had my first bone density test one year ago. I
was told I have osteopenia and advised to take 1500 mil calcium and 400 vit. D. I was quite
surprised that I had osteopenia as I have been a big milk drinker all my life and have always eaten
sensibly. In trying to look back over the years to see what I might be doing to contribute to the
problem, the only thing I could come up with was that I have been taking Prilosec for several years. I
have heard nothing about whether any studies have been done on the use of antacids, which
reduces acids in the stomach, and the absorption of vitamins. Could it be possible that while helping
with problems like GERD, antacids could be removing important acid levels that help to break down
the nutrients in foods?
Also, I am having problems with excess gas while taking calcium; I've tried both calcium carbonate
and calcium citrate. Any suggestions?
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A: Believe it or not, 16% of all perfectly healthy, normal premenopausal women have "osteopenia"
just because of the way the condition is defined. You have done nothing bad that made you develop
osteopenia. Prilosec probably had little to do with it.
Calcium causes gas in lots of people. What's wrong with milk, cheese, ice cream, cottage cheese,
yogurt, etc. 300 mg calcium per dairy serving.
Q: I have been sick for the last three years from having a stomach surgery nissen for acid refllux.
It took 3 more surgeries after that to get me where I could eat for almost 2 years since my body I
guess had been run down for all this time. I have now been told I have osteo, osteoarthritis,
chrondomalasia arthritis and now I have a compressed fractured spine L4. How do I fix a back
fracture like this? Do you think that I have developed these health problems from being
undernourished for so long? I need help. The doctors say that this did not cause this, what is your
feeling?
A: Presuming the bone "loss" (or "never gained") is limited to
osteopenia, a supervised regime of aerobic exercise to encourage a healthy cardiovascular system
AND weight bearing exercise (low weight and higher repetitions to tone rather than build bulky
muscle) would be appropriate. The weight bearing exercise has at least two advantages. First, with
low weight and high reps, they will not be building large muscles which would be a problem for
younger girls with eating disorders and body image problems. Second, the weights will help promote
bone growth up until 25-30 years of age and may help reverse some of the osteopenia, presuming
adequate calcium AND Vitamin D intake AND adequate estrogen via regular periods (this is obviously
a problem in some patients in an eating disorders clinic - some may need oral contraceptives to
regain normal estrogenization
while working on weight issues).
Q: I was a professional dancer for many years. In my early 40's, I started to notice that it would
take me a long time to heal after a fall or hitting my arm accidentally against a hard surface. I had
folllowed a macobiotic diet for several years before this and excluded all dairy and meat products
but did consume fish. At 45, I had my first bone density scan. Results indicated that I had severe
osteopenia in my spine (2.4 S.D.) and mild ostepenia in my hip (1.4 S.D.). No one in my family has a
history of osteoporosis.
Scans over the past 5 years have shown very minor improvements or no change at all. At 47, I
stopped dancing. Since then, I have continued to do exercise and take calcium and magnesium
supplements. My bone scan this year, at age 50, indicated a decrease in spinal bone density (2.6
S.D.) but no change in hip density. I attributed this change to the enormous stress experienced
returning to school. Recently, I started to take the biphosphonate, Actonel.
I am still cycling, although it is scant, and do not take any hormones or any meds, nor have I taken
any before. Based on my exercise and diet history, my questions are the following: what may have
caused me to get osteoporosis? and is there any difference in terms of side effects and effectiveness
between Actonel and Fosamax?
A: The difference between -2,4 and -2.6 is really very small and may in fact be no real difference
at all. So I don't think anything caused you to have osteoporosis. If anything was 'responsible' it is
probably related to your going through menopause. Actonel is a good drug for your situation. There
are no head-to-head studies directly comparing Actonel to Fosamax. They are both good.
Q: I have been prescribed actonel for osteoporosis. After a few days of taking the drug I
experienced burning and discomfort in the rectum. I am sensitive to all acidic type foods and I
wonder if this burning sensation could be side effect of Actonel? Do you have any information about
the side effects, and what drug would suggest as being the most appropriate for me? Thank you.
A: I don't think this is a side effect of Actonel. Why don't you stop it for few days to see if the
symptoms go away. If they don't you can be more confident that they are not related to Actonel and
you should seek the advice of your physician to see what it might be. If the symptoms do go away,
wait another week and re-try Actonel. If the symptoms come back you should stop the Actonel and
try a different drug for osteoporosis.
Q: My T-score (hip) is -2.46. I am taking Fosamax 70 mg. once a week and Premarin .625 mg. od
plus Calcium . I recently added Ipriflavone (ostivone) 300 mgm bid. Is the combination of Fosamax
and Ipriflavone contraindicated?
A: I think you're swatting a fly with a sledge hammer. You don't state your age but I presume you
are past menopause because you are on HRT. I also presume that your spine T score is better than
your hip T score. For most women 0.625 mg Premarin together with calcium is sufficient to prevent
bone loss and reduce your risk of fracture. Adding Fosamax 70 mg once a week adds a little bit more
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protection but not very much and at considerable expense. Adding a third drug, be it Ipriflavone or
anything else, is only likely to add expense without adding benefit. There's no contraindication to
adding it, just no reason. A hip T score of -2.46 isn't too bad. Given the little information you
provided I would suggest that Premarin plus calcium is the most cost-effective approach in your
case.
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.obgyn.net/osteoporosis/osteoporosis-ask-expert-1
Links:
[1] http://www.obgyn.net/osteoporosis
[2] http://www.obgyn.net/integrative-medicine
[3] http://www.obgyn.net/contraception
[4] http://www.obgyn.net/pregnancy-and-birth
[5] http://www.obgyn.net/authors/paul-d-burstein-md-facog
[6] http://www.obgyn.net/authors/michael-kleerekoper-mbbs-facp-face
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Osteoporosis Ask The Expert

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