Michael Kleerekoper, MBBS, FACP, FACE

       I am 46, pre menopausal, regular periods no symptoms of menopause, and        have been suffering from lower back pain for approx 2 months. I have       however had discomfort in my left hip for about a year,. I was sent for an       x ray by my GP and the results this week indicated that I have some       evidence of osteoparosis and that my spine is slightly distorted,       something I was unaware of. My doctor said I may have been born with my       spine in this position. I have an enlarged thyroid gland, I have had a       blood test previously and nothing showed. I have been given some       anti-inflammatory tablets, advised to take pain killers and asked to       return to the doctor in a month's time. I also have slight asthma. I was       advised that when start the menopause I may have to have hormone       replacement treatment. I was wary of this because I attend a hospital for counseling       and annual checks and mammograms because there is a family       history of breast cancer, my ! great grandmother, grandmother and mother       all developed breast cancer around age 60. I am estimated to have a one in       four chance of developing breast cancer. So I am between the devil  and       the deep blue sea here. I suggested to my doctor that I perhaps should       start to take calcium supplements and multi vitamins. I go to a gym and       exercise 3 times a week. Is there any advice you can give me. I am bewildered       and a little depressed about all this. Thanks.

 Without       a DEXA bone density, no real comments about your density status can be       made.  That being said, if one were to have either osteopenia or       osteoporosis at 46 while still getting periods, most experts would       recommend just what you have suggested to your doctor. If there is great       concern about osteoporosis at this time, a DEXA can be done. If you were       to implement your own plan above, a DEXA should be done in menopause and       medications such as bisphosphonates (Fosamax or Actonel) can be used along       with your "own plan" delineated in your question. Hormone       replacement therapy is not approved for treatment of osteoporosis at this       point.                                                                   

       I am a white, 30 year old woman who sustained a stress fracture to the hip       while running in early August.  My surgeon is more or less convinced       that it was a repetitive stress injury as I had gone from no running at       all to 6 miles, three times a week, in only 3 months.  Since then, I       was referred to an osteoporosis clinic.  Initial ultrasound findings       on my (injured leg!) heel were -2.0, osteopenia (10 weeks after surgery).        I am only 5 foot 2, have nearly always weighed 98-104 pounds, and usually       been inactive.  I was       diagnosed with mild scoliosis at 12 and the hip fracture is the only       broken bone I have ever had.  The only blood test so far measuring       out of the expected range was PTH at 8 (it was mentioned that normal is 12       or above).

I have tiny bones, and my questions are:
       
       1.  What are the relative risks of Lilly's Forteo (recombinant PTH)       versus Fosamax for women of childbearing age?
        2.  What are the chances that with small bones my DEXA scores would       be significantly lower than "normal" anyway?
       3.  I understand that BMD is only an indication, not a measure, of       bone strength, and that younger people with low BMD have lower risks of       fracture than older people, because bone structure weakens with age, just       as bone density decreases with age.  Is this accurate?
       4.  What is the best exercise to increase bone mass?
       5.  How soon should I have the PTH re-tested?
       6.  Is there anyone out there who is specializing on YOUNG cases of       osteopenia/osteoporosis?
       
        Thank you for your time.

Many       questions, many problems. Your orthopedist is       almost certainly correct in that you have sustained a repetitive stress       injury. What you appear to have done is simply overloaded a normal       skeleton. The treatment of this is to avoid the overload situation, not       use drug therapy.                

Your small size probably       accounts for a low bone density score in the heel. Additionally, studying       the injured side within 10 weeks of the injury probably reflects some of       the acute unloading that occurred while you were recovering from your       injury and presumably not load bearing on that side.               

Let’s leave the issue of       Forteo and Fosamax aside for now. Forteo is not yet on the market to my       knowledge and has not been used in premenopausal women. Likewise, while       alendronate is on the market it has not been well studied in premenopausal       women.               

This brings me to an important       question. What happened to your periods as you cranked up your mileage? If       they decreased in any way that is a sure sign that you are exercising too       much and need to cut back to the point where your periods become normal       again.               

For any given BMD younger       people have a lower short-term (say 5 years) fracture risk than older       peoiple. However lifetime risk is probably greater.               

There is probably no exercise       that can increase bone mass in a 30 year old woman. Sorry, it doesn’t       work that way. Exercise is important for the growing skeleton and       immobilization is bad for any skeleton. However between those extremes       exercise is good for your health but doesn’t build bones.                

I can’t imagine why PTH was       measured in the first place.  The lab has a hard time distinguishing between a value of 8       and 12. Unless you have a serum (blood) calcium that is either lower or       higher than the normal range I would not measure PTH again.               

There are lots of people who       take care of younger patients with osteopenia/osteoporosis. I am not       convinced you have either and don’t need a specialist.                

I suggest you do the following:              

Check your family to see if any       of them (mother, aunts, grandmothers) have low bone mass, osteoporosis,       fractures.              

Have your bone density checked       at the heel on the uninjured side.              

Have your bone density checked       at your spine, hip, and forearm.

       I am 62 years of age and have osteo.  I have also taken dilantin for       seizures for 42 years.  I am presently taking 10 mg of fosomax daily       and wearing the hormone patch.  It has caused bleeding and my gyn/ob       wants me to consider Evista.  My estrogen level is never high enough.       In your opinion will I need Fosamax and Evista?

       Bleeding on hormones is an expected event.       However there are many options for doses, combinations, and regimens for       estrogen and progesterone that can minimize and quickly (in most cases)       stop the bleeding.
       
       I am not sure why you are taking both hormones and Fosamax. If this is       only for your bones there is some, but not much, advantage to combining       hormones and Fosamax. If you are taking hormones for other problems faced       by 62-year-old women, I would stay on them. Otherwise Fosamax should be       fine on its own.
       
        Talk to your doctor about once a week 70 mg Fosamax tablets. I see little       need to add Evista to Fosamax.                                                    

During the last year I have been told by my Doctor that I       have Osteoporosis.  Since my teens I have had thyroid disease and to       take synthyroid.  I am now 55.  Last Jan I had an episode that       started with rapid heart rate (160 - 180 beats per minute)  and       extreme high blood pressure.  I have not had either before.  My       Doctor said I was now hyperthyroid.  My thyroid medication was too       high and he has lowered it twice.  I have no thyroid (it was removed       at the age of 22).  Now I am on attenolol and tiazac for the high       blood pressure and rapid heart rate, celexa and lorezapam for the side       effects of tachyardia and hypertension.  I take fosomax once a week       for the bones and have had to discontinue the hrt now because of the       interaction with synthyroid.  It has taken many months to bring down       my blood pressure and stabilize my heart rate.  Do you think that       someone with thyroid disease could take forteo? Forteo is a thyroid       derivative and I really don't want my bones to dissolve and get fractures.        My mom has already fractured her back and foot and hand and has lost 3       inches in height. By the way, each time I have a thyroid test it       always comes back as "normal"  How can this be?                                                 

Several things to clear up. I don’t       know any good reason why thyroid medication should interfere with HRT.               

Forteo is a brand name for a       synthetic form of human PARAthyroid hormone. It has nothing to do with the       thyroid aside from being its “neighbor". Forteo is not yet on the       market and no one is certain who the best candidates will be for this       medicine. If you are doing well on Fosamax once a week stay on it.                

I cannot address the       “normal” thyroid test unless I know whether you are referring to a TSH       test or a free T4 test. The important one in your case is TSH.

 I am 40 years old and had a low bone density         scan 1 year ago.  My Orthopedic surgeon put me on Fosomax, 5 mg.         for prevention.  I feel better while on Fosomax.  My body         seems like it is on a more even keel, not so nervous. What are the long term effects of Fosomax         for someone of my age.  The only information I can find is about         gastrointestinal upset, etc.  I have had a few people tell me         lately that their Doctor would not put them on Fosomax for very long         term because of the reported long term liver & kidney problems.          These people are my same age or a few years older and are having the         same low bone density problems.  I have talked with my Physician,         who says that he hasn't heard of any long term effects.        Thanks for your answer!

Where to begin? At 40 are you still having regular periods? How low was       the bone density result?

16% of all perfectly healthy, normal 40 year old       women will have a bone density T score between –1.0 and –2.0. In that       case you are n ormal and don’t need Fosamax or any other medicine for       your bones. 

There is no information from any other source that       Fosamax makes people feel better. I am glad you do feel better but it       little to do with the Fosamax. Fosamax is known to be safe for at least 7 years and       probably for much longer. I know of no reports linking Fosamax to kidney       or liver damage.

Two years ago at the age of 56 I was diagnosed with severe       osteoporosis of the Lateral Lumber Spine (T score -3.67). My Lumber spine       and left hip scores are -1.12 and -1.31 respectively. Three years ago I       had a complete hysterectomy because of endometrial cancer. Prior to that,       I was on hormone replacement therapy for six years. I now take Evista and       Synthroid for hypothyroidism. My obgyn wanted to wait two years for       another scan, which is coming up in a few weeks, to see if my exercise       regimen and calcium intake was stabilizing the situation. From what I have       been reading it seems that I should have been taking Fosomax or similar       these past two years. My doctor says if I start Fosomax I should also take       the Evista. Is it usual to take       both? Would I be a good candidate for Forteo?                                                               

With       a spine T score of –3.67 and normal results elsewhere I have some       reservations about the quality of the spine scan. If the result is indeed       correct I hope that you have had a thorough investigation looking for       secondary causes of bone loss. 

Make sure that       your thyroid hormone dose is not too high. Your TSH test should be normal       if you are taking the right dose. 

If your bone density is       stable on Evista and you are doing well I don’t see any reason to add       either Fosamax or Forteo. At the same time there is no harm taking both       Fosamax and Evista aside from the additional expense. Even if the drugs       are covered by your medical insurance there is additional, unnecessary       expense incurred somewhere in the system.

        My mother is 85 years old.  She has severe high         blood pressure and  has had spinal surgery for bone spurs and         narrowing of the spinal column.  She also has intestinal problems.          She has side effects to almost every medicine she takes.  She has         been diagnosed with osteopenia and the doctor recommends that she take         Actenol.  She thinks that at her age, there is no time for the         actenol to do any good and so why should she put up with the side         effects.  Is she correct?                                                       

Mother always knows       best!  If       your information is correct and at 85 your mother only has osteopenia, not       osteoporosis, then she probably does not need Actonel.  However she       should take 400-800 units of vitamin D a day as well as 1500 milligrams of       calcium. She must also remain as active as possible.

Quite frankly, knowing that       mother had spinal surgery for bone spurs and narrowing of the spinal       column, the doctor might have anticipated that the bone density test was       of limited value. (I am making the assumption that the test was done on       the spine). 

Let me use your mother’s       experience to remind any readers of this response that knowing when not to       do a bone density test is probably as important as knowing when to do the       test. 

In your mother’s case, by the       time a patient has reached 85 the likelihood of osteoporosis is so high       that the test adds limited information. When the test does not show       osteoporosis, as in your mother’s case (it showed osteopenia) there is       usually a good reason that can be identified. 

At the other end of the age       spectrum, too many healthy women are having bone density before they have       reached menopause or had any medical reason to expect that any bone loss       has occurred. Since 16% of these healthy younger women will have       osteopenia no useful purpose is achieved by doing the test, placing an       unnecessary diagnostic label on a healthy woman, and worse yet beginning       unnecessary, probably expensive medication. 

Why am I so confident that 16%       of these healthy normal young women will have osteopenia? Easy! Statistics       101 teaches us that 16% of any group will have a value that is more than 1       standard deviation below the mean value for that group, provided the       values are normally (evenly) distributed about the mean. Bone density in       healthy young women is normally distributed around the mean value. 

While I am still on statistics       101, remember also that 50% will be above the mean and 50% below the mean.       In terms of bone density and T scores, the 50% below the mean will have a       negative value for the T score result. This does not mean bone loss! 

I       sure hope this long answer to your very simple and straightforward       question reaches the right readership and that bone density tests will       always be done when indicated and infrequently done when not indicated.

I am 28 years old and was diagnosed with osteopenia about 5 months       ago.  I have been taking Fosomax 70mg since diagnosis.  I also       have ulcers, so I take Zantac 150 2x a day.  The first 2-3 weeks I       was very sick (vomiting), but       have overcome that.  Now my hair is starting to break and fall out.        I have never had any problems with my hair until now.  Is there       anything else I can take other than Fosomax that will help my bone       density.  Thank you for your time.                                                       

I       suspect that you don’t have osteopenia and don’t need Fosamax. Because       of the spread and distribution of the normal values for bone density, 16%       of all perfectly healthy, normal 28 year old women will have a T score       between –1.0 and –2.0. To label these healthy women as having       osteopenia is incorrect. This probably represents your maximum bone       density.  I am assuming that you are otherwise healthy.  I don’t know of       any association between Fosamax and hair problems.

Please re-check with       your doctor that you really need treatment for your bones, or consider       getting a second opinion from an expert in osteoporosis (endocrinologist       or rheumatologist).

I am 69 yrs. old and I have osteoporosis.  I am on       Evista, plus multi-vitamin and Caltrate and Verapamil.  I just found       out I have another compression fracture in the lumbar section of my back.        This is the second one -- I had one 3 1/2 yrs. ago, and that particular       one I knew how it happened.  This recent one I don't know how it       happened.  I did a lot of driving this past month and I slept on a       pull-out couch, and when I arrived home my back was really aching.        I've had two bone density tests and the last one was 1 1/2 yrs ago and it       did show an improvement over the previous one.  What I would like to       know is I should go on Evista and Fosamax...and should I see a specialist?                                                         

You       need as immediate a reduction in fractures as possible. The biggest risk       for a future fracture is a previous fracture. Actonel has FDA approval for       a claim of reduction in recurrent vertebral fractures within 6 months, the       most rapid FDA approved claim in the industry. You may wish to talk to       your doctor about this. With recurrent fractures, you may also wish to see       an endocrinologist or rheumatologist to evaluate other causes of the       problem.                                                               

         I am 55 years old, I take actenol in the morning 1/2 hr. before eating with a full glass of water.        I thought I read somewhere calcium         should not be taken for a certain period of time after I take actonel.          I can't find the article now. I have cereal with milk every morning. Would         that cause any problems? Thank You.                                                                     

Articles

Questions this month have been answered by:Michael Kleerekoper, MB, BS, FACP, FACE, OBGYN.net Editorial AdvisorHarvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor

Osteoporosis Ask The Expert

       I have been told by members of the health profession that drinking pop       (more than 2 cans/day) increases the risk of osteoporosis, however nobody       seems to be clear on the reason why.  I've even had people tell me it       was the carbonation or the caffeine.  Why not drink coffee       or tea?  More reasonable mechanisms seem to be the phosphoric acid       "leaching" calcium and/or drinking soda instead of milk.        What is your opinion?

 If       soda increases the risk of osteoporosis, it is probably because those who       consume large amounts of soda may consume very little milk, hence are       deficient in calcium intake. This is a growing and alarming trend       especially among young children and adolescents. Many children seem to       favor juice       boxes, while teenagers seem to have replaced milk with Diet Coke and       Mountain Dew. There is some data that excess amounts of caffeine may       inhibit calcium absorption. That is not to say that coffee or tea are       dangerous per se.                                                                   

       My 71 year old mother was         put on Fosamax after a bone density test was done. She is hypoglycemic,         is on nitro patches for a heart condition, has inhalers for lung         problems, is on diuretics for Meniere's disease. She has developed a         great deal of gas and loss of appetite - I was wondering if perhaps Fosamax       might be causing some of her problems. She is allergic to many         pain killers and also to a great number of antibiotics and was recently         prescribed Zithromax for a lung infection. Might a second opinion be in         order? Thank you in advance for         your assistance.                                                             

The       need for multiple medications certainly confuses the picture. Fortunately,       Fosamax does not interact with other drugs. Fosamax can cause stomach and       esophageal irritation but does not cause loss of appetite in my       experience. The weekly dose seems to be better tolerated and may have       fewer side effects. It is just as effective as daily dosing. It needs to       be taken first thing in the morning, on an empty stomach, with water only.       You must be upright and have nothing else to eat or drink for 30 minutes.       A nuisance, but       better to have to do only one day a week.                                                    

       I am taking synthroid (have for 25 years), and have learned  how it       depletes the calcium from the bones.  I am dismayed and worry that I       have to take it now, in spite of having poor bone health.  Is there       any alternative?  Why doesn't the body thyroid hormone destroy bones?        My physician has no answers.  Thanks.

       Synthroid, per se, does NOT destroy bones. If       you are hyperthyroid, either by virtue of having an overactive thyroid       gland or are taking EXCESSIVE thyroid replacement, that may accelerate       bone loss. This is a good reason to have       your TSH level checked periodically to make sure your levels are in the       normal range. Individuals with previous thyroid cancer may need to have       excessive thyroid replacement. In this case it is important, more than       ever, to have adequate calcium and Vitamin D intake, exercise, and avoid       smoking.       Hope that helps.                                                    

I       have been diagnosed with osteoporosis by my internist (1-1/2 years ago).        My T-score reading was normal for my spine (above -1) and for the hips,       -2.25 and -2.27.  I have been taking Foxamax since that first       diagnosis, with no further testing.  I also have taken HRT for the       last 20 years, as well as living a healthy and active lifestyle. I will       request another test at the end of 2 years.  I had read somewhere       about the effect of the parathyroid glands on your absorption of calcium.        Can you give me any further information on what this gland is, and whether       I should have any further testing other than the DEXA that I plan to have?        Thank you for any help you can give me.                                                 

Since       your t-scores are better than -2.5, the diagnosis would be osteopenia.       This is a risk factor for developing osteoporosis. It would be helpful to       know your age and complete health history. I would agree that waiting two       years after changing therapy is appropriate.
       
        To answer your question: the parathyroid glands are imbedded your thyroid       gland. Their job is the fine tune the amount of calcium in you blood. If       they become overactive, often the result of a benign tumor called an       adenoma, the       parathyroid increases the blood calcium level by taking calcium from your       bones. The calcium level can be checked, and if elevated, a measurement of       parathyroid hormone can be done.                                                                            

 I am a 46 yr. old female who has recently been diagnosed         with Osteoporosis of the spine and Osteopenia of the hips. Is it ok to continue Chiropractic care (for the         reason being that I have a curved spine with one leg a little shorter         than the other due to surgery as a child) or is this too risky for the         spine to fracture? The Chiropractor says he is very careful when doing         the adjustments. 2. Does the bone density test show fractures of         the spine? 3. I was not tested for Hyperparathyroidism. Is it normal         procedure to check this?

               If you have osteoporosis at age 46, it might be very       appropriate to check for secondary causes. Did you lose ovarian function       at a very early age or undergo premature menopause? What medications have       you taken? Need to know a lot of information to answer question       appropriately. If the diagnosis was made by DEXA, which sites of the body       were measured? Is there evidence for accelerated bone loss or did you not       reach your predicted peak bone mass? Please submit more information and I       will try to be helpful.                                                                    

I am a 57 year old menopausal female, taking HRT since 1990. I am       also taking didrocal treatment for osteoporosis which was diagnosed about       4 years ago. My latest bone density has shown considerable improvement. My       doctor stated that I am now considered to have osteopenia rather than       osteoporosis. I would like to be able to discontinue HRT but I am       concerned about the fact that my bones will return to the condition they       were in before starting HRT. My question to you is will my osteoporosis       get worse if  I stop taking HRT but continue with didrocal, good diet       and exercise? Thank you.                                                               

or etidronate, it has been shown to       be more effective with estrogen than alone. In the United States, it is       not an approved drug for osteoporosis and is not used often because better       drugs, such as risedronate and alendronate, are approved. If you are       considering       stopping HRT but are continuing with a bisphosphonate, calcium, Vitamin D,       exercise, and avoiding tobacco, I would recheck a bone density in two       years.                                                                      

       I am trying to find out about the recovery         from pregnancy related osteoporosis.  How long will it take to         fully recover?  Will I be able to care for my baby while I'm         recovering?  Is there any physical therapy or medication (vitamins,         etc)?                                                        

Transient osteoporosis       of pregnancy has been reported. It is rare and the exact cause unknown,       although there may have been low bone mass prior to pregnancy. In that       case, looking for secondary causes, hyperparathyroidism for example, would       be appropriate. It appears that most individuals who have osteoporosis of       pregnancy have remarkable increases in bone mineral density in the months       following delivery. Attention to adequate Vitamin D and calcium is       important. The total daily calcium should be 1200 to 1500 mg.                                                                    

       My daughter is 34 and taking Didrocal to         slow bone loss as her Bone Density showed a 30 - 40 % loss. She is also         on a high Calcium eating regime and exercises. She has been approved for Envitro (sp)         Fertilisation and starts the medications on the 10 Oct 2001, she seems         to be getting conflicting reports about whether she should stop the         Didrocal now or during the pregnancy or if it is safe to take         throughout. Thank you for you time.                                                        

   It would be important to       know the cause of her osteoporosis, such as high dose steroid use,       prolonged heparin, anorexia, etc. The use of drugs like Didronel have not       been studied during pregnancy and I would NOT use them. In laboratory       animals, albeit at high doses, skeletal abnormalities have been found. I       would encourage adequate calcium and Vitamin D intake, supplementing diet       when necessary.                                                             

I am on once a week fosamax since September and have gained       16 kilo on my 5ft 1 frame.  Three years ago I underwent a total       hysterectomy and oopherectomy due to uterine cancer.  Five months       later I did a bone density test and I had medium loss  and a year       later I lost a total of 28% in my hip and in my lower back.  I was on       a macrobiotic diet for 2 and a half years and recently left it in its       strictness.  After not eating sugar for 8 years, I have eaten large       amounts of chocolate.  I wonder if the fosamax is a salt and is it       changing my metabolism?  I would truly appreciate some help in this       area.  I exercise 4 times a week including water aerobics (I have a       torn ACL) and mild aerobic classes and treadmill.  I still eat azuki       beans, sesame seeds, seaweed and as much greens that I can find.                                                         

I       can find no references to weight change, gain or loss, attributable to the       use of Fosamax. It is tightly bound to bone and has no other effects. I       would not expect any metabolic effect except upon bone resorbtion.                                                               

        I have recently been diagnosed with Osteopenia. I had a hysterectomy two       years ago and have been taking Premarin .9 since then. I have stopped       taking the Premarin and am supposed to start Evista next week, but the       doctor also prescribed Actonel due to the bone densinometry results.       Should a person take both Evista and Actonel at the same time? 

 In most cases, the use       of combined therapy is not recommended. Since you do not have       osteoporosis, using two drugs does not make a lot of sense to me. Hope       that helps.                                                      

I am a 67 year old male with osteopenia. I  take       Dilantin for seizure control. The question is: Other things being       equal, is Fosamax therapy effective while taking the       anticonvulsant bone wasting Dilantin? Or is it first necessary to switch       to a non-bone wasting anticonvulsant (on advice of a neurologist). 

I know of no drug to drug       interactions with Fosamax. Dilantin may increase the rate of bone loss and       being on Fosamax sounds like a very appropriate strategy, as well as       maintaining a daily calcium in take of 1500 mg and Vitamin D. Exercise,       and of course, no smoking.                                                      

Hello.  I am 25 years old and just received a report that I       have mild osteopenia.  I had a bone density study done on       recommendation from a specialist on PXE (pseudo-xanthoma elasticum) which       I have.  PXE is believed to possibly be caused by calcium deposits on       or around the elastin which clumps together and hardens in a person with       PXE.  I also have type 1 diabetes and mild anemia.  Are there       any suggestions that you could give me on calcium intake, etc.?  I       also am trying to get pregnant and would appreciate any information,       cautions, etc. you may have on that issue.  Thank you! 

Your question is a very       complex one. There are several references to pregnancy and PXE. It seems       that the outcome is not necessarily adversely affected although there may       be aggravation of skin lesions. Your diabetes is another serious       consideration. I would strongly suggest consultation with a perinatologist       prior to conceiving.
       
       The issue of osteopenia is complex as well. At age 25, you have yet to       reach your peak bone mass. The definition of osteopenia is the comparison       to "young adult" but presumably at the peak of bone mass. You       are on the wrong side of the bell-shaped curve. Nonetheless, you may be at       risk of not reaching peak bone mass and should do your best to have       adequate calcium (1000-1200 mg/day), Vitamin D (400IU-found in prenatal       vitamins, multivitamins), exercise, and avoidance of smoking. Numerous       medications, corticosteroids in particular, may affect bone mass. Hope       this helps.                                                                   

Why       should a person not take Actonel and Miacalcin concurrently for       osteoporosis?                                                         

Actonel is a highly       effective drug. Miacalcin is not. There may be some pain relief with       Miacalcin in patients with pain from vertebral fractures. Otherwise, the       benefits have been disappointing. It has rare side effects, but is costly       and largely ineffective.                                               

I'm       a 38 year old woman and my doctor has just diagnosed me as being in early       menopause. The only symptom  I have is no periods. Since I don't have       any troublesome symptoms, I have considered not doing HRT. My only concern       is osteoporosis. I have always been active, and I am large-boned. So I'm       wondering if nutrition and exercise is enough at this point, or if HRT       would be STRONGLY advised - if osteoporosis was my only concern.
       Thanks!                                                                

                     At age 38, I would be careful to distinguish       premature ovarian failure from failure to menstruate due to not ovulating       or to other secondary causes. It would be wise to evaluate pituitary       function, thyroid function, etc. If you have no risk factors for       osteoporosis, have adequate calcium and Vitamin D intake, it might be       reasonable to consider bone density measurement in the next few years,       with the prospect of using estrogen/progestins, Evista, or other drugs       that may be available in the future to retard bone loss. If you develop       symptoms of estrogen deficiency, such as vaginal dryness, pain with       intercourse, hot flashes, etc., you may consider hormone replacement with       multiple benefits in mind.                                                         

I       am a 38 year old white female who has been diagnosed with osteopenia after       the following results:
        Lunar AP spine bone density t-score -2.3  and z-score -2.3 Luanar       femur bone density t-score -2.0 and z-score -1.9
       
       I have GERD's disease and have been taking Prevacid 30mg a day for the       past year.  I also use calcium supplements with Vitamin D since I       lack much dairy products in my diet.       

Approximately 9 months ago, I was in a snowmobile accident where I       tipped the snowmobile over on the side and fractured my pelvis in 4 spots.        This accident was not at a high rate of speed as I was in a turn going       about 15 miles per hour.  At the time my Orthopediac doctor felt that       I didn't have signs of Osteoporosis and didn't allow me to have a bone       density test.  My OB/GYN had different feeling when I went for my       annual exam a few weeks ago and said it should be done.
        
       My question is what should be the next step for me in dealing with       Osteopenia being pre-menopause and is an internal medicine or       rheumatologist the place to start?  I have severe cramping in my left       calf and foot during sleep which didn't exist on a regular basis prior       to my pelvic fractures?  Thanks for any suggestions on this matter. 

                             I would be concerned about two issues: first, you are very close in age       to the time when you would have reached your peak bone mass. Does your low       bone mass reflect extraordinarily rapid loss, or did you never reach the       anticipated peak? Second, your z-score is very low compared to other women       of your age, are there secondary causes that should be evaluated? I am not       sure that your fracture was a fragility fracture, but it certainly serves       as a red flag for further careful investigation. I would consult your       gynecologist to do further studies or perhaps refer you to a       rheumatologist       or endocrinologist, if he/she is more comfortable referring you.                                                                    

        I have a question re a particular Fosamax         incident.  I've taken Fosamax for the past 10-11 months, after         a bone density test indicated bone loss.  I am 51 years old,         paraplegic (T4) for the past 13 years.  My question is just about         one incident where I took my dosage, and due to an unavoidable         situation, only 15 minutes or so later, was forced to lay down for         an extended period of time.  I know that's something one is not         supposed to do, and this is the only incident in which I have.  But         my question is whether this can cause any permanent problems or damage,         or is simply a discomfort issue?  Since I have no sensation below         chest level, I doubt I would even recognize any expected resulting         discomfort.... even if it went on for quite some time.  I was         however concerned about the potential that I could undergo lasting         damage that I wasn't even aware of at the time. Is the warning re laying down         after medication merely to avoid temporary discomfort, or to prevent         physical harm. If the latter, how serious might that be and is         there anything I might do to mitigate or reverse any potential damage         that might have been done? Thanks for any info you can provide.                                                              

                            The reason it is important to remain upright for at       least 30 minutes after taking Fosamax is to decrease the possibility of       causing irritation to the esophagus. If this only happened once, and no       harm occurred, I would suggest being careful to remain upright after your       dose in the future. Fosamax is available in a weekly dose form, and by all       accounts seems to work just as well and may reduce risk by avoiding       repeated exposures to the esophagus. If you are on a daily dose, you might       want to discuss this with your physician.                                                            

I       am 64 years old with osteoporosis.  I take Fosamax weekly and 1500       milligrams of calcium supplements daily.  I walk two miles daily.        I have read recently that various groups are recommending jumping as       an exercise to strengthen the bones.  The patient is to jump       vertically, approximately 4 to 5 inches and land flatfooted.  Fifty       jumps are suggested, and the routine is to be repeated three times a week.       Can I jump 100 times per set? Can I jump every day, instead of only three       times per week? Thank you.                                                               

                     There are several studies of jumping as a way of       improving bone mass. The routine you mentioned is one that has been       reported. The idea is to improve bone strength by increasing the load on       bone. This is why weight-bearing exercise is important. My only concerns       are that jumping may increase the rate of injuries especially in those who       are less stable on their feet or have a tendency to fall. There is at       least one study reported using vests with pockets for placement of light       weights to increase weight bearing, using walking with these weights as       exercise. Perhaps simply wearing a back pack would help. I agree that       adequate calcium and taking Fosamax is a good strategy, and admire your       interest in exercising.                                                           

        I have been taking Didrocol for several         years following my first bone density test at age 60, showing left femur         0.67, right, 0.701 and avg. of the 1st four lumbar vertebrae, 0.874.          A follow up one year later showed no significant change.  I have         broken ribs and collar bone in two falls since then and Fosamax is         being recommended.  I had chosen Didrocol initially, given its ease         in dosage and effects.  Are there any clinical studies comparing         the relative effectiveness of both these medications? Neither build         bone mass and I have just read about a new product Forteo, which builds         bone mass and sounds promissing.  I am now 67 and will decide         following another bone density test.  Thank you for any         information.                                                              

                     Didrocal is not used in the United States, as       etidrionate has never been approved for the prevention or treatment of       osteoporosis. One year is too soon to see a change in bone density. I       would suggest a minimum of two years. Fosamax can be given in a one time a       week dosing. Nothing is much simpler than that. It indeed does increase       bone mass and reduces fractures. I works by inhibiting the resorption of       bone. Forteo will be approved soon for osteoporosis, but will be a daily       injection, likely to be expensive, and probably not necessary for you       unless you continue to lose bone mass in spite of treatment with Fosamax.
       
       The fractures you have suffered are not generally considered fragility       fractures. There are several factors to consider: bone quality, bone mass,       force of falls, and the tendency to fall. For that reason, it is important       to have a plan to improve muscle strength as well as retain flexibility       and agility.
       
        Your calcium intake, from diet and supplement if needed, is 1500 mg per       day. Also, you should have 600 to 800 units of Vitamin D. Smoking must be       avoided. Many medications may have a detrimental effect on bone mass. This       should be discussed with your physician.  Hope this helps.                                                       

        This past March 01' I had a Dexa scan which         revealed Osteoporosis. I have had  TAH & BSO at the age of 23.       I'm now 30 and having continuous low back pain,         with no relief from Celebrex, Vioxx, Asaids.  Is this bone "pain" from       osteoporosis? Ii was instructed to stop the usage of Actenol, since this         one of the side effects ( joint pain). I can not tolerate Fosamax nor         Effexor.. My doctor is recommending me for bone scan. I really don't         understand why. Can't anything else be done to help the bone loss?       My T-score -2.67 and Z-score is -0.57          of the femoral neck and my lumbar spine T-score is -2.90.  I'm        worried that since I'm so young, I will be unable to continue my active       lifestyle after 40.                                                                

               It would be important to know a lot more about you       medical history, including why you underwent TAH-BSO at age 23. Have you       received estrogen since that time? You should be just reaching your peak       bone mass now. I might be helpful for you to have x-rays of your spine and       perhaps a bone scan, as it is unlikely that your back pain is due to       compression fractures of the spine. You represent a complicated situation       that is not really amenable to answering by email. I would discuss this       with your physician. It sounds like you deserve complete evaluation.                                                    

What       are the effects of liquor and Fosamax?                                                        

              Obviously Fosamax must be taken only with water, but       I know of no interactions with any other drugs as far a metabolism. Recent       studies do not show the use of alcohol to be a risk factor for       osteoporosis, however with any medications or substances that may       interfere with balance or cognition, the risk of falls increases. Modest       use of alcohol should not be a problem.                                         

Questions this month have been answered by:Paul D. Burstein, MD, FACOG, USA, OBGYN.net Osteoporosis Editorial AdvisorMichael Kleerekoper, MB, BS, FACP, FACE, OBGYN.net Editorial Advisor

        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?

 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.                                                             

       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?                                                         

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.                                                

       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.

                        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.                                                  

Is there any relationship between osteoporosis and Vitamin       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.                                                               

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.
       
        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.

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.                                                       

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?                                                               

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.                                                             

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?                                                                              

 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.                                                                          

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!                                                                

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.
       
       Avoid smoking like the plague, hope this helps.                                                      

       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.                                                                

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.                                                               

        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.                                                                    

 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.                                                     

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. 

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.                                                               

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.                                                                

In general, you would want       400 IU of Vitamin D. That is the amount contained in a multivitamin 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.                                                                    

What       information does a urine test provide when suffering from       osteoporosis.  What are the doctors looking for in the urine and why?                                                        

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.                                               

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.                                                                

  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.                                                            

       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?                                                              

              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.                                                                    

        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?                                                               

                            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.                                                            

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 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?                                                                       

                     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.                                                        

      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?

                    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.                                           

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?                                                

                    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.                                             

Questions this month have been answered by:Paul D. Burstein, MD, FACOG, USA, OBGYN.net Osteoporosis Editorial AdvisorMichael Kleerekoper, MB, BS, FACP, FACE, OBGYN.net Editorial Advisor Harvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor

       I had a hysterectomy with ovary removal 2 years ago, am still taking       premarin.  I have grown fatter, am lethargic and have muscle aches       with difficulty exercising.  I am also quite flabby. I know that       post-menapausal women quit producing adequate testosterone as they age.        Is this something I should also be taking?  What is the usual dosage       for a 63 yr old who weighs 160 pounds?  Why hasn't my own       gynecologist suggested this to me? Can you help?

 The       long term use of estrogen has been called into question with the results       of the Woman's Health Initiative study which was halted in July 2002.       However, there is little data on the use of postmenopausal testosterone       and excess risk, nor has the estrogen-only portion of the WHI study been       stopped. In your case, my might benefit from estrogen/testosterone therapy       in that some of your symptoms might suggest androgen deficiency. The most       practical way to take this would be a product called Estratest HS. This is       the lower of the two doses and contains an estrogen and a small amount of       methyltestosterone. This would be empiric therapy as levels are difficult       to accurately measure and probably only then in a research laboratory. If       you feel better, that is the goal. This is probably best as short term       treatment--perhaps several years, or at least until there is compelling       data to suggest a benefit from longer therapy after symptoms resolve.       There is some evidence that testostero! ne may augment the effects of       estrogen on bone. It may increase lean body mass (as opposed to fat mass)       and may enhance libido and quality of life.
        Hope this helps.                                                            

        My doctor has advised me to take didrocal. I am confused. I know that the       white tablets must be taken two hours after eating and no eating for       another two hours. What about the blue tablet? Can that be taken anytime       or does the eating restrictions apply?                                                        

The disodium etidronate tablets       should be taken as a single, oral dose at bedtime, preferably on an empty       stomach. However, should gastrointestinal disturbance occur, the dose may       be divided. To maximise absorption, patients should avoid taking the       following within 2 hours of dosing: Foods, especially those high in       calcium, such as milk or milk products. Vitamins with mineral supplements       or antacids which are high in metals such as calcium, iron, magnesium or       aluminium. Intermittent Cyclical TherapyTwo white tablets of disodium       etidronate (400 mg/day; 5-10 mg/kg/day) for 14 days followed by a 76 day       period of calcium (the minimum recommended supplement is 500 mg/day of       elemental calcium). It is recommended that patients maintain an adequate       intake of dietary calcium and vitamin D. However, calcium can reduce the       absorption of disodium etidronate. Therefore, supplemental calcium should       not be given on the same days as the tablets of disodium etidronate and       foods high in calcium should be avoided within 2 hours of taking the white       tablets.
       
       This is the best information I can find. This drug is not approved by the       Food and Drug Administration for treatment of osteoporosis, but I do not       have experience with it. Hope this is helpful.                                                

I am 43 years old and just completed 8 rounds of chemotherapy for       breast cancer last month.  Last week I got diagnosed with severe       osteopenia.  I'm amazed.  What could have caused it?         Can chemotherapy chemicals leach calcium from bones?  Does the       suppression of white and red blood cells during chemotherapy affect       calcium absorption or bone production? 
       
       Here are a few more details about my case, in case this helps.  I had       a lumpectomy on 1/24/02 for a 2.5 cm tumor that was estrogen-positive,       grade II/III.  Seven of 13 lymph nodes were involved with tiny       micromets.  I started chemotherapy on 3/6/02 and had 4 rounds of       Epirubycin and Cytoxan, followed by 4 rounds of Taxoterere.  My last       chemotherapy treatment was on 8/28/02.  I started Tamoxifen (20       mg/daily) immediately after chemotherapy, and am currently in the middle       of 6-1/2 weeks of radiation (I'm taking no chances!!).  I took 1000       mg calcium plus Vitamin D daily throughout chemotherapy and walked one       hour 3-4 times a week during treatment.  I quit alcohol and caffeine       the day I was diagnosed.  I gave up junk food, and started eating a       lot more veggies, fruit, soy shakes, chicken, salmon, and other healthy       foods.  I lost 25 pounds during treatment, so I'm down to a happy 135       lbs at 5 foot 6 inches.  I was pre-menopausal ! ! before       chemotherapy, but my period stopped after the second month and I'm       currently experiencing strong hot flashes with no period in sight (yet).        I've never had children.  I've always been extremely healthy and       there is no history of osteoporosis, hip fractures, dowager's humps, or       even broken bones in my family.
        
       In addition to eating more spinach and doing more weight-bearing exercise,       which drug do you think would be most effective to treat my osteopenia? I       need to avoid estrogen-like drugs because my tumor was estrogen positive.        Does Fosamax act like estrogen?  Is it possible to reverse osteopenia       completely?
       
       I'm completely determined to be 100% healthy, happy, whole and beautiful,       and I plan to live to be 100 years old.  Many thanks for your time       and expertise to help me get there!

                        Your bone mineral density is a "snapshot"       of today. It doesn't explain how you got there. The comparison is between       you today and yourself in your 20's--based on a database model of what       your peak bone mass would have been. If you had it and lost it, that is a       problem. If you never had and are not losing bone mass, we would expect       you to have normal bone quality and little fracture risk. Fosamax and       Actonel are non-hormonal drugs that may be helpful. Since you seem to be       experiencing a regrettably early menopause, these drugs might be       advisable. Chemotherapy can cause bone loss but it is unlikely to do so       quickly. It might be appropriate to repeat a bone density in 1 to 2 years       to look at rate of loss. It is important to have the repeat test on the       same equipment. Treatment other than calcium and vitamin D is seldom an       emergency.                                                  

        I AM A 46 YEAR OLD FEMALE WITH WILSON'S DISEASE.  I AM CURRENTLY       BEING TREATED WITH SYPRINE AND ZINC .  RECENTLY I HAVE BEEN DIAGNOSED       WITH OSTEOPENIA AND TAKING FASOMAX.  I AM AWARE OF THE FACT THAT       ESTROGEN ELEVATES COPPER LEVELS AND THAT IS CERTAINLY  IS NOT WHAT I       NEED DUE TO MY CONDITION.  THEREFORE DOES FASOMAX HAVE THE SAME       EFFECT AS ESTROGEN WHEN IT COMES TO COPPER LEVELS IN THE BODY?  CAN I       TAKE ANY OTHER HRT COMBINATIONS WITHOUT IT AFFECTING THE WILSON'S DISEASE?                                                 

I have tried to search any contraindication       of estrogen in Wilson's Disease. There are truly few        contraindications to taking Fosamax. If you are only 46 years old, do you       really need it? Osteopenia at age 46 may reflect lack of reaching       predicted peak bone mass, and may not mean you have metabolic bone       disease.                                                              

I       have been taking actonel once a week for three weeks. I have a history of       carpal tunnel and ever since I started the actonel this condition has       become more severe. I have had to take medication for pain. Two or three       days before my next dose is due the pain eases off. Could this be caused       by the Actonel? I do need some type medication for osteoporosis. I am 66       years old and have been on hrt for 20+ years.

 Very interesting       question.... Some patients have muscle pain or even some bone pain. It is       obscure and seems to go away. I cannot really explain a relationship of       Actonel t worsening of carpal tunnel symptoms.                                                               

I am a 52 year old woman who was diagnosed with osteoporosis 5       months ago. I have been taking Fosamax 70 mg. once a week. I also am       taking dilantin and topamax for seizures. I have been on dilantin for 23       years, which I think is a very long time, but when you need it you need       it. I  have tried other medicines but they didnt work. I started       menopause a year ago October  and have not had one seizure.The       seizures when I did have them ranged from 14 to 18 a month, petit-mal with       some grand-mal also. Menopause seems to be a blessing, the start of it       anyway for me and my husband. The dilantin has really warped my memory       which is side effect. I was never told to go for a bone density test or to       take calcium, which might have prevented the bone loss that I have and I       have seen many top notch Doctors. Do you think I  can go off the       dilantin like I said I! have been seizure free for one year with his       permission. I do wish Doctors and pharmacies would advertise.                                                              

Dilantin       has been associated with an increase in bone loss, described as secondary       osteoporosis. You may well need dilantin and I would not want to be the       one to tell you to stop. Remember that bone density testing does not       reflect bone loss, as you are being compared to your predicted peak bone       mass at age 20-30, which may have never been reached. The decision is to       decide if your low bone density reflects ongoing bone loss vs. never       having had it in the first place. Depending on your bone density and risk       of fractures, therapy may be appropriate. Fosamax is effective therapy.       Calcium and Vitamin D, as well as exercise are all important over a       lifetime, not just once one has reached menopause. You need 1200 mg of       calcium daily, hopefully obtained in diet, but supplementing if needed.       Good news is that you are aware of the issues and doing something about       it. Hope this helps.                                                               

I       have been on prednison since march for lupas and myositis, 60 mg down
       to 4 mg.  I have 4 compression fractures that were very  very       painful.  My dr. has me on actonal and miacalcin.  Will this       help with the compression fractures or do I have to be off prednisone       before the fractures will heal?                                                                              

        Actonel is an approved drug for your condition.       Miacalcin has an effect of relieving pain in symptomatic vertebral       fractures although it is not as effective a drug as Actonel for the       treatment of osteoporosis. Your dose of 4 mg is a small one. You may well       need it to treat your underlying illness. In addition to the medications,       make sure you get the recommended daily intake of calcium (1000 mg under       the age of 50, 1200 if over 50, and 1500 if over 65 years) as well as       Vitamin D (600 to 800 units). If you smoke, STOP! Try to exercise, but be       careful of injuries. It might be helpful to see a physical therapist       familiar with osteoporosis to help with an exercise program. Hope this       helps.                                                             

Medical History:  I am a 33 year old, premenopause, 5       ft, 11 inches, 135 lbs. I was diagnosed hypothyroid approximately 3 years       ago, otherwise healthy.  I recently had a bone density scan (spine       -1.8, hips -1.4).  I am continuing laboratory testing in an attempt       to determine the underlying cause.
        
       Questions: 
       What is the most common cause of osteopenia in younger women?
        What treatments are safe for women while trying to conceive?
       What special precautions or testing are recommended during pregnancy?
       Will pregnancy worsen the osteopenia?
        
       Any information would be greatly appreciated?                                                         

       This is a case where getting a bone density may well       be a detriment. The bone density most likely reflects never having reached       the predicted peak bone mass and NOT have a metabolic bone disease with       loss of bone density. It might be a different story if you have been       severely hyperthyroid, or on repeated doses of steroids, or have had other       major medical problems. None of the medications would be appropriate in       pregnancy or in someone trying to conceive. I would be careful to not       carry a diagnosis of osteopenia in terms of being insurable. Having lower       than predicted bone mass does not necessarily increase your risk of having       fractures. It is likely that the bone quality is normal. Appropriate       calcium intake (1000 mg per day) and Vitamin D (400 units per day) as well       as exercise is the best bet for maintaining bone density and strength.       Avoid tobacco and excessive alcohol. Hope this helps.                                                                

       I am 32 years old and still get my period.  I had osteopenia since I       was 26.  We found out when I broke 2 ribs coughing.  with in the       last 2 1/2 years  I lost 8.6% of bone mass in my hip and 8.3% in my       spine.  My spine is now -2.3.  I am concern with the percentage       of bone loss in such a short period of time and my age.  It is       significant?  What could happen when I am postmenopausal? My doctor       has put me on Actonel weekly.  How long do I have to be off of the       medication before I can have a baby and what is the average percentage of       bone mass gained per year? What could be causing the bone loss at such a       young age.  I have been tested for RA,  GI problems, kidney       problems, and endocrine problems.  Blood work has always been normal.       Help if you can.                                                                       

  You       raise some very good questions. First of all, tussive fractures (coughing)       may not be due to bone loss. There are some extreme forces developed with       severe coughing. Your bone density at age 26 was probably your peak, not       necessarily a reflection of loss. The problem with repeat testing is that       one must be sure that the data is truly comparable--same machine,       software, database, technique, and that there exists precision data to       know if a difference in bone density is real or artifact. This is very       important because apparent loss of bone density may reflect imprecision in       measurements rather than real loss.
        
       Actonel is approved for treatment and prevention of POSTmenopausal       osteoporosis and steroid induced osteoporosis. We would rarely if ever use       it in otherwise healthy premenopausal women, especially if they plan to       conceive.                                                              

       I am a 51 year old woman dx'd with mild osteopenia 2 years ago (T-score       -1.4
       hip and spine).  The dexa was done because the year prior, my dentist       was
       concerned about excessive bone loss on x-ray unrelated to dental health.        At
       that time, I was having regular, albeit, excessive periods.  I       increased my
        calcium from 1000 total (diet plus supplement)(which I had been taking       since
       my mid-thirties) to 1800, continued with multi vit which contained 400 D.
       Later that year, I was dx'd with persistant asthma that is only controlled
       with high dose inhaled corticosteroids.  Later that year I had TAH/bilateral
       oopherectomy due to adenomyosis and started vivelle dot .05.  Two       months
       later, rheumatologist consult for inflammatory polyarthritis started me on
        fosamax 70 because of osteopenia with high dose inhaled corticosteroid.
       Later that month I had outpatient foot surgery for ganglion cyst and was
       limited exercise for another 2 months.  I have been able to walk       regularly
       for the past 8 months (with brief hiatus's secondary to joint pain.)        This
       summer I had 2 short bursts of prednisone.  I just had my second DEXA,       on
       the same LUNAR machine as the first, after 10 months after starting       fosamax.
        I had assumed that with the fosamax and estrogen, I would have gained at
       least a little bone despite the steroid.  I not only did not gain       bone, but
       lost, from T =1.4 to T -1.69 (which I believe is more than than margin of
       error for reproducibility of results/)
       
       Is this just a temporary setback due to lack of activity from hysterectomy
        and foot surgery or side effect from inhaled steroid (they are supposed to
       not have systemic effect, but I have petecchiae on my forearms, bruise       like
       a son of a gun and have new hair at my hairline.  Also, rheumy mailed       me
       journal article detailing bone loss on ICS).  And second question, I
       remember somewhere, some specific high impact exercises for osteoporosis       but
       cannot locate the source - do you know what these exercises are?  (If       my
        joints will tolerate them, that is.)  I don't think there is anything       else I
       can do, but would like your opinion re if I'm missing something?                                                                    

         Excellent questions. First of all, inhaled steroids       seem to show a slight impact on bone loss. Not nearly as much as high dose       systemic steroids. Fosamax for a T-score of -1.4 is a bit aggressive.       Studying the change in bone density in 10 months is too soon. I would wait       two years, the use of high dose steroids the exception. One study showed       that in the first year of treatment some people do lose bone mass. If you       look at them at the end of the second year, they seem to have gained it       back and are on the predicted slope of improvement in BMD. I am not sure       that comparing T-scores is the answer. I would look a the percent change       in bone mineral content. One last point, if you have low bone mineral       density (T-score in osteopenic range) and do not have ongoing bone loss       due to excessive resorption of bone, you might not expect to see a change       in bone density with treatment. The lower then desired T-score may reflect       bone mass never there, not bone mass lost. Long-winded to be ! sure, but       not an easy question.                                                              

I received results of my bone density test today &was       told there was minimal bone loss.  I am 69 years old. My doctor       recommended Actonel 30mg. Unfortunately, the way health insurance is going       my prescription will run $160 a month. I have never taken a calcium       supplemement. Could I take one instead of starting this Actonel? I have       not been diagnosed with osteoporosis.  
       Thank you for your time.                                                                

       I certainly share your concern. If you have close to       normal bone density, does it make sense to take an expensive drug. I would       have to know about the results of the test. If your bone density,       expressed as a T-Score is better than -1.5, no specific treatment is       warranted even with risk factors. If it is better than -2.0 without risk       factors, treatment is not needed at this time. Calcium and Vitamin D are       important in any case. Your calcium requirement is 1500 mg per day and you       need 600-800 units of Vitamin D. You should strive to exercise daily.       Walking is helpful, as well as exercise to improve strength, balance, and       endurance. Again, it would be helpful to have more complete information       regarding your bone density testing. Hope this helps.s                                                               

Two       month ago I begun a treatment with Fosamax 70 (Alendronate Sodium). I am       52 years old and in my last Densitometry I have Osteopenia 2% and lumbar       Osteoporosis 89.3.  A week ago I had an acute renal colic (Nov 8th).       The renal ultrasound revealed very little stones. Now I am ok, but I would       like to know if any of you have had experience with Fosamax 70 in patients       presenting renal calculus (stones).  Thanks for your information.                                                                

I did a literature search       and could not find anything about renal calculi and Fosamax. The       bisphosphonates have been used to treat malignant hypercalcemia. Since       hyperparathyroidism is associate with elevated serum calcium and is a       cause of renal stones, perhaps Fosamax would be be beneficial.                                                                                                 

I       am a 24-year-old caucasian female just diagnosed with osteopenia after a
        Dexa scan indicated that my L3 vertebrae exhibited 11% bone loss (or, more
       accurately, that it was 11% under what a normal 30 year old woman's bones
       should be.)  I suffered a compression fracture in my T12 vertebrae as       a
       result of a fall last June and thus requested the scan.  My doctor       has
       prescribed 35 mg of Actenol taken once a week.  I am also on Mircette,       a
       birth control pill.  My questions are this: Has there been       significant
        research done on premenopausal osteopenia and osteoporosis?  If I       intend to
       become pregnant in the next five to six years, will Actenol interfere or
       cause problems with the pregnancy?  Will I still be able to breast       feed my
       children?  On a secondary order, Actenol seems to be causing some       nausea for
       me.  Is there anything that I can do to prevent that kind of a side       effect?                                                        

If your fall caused the       fracture, it is probably not osteoporotic in nature. Getting a bone       density is unwarranted. The comparison of your bone density at age 24 to       someone at age 30 would indicate that you have not yet reached your peak       bone mass and NOT that you have a bone disease. Actonel is not appropriate       and should be stopped. The rare exception of using Actonel in normally       menstruating women would be in the case of steroid (such as high doses of       prednisone) induced osteoporosis. The use prior to pregnancy is unknown,       untested, and should be discouraged. I would suggest adequate calcium and       Vitamin D intake, exercise, and not smoking as the best way to be kind to       your bones. Oral contraceptive users tend to have higher bone mass than       nonusers, so if you are trying to delay pregnancy, that may be an added       benefit. Hope this helps.                                                       

I       just had a DEXA bone density scan and my T scores are -1.6 for spine and       0.0 for hip.  I am 42 and have been on prednisone for asthma.        Are those T scores low?  Should I be on medication? 

  The use of predisone       for over 6 months at a dose of 7.5 mg daily or greater may make the use of       Fosamax or Actonel reasonable. One issue in young women is what might       happen if you become pregnant while on or after taking these medications.       Your bone density is very close to normal and may not represent any loss       at all. I would make an effort to take adequate calcium, Vitamin D,       exercise and about smoking, excess caffeine and excess alcohol.                                                            

I       have a 69 year old female patient who presented with the following test
       results:
        
         1996:   DEXA  hip  T-score:-2.39
         1997    DEXA  hip T-score : -2.22        Increase of  +7.94%
       
         1999   CT spine   T-score: -2.59
         2000   CT spine   T-score: -2.54
         2002   CT spine   T-score: -3.27  A       decrease of 19% since 2000!!!
        
       She has been taking Fosamax faithfully for the last 5 years. How common is       this degree of deterioration, and what should be done now?                                                                

               I think you need to compare percent gain/loss in       bone mineral content--grams/square centimeter. I am not conversant with       CT, presumably quantitative CT, results and cannot comment. The change       noted in one year may reflect the regression to the mean. In other words,       patients who appear to lose bmd in the first year tend to gain and be on       the predicted slope after two years. In your patient's case, she gained       bmd and we would be happy with that. The next problem is precision. These       tests are very accurate, but precision (reproducibility) is totally       unknown in most department doing BMD testing. That is subject to personnel       and equipment calibration. Are the techs certified? Do they calculate       precision? Are these results known to clinicians? I would make sure your       patient is getting adequate amounts of calcium and vitamin D as well as       avoiding tobacco, etc. Has she been evaluated for secondary causes, such       as hyperparathyroidism? Is she on steroids? Hope this helps.                                                                  

         Take Evista for osteopina, but get severe leg cramps in the middle of the       night.  Also, I have lots of bruising on my legs.  Is this       common?  I've stopped taking it.  Now what?                                                                    

       Leg cramps are a known adverse effect of Evista.       They may subside with time. I cannot explain the bruising. The most       serious risk of Evista is that of abnormal blood clotting, such as clots       in the leg veins or lungs. The cramps most likely do not represent blood       clots. You should discuss your symptoms with your physician.                                                           

I have been on Fosamax for 1 1/2 years and have increasingly       elevated liver function tests (SGPT and SGOT).  I went from 5 mg       daily to 70 mg weekly and the liver functions are worse.  I have been       tested for hepatitis and many other liver diseases and everything,       thankfully, is OK.  The only difference is the Fosamax.  Has       this been reported as a side effect?  If it hasn't, how does one       report it.                                                                            

                     Fosamax is not metabolized in the liver or by the       body. It is excreted in urine. There is no evidence nor any reason to       suspect that it would affect liver enzymes. There are many causes of       increase in liver enzymes, but Fosamax is unlikely to be one of them. You       may wish to consult a gastroenterologist.                                                        

              Hi...I am a 66 yr old woman...Ihave been diagnosed with ostioporosis        after a bone density test I have it in my spine and not in my hips..my       doctor wants me to take medication.My question is this....since I ran       nearly four hundred miles in the past 2-1/2 yrs.and have gone to yoga       every day for th past yr and 1/2   I am a jogger for the last 20       yrs and eat very healthy ...orange juice with calcium ,yogurt,cheese,       fish,take 1200 milligrams of calcium..although not every day ...no fried       foods.I am a little surprised at the diagnosis.My sister is 70 yrs old and       was diagnosed with osteoporosis also and she has been running every day       for six to nine miles a day. for 20 years.also she is an avid walker,she       always ate a lot of cheese and had to stop because her cholesteral        was too high.What are we doing wrong.?..we thought we were doing the right       ! thing.Please respond if you c! an  thank you.                                                              

            One word of caution. Bone density testing measures     your bone density on one day of your life. If it is lower than predicted by     the computer model of comparing you at age 66 to yourself in your 20's, we     cannot differentiate those who reached the predicted peak bone mass and lost     it from those who never reached it. The definition of osteoporosis is really     more than just low bone density. It reflects loss of bone quality. However,     we do not have easy ways of assessing quality. Depending on the level of     bone density compared to predicted peak bone density (know as the T-score)     it may be appropriate to offer medications to prevent further loss. This     decision is made on bone density as well as risks for fractures, of which     bone density is only one. Your exercise and good lifestyle changes should be     applauded. The peak bone density any of us achieves is based in part on     genetic and other factors beyond our control.                                                 

 Are     there any clinical studies supporting the use of plant based estrogen to     improve bone density?  Do you recommend plant based estrogen to improve     or maintain bone density?                                                

                   I think you are confusing two issues. Many     commercially available estrogens, both oral and by patch, are derived from     plant sources. These include Mexican yams and other plants. The precursor     molecules are made into 17 beta estradiol, identical to the major estrogen     of the premenopausal ovary. Phytoestrogens are derived from plant sources,     most notably from soybeans. There are compounds that exert mild estogenic     effect. The source is using soy as a food, not soy extract which may not     contain active hormonal effect. The most common sources of soy would be soy     flour, soy milk, tofu, miso. In fact, all beans may have this effect. The     problem is that the amount needed to be consumed is far greater than the     usual American diet. Studies of Phytoestrogens have shown mixed     results--perhaps some reduction in hot flashes, maybe some increase in bone     density, but no fracture data.                                           

        I'm 58 years old and just started taking Actonal on a weekly basis.        24 hours after I took the first pill, I was terribly sore from head to       toe.  The second pill was worse.  After 24 hours, I couldn't       lift a glass and my wrists and arms bacame swollen. I had severe back pain       and I was unable to move my hand enough to make a fist.  The neck       area was so tight I could only move it a matter of inches either way.        I had a headache centered in the back of my scull.  It has had a       total debilitating affect on me.  Am I having a reaction to the       medication or is this normal?  Will these symptoms go away after       time?  I am 5'3" and weigh 135 pounds.  My Grandmother,       Mother and now my sister and I have all been diagnosed with osteoporosis.       Please help.                                                

                   Obviously,     these are not normal symptoms from taking one dose of Actonel. In studies     presented to the Food and Drug Administration, most side effects were     similar to placebo. I suggest you consult your physician.                            

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 AdvisorMaria Luisa Bianchi, MD, Italy, OBGYN.net Osteoporosis Editorial Advisor 	Harvey S.Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor

A 53 year old woman was investigated for secondary amenorrhea at age 26 and found to have hyperprolactinemia. She took therapy with bromocriptine only for three short periods when she wanted to conceive. She is fortunately G3P3A0. She has not been on therapy for 10 years and has been amenorrheic all that time. She has sustained 6 vertebral compression fractures in the past 12 months and has a T score of -4.6.

Estrogen deficiency, whenever it occurs, for whatever reason, is associated with accelerated bone loss and increased risk of fracture. By age 53 this patient has been estrogen deficient for most of the last 27 years and has paid a big price for this in many ways, not the least of which is her severe osteoporosis with fractures.

Commonly neglected causes of secondary amenorrhea in younger women include not only hyperprolactinemia but increasingly anorexia nervosa, bulimia, and exercise induced hypothalamic dysfunction. These should be treated with diet and lifestyle modification but the success rate from this approach is limited. These women should all be counseled about the consequences of long-term estrogen deficiency and should be considered for estrogen replacement at an early age.

A 53 year old woman was investigated for secondary amenorrhea at age 26 and found to have hyperprolactinemia. She took therapy with bromocriptine only for three short periods when she wanted to conceive.

Osteoporosis Case of the Month

I am a student midwife with a keen interest       in osteoporosis. Are you aware of any literature investigating links       between pregnancy and osteoporosis? I am particularly interested regarding       breastfeeding/parity/nutrition in pregnancy/hyperemesis gravidarum?

There       are many answers to your question. 

1)There is a rare       complication of otherwise normal pregnancy called “osteoporosis of       pregnancy”. It presents with back pain and vertebral fractures during       pregnancy. It appears to be a short-lived condition in that the       osteoporosis does not progress after pregnancy. Unfortunately the problems       caused by the initial fractures persist. The cause of this condition is       unknown. It is unclear whether it is aggravated by subsequent pregnancy       because, not surprisingly, women who have experienced this once are       reluctant to chance experiencing it again. Remember this is a rare       complication of pregnancy. 

2) Many           epidemiologic studies have addressed the issue of a link between           pregnancy, breast-feeding and osteoporosis but there is no consensus           opinion. Pregnancy and lactation are periods of negative calcium           balance for the mother as she is nourishing her baby from her own body           stores of calcium. This results in transient loss of bone much of           which is regained after weaning. Some have suggested that this           contributes to osteoporosis later in life but as I noted, there are           conflicting opinions on this. 

3) One thing on which       everyone agrees is that pregnant and nursing women should take in more       calcium, at least 1500 – 2500 mg per day from diet and supplements.       Vitamin D 400 units should also be taken daily. I am not aware of specific       studies relating hyperemesis gravidarum to osteoporosis but this is not       good for the health of mother or baby. As the hyperemesis comes under       control it would be wise to make sure that intake of vitamin D and calcium       is maintained.

              I'm 21 years old I found out I have endometriosis.       I have had laparoscopy twice to determine it. The doctor had suggested       that I take a shot called lupron depot. I was on the shot for       approximately nine months. My family care doctor wanted me to have a bone       density test done, it showed that I had  12% bone loss which was       considered osteopenia. I don't know the other results of the testing. Also       I for about 6 months I was taking a shot called depo-provera three months       per a shot. Should I be taking one of those medications for bone loss? Is       there anything you can do besides, taking calcium pills which upset my       stomach? Thank you for any information, I greatly appreciate it.                                                        

Your doctor may have been         misinformed when he told you that you had any bone loss at         all. Since your bone density had not previously been measured,          it is not possible to know whether you have ever had any more bone         than you now have. It's a matter of "Never Gained" bone as         opposed to "Lost" bone.         Doing bone density tests in 21 year old women has limited value since         you can still be accumulating bone and probably will do so until         somewhere between 25 and 35. Lupron depot and depo-Provera may         have some bad effects on bones but not all the answers are in yet. Some         doctors are using a combination of estrogen, progesterone or both,         with the lupron which does protect the skeleton. For now I would focus         on your endometriosis which is clearly causing you problems. You have         already had one bone density test and you should have a repeat one a         year after that first one. In all likelihood you will get peace of mind         when the result comes back that you have not lost any bone during the         year.         Regarding calcium tablets upsetting your stomach, try a diet rich in         calcium - ice cream, milk, chocolate milk, cheese, yogurt, lots of good         stuff. The tablets are for those who truly can't get calcium from their         diet.                                              

I       recently had my first baby, at 38.  Several weeks into the pregnancy,       I was tested for ACA (due to 2 previous miscarriages), and was shown to       have elevated levels of anticardiolipids (>150 IGM), although I have no       indications of autoimmune disease such as arthritis, thrombosis, etc.        I took heparin and low-dose aspirin for the duration, and delivered       (induction followed by c-section) a healthy baby a few days after term.        Pathology on the placenta showed infraction (explaining the deteriorated       condition of the placenta and heart decelerations during contractions).        This history indicates that heparin would be indicated in any subsequent       pregnancy.  A bone density test shows osteopenia (-1.55 & -1.60).        My mother has osteoporosis.  I am trying to decide whether to pursue       another pregnancy, and I don't have a clear sense of the risk posed by       using the heparin.  Can you shed some insight on the extent &       magnitude of risk associated with heparin use and osteoporosis?

There isn't much documented evidence         to put any numbers on the risk to your bone health from heparin. My         impression from more than 20 years in practice and from reading about         this is that the effects are quite small. Don't worry for now about your bone         density test results. Most experts agree that healthy premenopausal         women don't need and shouldn't have a bone density test. Because of the         way the T score values are derived, 16% of all perfectly healthy, normal         premenopausal women will fit the criterion for having "osteopenia".         Despite this label they are still perfectly healthy and normal.         The time for you to worry about your bones is during pregnancy and         breast feeding where you need extra calcium, and as you go through         menopause where you should consider hormone therapy.                                          

I am a 66yr. old woman whose recent bone scan of the hip       had a t-score of -4 ( I was so surprised I don't remember the decimal).       The dr. prescribed 10 mm. Fosamax, daily.  I have been on premarin       for about 20 yrs., exercise, lift weights, and take 1200 cal.  My       druggist told me about the weekly dose.  Is it as effective?        Also, how much coffee is considered detrimental?                                                  

The weekly       dose of Fosamax of 70 mg is every bit as effective as 10 mg once a day.       You must still take it on an empty stomach with a full glass of water and       nothing to eat or drink for the next 30-45 minutes and then you should eat       breakfast. That 30-45 minute wait would be a good time to get in your       daily exercise.
       
       There is no firm data on how much coffee is too much. From the bones point       of view it doesn't matter too much at all. For the rest of your health       "too much of a good thing is no good for anybody". I would limit       yourself to 2-3 cups a day but there is as much bias as evidence in that       limit.
       
       Your bone density numbers worry me quite a bit. If you have been       faithfully taking your Premarin (what dose?) for 20 years or so, the T       score of -4 something suggests that there might be a secondary cause of       osteoporosis. Fosamax will almost certainly be effective but you should       check with your doctor about causes for osteoporosis other than being a       postmenopausal woman.                                                              

I       am a fifty-three-year old menopausal woman with osteopenia. I have been       taking Actonel (5 mg per day ) for several months. Recently I read that a       Dr. Epstein at the U. of Illionis (I think) believes Evista should be       taken off the market because it increases the risk of ovarian cancer. From       your responses to other women, I gather that you have no such reservations       about the drug. Is that correct?
       
       In my last conversation with my doctor, he suggested I take Evista and       Actonel together--to increase the protection against osteoporosis. This is       the first I've heard about combining these drugs and so far have not       started Evista.
        
       I'm generally in good health but should mention that I have a small       thyroid nodule (benign) and have hypoglycemia (it didn't register until       late in the five-hour glucose tolerance test). Because my mother had       breast cancer, my doctor did not prescribe HRT for me. I am still       seriously considering taking Evista (for possible protection of breast and       heart), but would like your opinion before I make my decision.       Specifically, if I take Evista, can it be combined with Actonel? Or would       it be better to drop the Actonel?
       
       One more question: Do I run any risks if I jog on a treadmill (not on       pavement)? Lately, I have been combining walking on a treadmill with using       a stair climbing machine, but before I got my osteopenia diagnosis I did       some recreational jogging and I now miss that activity.
       
       Thank you so much for any advice you can give.

              That's a lot to answer.         There are no studies about combining Actonel with Evista and it doesn't         make much sense. The potential added benefit is small, the added cost         high, and you increase the potential to have side effects from two drugs         rather than just one. For the bones Actonel is probably the         more potent drug (although direct head-to-head studies have not been         reported).         Evista may decrease your risk of breast cancer but it is not approved by         the Food and Drug Administration (FDA) for that  purpose and         studies about Evista and breast cancer protection are ongoing. Tamoxifen         is FDA approved for breast cancer protection.         There's nothing about an "osteopenia" diagnosis that should         limit your recreational jogging.                                                       

I am a 44 year old female that has advanced osteoporosis which was       discovered 10 years ago.  I have increased my weight bearing exercise       as much as possible and increased calcium, etc.  But only got some       bone density increase in my spine none in my hip.  I am still       regularly menstruating.  I just went on fosamax 5 weeks ago on the 70       mg. dose once a week.  I am having upper jaw pain ever since the day       I started the fosamax.  I gained 4-5 lbs. that first week and have       gas & bloating.  I know that the gas & bloating are normal       side effects but what about the jaw pain? Should I discontinue?  Would       a smaller dose 10 mg. a day 7 days be better? What causes this jaw pain?                                                         

Healthy,       regularly menstruating 44 year old women do not get osteoporosis - let       alone advanced osteoporosis, unless there is something very unusual going       on. I would have serious doubts about the diagnosis and the need for       specific treatment.       I know of no association between Fosamax and jaw pain.                                                       

I am taking weekly dosage of Fosamax - is there any       possibility that this medication can cause aching in the lower back and       hips?  I am a 52 year old female.                                                               

There       are uncommon reports of Fosamax being associated with joint pains but I am       not convinced. I would suggest you stop your Fosamax for a few weeks (no       harm will happen to you) and see if the pains go away. If they don't get       better it was probably not caused by the Fosamax, and you should find out       what the cause might be. Even if they do go away when you stop Fosamax you       can't be sure that was the cause. You would need to re-start Fosamax and       see if the pains come back. As I said, I doubt the two are related.                                                       

       I was diagnosed with RA 7 years ago, been       taking prednisone, the highest dosage was 30 mg and been up and down since       then. I had Dexa study about a month ago and was told that I had an       early osteoporosis, so was put on Vioxx 25mg and Fosamax 70 mg, and I'm       also taking Plaquenil. My Rheumatologist suggested a Remicade therapy, but       I'm concerned since I'm prone to infection and I'm scared because of the       side effects. I have to pay $400+ for every infusion, and I cannot afford       that. I need your advice to what is the best to work this out. I've been       suffering all those years, sometimes it's mild but sometimes it's       debilitating.                                                        

I       am not an expert in RA and suggest you follow your rheumatologist's advice       about Remicade. While you are on prednisone, Fosamax is an appropriate and       important drug to be taking.                                                              

Please send me as much information as you can on "actenol"       and the major side effects. I have been on Foxamax (causing closing of       throat), Now I am on Miacalcin and Caltrate plus D. I have had three       cracked ribs and the pain in horrendous. The doctor suggested actenol, but       I have a very bad stomach and I have had heart bypass. Please advice.       Thank you.                                                        

Actonel       has very few side effects when you take it properly - first thing in the       morning on an empty stomach with a full glass of water. Nothing else to       eat or drink for 30 minutes and don't lie down during that 30 minutes.       Then you should eat breakfast.                                                       

Questions this month have been answered by:Harvey S. Marchbein, MD, FACOG, FACS, OBGYN.net Osteoporosis Chairman and Editorial AdvisorMichael Kleerekoper, MB, BS, FACP, FACE, OBGYN.net Editorial Advisor