R. Wayne Whitted, MD, MPh

Q:  Is       there any evidence linking Fosamax       and weight gain?

None       that I am aware of or can find literature for.           

OBGYN.net       Chairman Osteoporosis Editorial Advisor

I       am 36 years old, and was diagnosed with Transient osteoporosis associated       with my pregnancy which started in my third trimester. I am 3 weeks post       c-section with a healthy baby girl, and have been on Fosamax daily for two       weeks now and 1800 milligrams of calcium daily. The pain I had in my hip       and knee has gone away but still have severe pain in one of my feet.       X-rays have been done and there is no fracture, an MRI revealed the       diagnosis of osteoporosis. How much is known about pregnancy related       osteoporosis? I am finding it hard to find information on it. How soon       should I expect relief or recovery? Can you suggest any other ideas of       treatment I might mention to my doctor? 

You       have what appears to be a complex situation. You need to have a dexa scan       in order to help follow treatment. It is important to see an       endocrinologist to have secondary causes of osteoporosis evaluated. Once       this evaluation is done than appropriate treatment options can be decided.       Generally speaking, osteoporosis is a non-painful disease unless there is       fracture.

       I am 46 years old and have       endometriosis. I had a complete hysterectomy 10 years ago, but cannot take       RET because of the endometriosis. I have been diagnosed with osteoporosis,       and also have a history of intestinal difficulties (caused by scarring       from the endometriosis): irritable bowel, chronic constipation, ulcers.       What would you recommend as the best drug treatment option? I exercise and       take calcium supplements.

Evista       and Fosamax or Actonel can be used for the prevention and treatment of       osteoporosis.  I'm not sure why you can't take ert unless you had a       recurrence of endometriosis while on it.  I would ask my doctor about       the above options.

I am a 52 year old       woman with osteoporosis of the low back and osteopenia of the hip.        My scores were something in the area of -3.5 - that's the low back and I       understand that's pretty bad.  I found out I had this after searching       for an answer to back pain over the last 3 years. At the time I was       diagnosed, I was still having menstrual periods, but am now in menopause.        I have been on Fosamax for about a year.  After seeing my ob-gyn Dr.       for a yearly pap, he has suggested I switch to Evista.  I have 2       sisters that have had breast cancer, so ERT is not an option for me.        My question is:  Is Fosamax or Evista the best medicine for me to be       on?  I have researched this a lot, and it sounds like the Fosamax is       better for bone building, but the Evista sounds like a good thing for me       too - because of the breast cancer risk.  Can I take both medicines?                                 

       Bone       stability is very complex and more involved than bone density readings.        what we know to date is that Fosamax and Evista near equally prevent       fracture from available fracture data, especially in the spine.  This       is despite differences in improvement of bone density.  Unfortunately       there are no studies looking at the synergistic effect of the two       medications.  Given your strong family history of breast cancer the       protective effects of evista may be important. This too is being       studied now. You may consider trying both medications for one year       with a f/u BDS.  It is very important to prevent the first       fracture if possible.

I am a 47 year old women with       regular periods.  I have been diagnosed with osteoporosis. I am small       frame, fair, history of osteoporosis in my family.  I have led an       active life style, do not drink or smoke, but did not have enough calcium       growing up.  My doctor has prescribed Evista with increased calcium       intake.  It is specifically only prescribed for women in menopause. Is       it unsafe to take Evista while my body is still producing natural       estrogen?

Evista,       although a good medicine for the prevention and treatment of osteoporosis,       is not indicated until a women is postmenopausal (no menses for 12       months).

       Please give me some information on       Alendronate (Fosamax). I already take HRT and calcium forte tablets. In 1       year my bone density has increased by 4%. I am very reluctant to take this       and would welcome comments. 

HRT       and calcium with vitamin D  along with exercise and minimizing       environmental risk factors to bone loss is the first and second line       therapies to keep the bones strong.  Fosamax, Actonel,       calcitonin nasal spray is used more frequently when bone loss is       significant making the person at risk for further fractures.  These       medications are osteoclastic inhibitors which allow some bone buildup.        They also have been shown to reduce fracture risk.  The main side       effects of Fosamax and Actonel are stomach complaints.  The nasal       spray can cause rhinitis. 

       My 65 year old aunt has been a health nut       for years.  She takes many herbal and vitamin remedies for all her       ailments, but rarely eats meat or dairy products.  Lately, she has       been having a lot of stomach problems and her doctor has detected that two       of her vertebrae have severely deteriorated due to osteoporosis.  She       does not want to undergo any large medical procedures
 or take much prescribed medicine. I have heard that calcium and       osteoporosis related medicines may be harmful to the stomach and       esophagus. Are there any ways to halt the osteoporosis from continuing       without damaging more of her stomach lining? Are there any home remedies?                                               

       Your       aunt sounds like she has complex medical issues to consider.  Calcium       is a benign medication but some people get terrible stomach cramps with       it.  Generally Tums (calcium carbonate) is well tolerated by even       people with "stomach problems".  Your aunt may consider       diets high in soy, although no good science to date shows that soy protein       can inhibit bone loss.  She needs to be regularly exercising, taking       1500mg calcium daily and 400IU of Vitamin D.  I would have her       discuss her options with her primary care physician and someone who       understands the patient that likes alternative therapies.

I have osteoporosis       and am taking evista and calcium ever day but I have been on steroids for       26 years and I have real concerns.  I'd like to know what to expect       down the road.  I'm afraid someday I will be in a wheel chair. My       Doctors are great-but of course tthey won't predict. I have Scleroderma       and Bulbous Phemigus and that is why I'm still on steroids. I take 10mg.       ever other day. I can't go lower-we've tried but I get weak and very tired.        Any suggestions would be helpful.                                               

You       are in a difficult situation.  Unfortunately, few studies have been       done to determine the efficacy of medications against steroid induced       osteoporosis.  to date only risedronate (Actonel) has been studied       and has been shown to increase bone density.  Unfortunately the       studied did not have significant numbers of events and people to       determine whether fractures were actually significantly impacted.        You may consider the synergistic effect of both evista and a biphosphonate such as       Actonel.  Again no studies have really looked       at this issue but it makes sense.

       I am 43 years old, peri-menopausal       (never missed a period yet)  with bone density readings in the -2.5       to -3.3 range. I have been on Evista for over a year, recently the hot       flashes have become worse and more uncomfortable. I began taking soy (55 mg isoflavones) in hopes of reducing the       hot flashes. After nearly three months of a daily tablet I have suddenly       developed very sore breasts, bloating and other "PMS-like"       symptoms during the early part of the cycle and see no relief as the days       pass. Could the combination of still having my own estrogen, taking the       Evista and high concentrates of phyto-estrogens be causing my very sore       breasts and other symptoms?                                        

Firstly,       evista is not indicated in the perimenopause or in women having menses.        It is indicated in a woman who has stopped menstruating for 12 months and       is menopausal.  Your bone density is alarming and suggest secondary       reasons for the cause of your bone loss. These need to be investigated.        Your pms symptoms suggest that you are still ovulating and at best are       perimenopausal.  Although I am a proponent of       phytoestrogens, they have not been shown to significantly impact bone loss       or fracture and therefore I would proceed with caution at this time.

             I am a 38 year old female         with a history of systemic lupus.  I recently completed one of the         most intensive chemotherapy treatments for diffuse proliferative         glomerulonephritis using plasmapheresis, Cytoxan (22 grams in 6 months)         and steroids(150mg tapered to 0mg).  I am currently off the cytoxan         and prednisone.  I am now taking Plaquenil, 200mg per day.          Due to the cytoxan therapy I am now in menopause.  I am taking         calcium supplements 600mg twice daily along with eating/drinking foods         with calcium.  My last dexa scan (Jan 2000) was slightly         decreased from the previous year yet in the normal range for my age. My questions are:       Is Fosamax safe for someone like myself who has a history of Class IV         kidney disease?  I understand that a change in its administration         has been recommended from 5mg/day to 40 mg /week for preventative and         10mg/day to 70 mg/ week for treatment of osteoporosis.  Do you have         an opinion on this recent change?  My kidneys are currently         functioning at 85% with protein of 450mg and serum creatinine of 0.9.          My fear is that the Fosamax might flare the lupus in my kidneys as for         me this has been the primary attack of my lupus.  I also         have an inherited blood disorder, APC resistance, where my blood tends         to clot more easily.  I have had a history of blood clot after my         son was born.  I also have tested positive on some occasions for         anti-cardiolipin antibody.  Because of this I am not a candidate         for estrogen. Estrogen has also been considered a possible trigger for         lupus patients.  Is progesterone known to be beneficial?  Would       Actonel be beneficial in my case? I am a very small framed         and light weight person....5'4'' (shrunk one inch) weighing 110 pounds         with a history of steroid use, now menopausal, so I know I am the prime         candidate for osteoporosis.  I appreciate any comments and         recommendations you all may have.                                                                    

You       have a very complex problem that needs the input of an endocrinologist.        You are not a candidate for estrogens or evista because of your clotting       issues.  the bisphosphonates are metabolized by the kidney but will       not flare your lupus.  The recommendations are to alter doses if       creatinine clearance is less than 35ml/min. Always, you should evaluate       your bones in relationship to the t-score which compares you to the       healthy 30 year old women. 

       I am a 44 year old pre-menopausal women.        I had a bone density test in 1998 which showed a -1.6 in the neck of my       femur and only slightly better readings in the rest of the hip area. This       test was at my request as my mother has osteoporosis --  I'm white,       small frame, have had a low calcium intake since a baby (do not like milk       and stayed away from cheeses because of the fat content), and am somewhat       sedentary due to a damaged joint in my left ankle that began in 1994.         I requested another test this year as I have been taking 1200 mg of       calcium since the 1998 test results and have tried to increase my       activity.   This year's test shows the neck of my femur is a       -2.0.  Other hip readings are slightly better than 1998 results.        Spine tests show anywhere from a -1.0 to -1.5.  At my request, my       gynecologist is referring me to a rheumatologist as she indicates they are       the experts on bones and therefore osteoporosis.  Is this true?        What possible medications can a pre-menopausal woman take to build bone       back so that they don't actually get full blown osteoporosis (-2.5).        Everything I have read indicates all medications are designed for post       menopausal women.  It may be quite a few years yet before I become       menopausal and need to do something now (not later) to build bone mass       back. Thanks for taking my question.                                        

Actually,       I would refer you to a endocrinologist who specializes in       osteoporosis.  However, you can help yourself.  You need to consider       you personal risk assessment and alter the problem areas.  There are       other exercises you can do that can take into consideration the ankle       issue.  Do not let this be a deterrent to healthy living.        Secondary reasons for osteoporosis need to be evaluated.  Medications       are available to assist you in building bone back but to not take away your       need to improve you daily living issues. 

              Can you tell me if Actenol or Fosamax have       any steroids or any estrogen replacements in them?                                         

Neither       of these drugs have steroids or estrogens within.

              I am a 49 year old obese but physically       active white female who, until age 35, drank huge quantities of milk.        All my life, I have had plenty of weight-bearing exercise including       resistance training.  About 6 months ago, my dental hygienist       commented that I had bone loss in my jaw out of proportion to my oral       health and she did not understand that.  So, at my annual gyn appt.,       I mentioned that to my physician.  Since my periods had been regular       up until 4 months ago and I was apparently still ovulating, I am not       taking any hrt. It was decided to order bone scan.  I don't smoke, I       do take Flonase (and have for past ten years, for perennial allergies)       though it is not supposed to be systemically active. I take 1000 mg       calcium and a multiple vitamin with 400mg Vit D. I also appear to have       lost .75 inch in height.  My mother, at age 70, is fine.  I have       always assumed, because of all the milk, exercise and heavy weight, that       bone loss was one of my lesser concerns.  The bone scan       showed mild osteopenia.  The only symptom of perimenopause is the       last 4 months of irregular bleeding.  Are these tests ever wrong or       misleading?  What's the best course of action?  And how much       coffee is too much?  Also, about 13 years ago, it was thought I may       be developing Rheumatoid Arthritis and I had x-rays of my hands and feet.       Would these be helpful in assessing rate of loss?  Thank you for any       thoughts you may have.                                         

One       bone density scan gives a person an impression of the strength of bone at       any given moment but it is comparing one scan with another that helps us       understand the rate of bone loss in any given individual.  Mild       osteopenia is likely nothing to be concerned about.  I would like to       see the actual T-score values in order to interpret your bone density.        Remember anything less than       -1SD is consider normal bone.  It takes 4 glasses of mild daily to       provide adequate calcium and we know the average American takes in about       500mg/day. Also it takes a minimum of 30min daily weight bearing exercise       to help promote bone stability.  This program is above and beyond       normal activity in the day.

              I am a 49 year old premenopausal woman just       diagnosed in Sept. with osteoporosis.  I don't have my numbers, but       the dr. said that unless       we can stop the bone loss, I'm at risk for spontaneous fractures by the       time I'm 60.  I tried Fosamax but was unable to take it due to esophageal       problems.  I am currently taking Miacalcin. I eat well,       exercise, don't smoke, did not have a late menarche, but am a thin       Caucasian with a family history of osteoporosis. I have just sustained a       stress fracture in my hip. I am really curious as to any information on       osteoporosis in       premenopausal women - everything I read describes it as a postmenopausal       problem. I also have a history of calcium kidney stones.  We have       checked for parathyroid function, which seems to be normal.                                        

Without       all of the information it is difficult to offer information.  I need       to know the exact t score analysis.  Have you had a risk assessment       analysis looking at all of the risks for osteoporosis.  Have you been       evaluated for secondary causes of osteoporosis?  I would recommend       considering finding a good endocrinologist to evaluate this problem.        Premenopausal osteoporosis is unusual and suggest another problem that       needs to be investigated.

Articles

Questions this month have been answered by:R. Wayne Whitted, MD., MPH, OBGYN.net Editorial Advisor

Osteoporosis Ask The Expert

        I am confused about the difference between osteopenia and osteoporosis. Can you help me?

Osteopenia       is defined by the WHO as a T score of -1 to -2.49 and osteoporosis as -2.5       or less.  These values are based on bell curve distributions in a       healthy population of 30 year old women.                                                              

              I am a 47 year old woman who has been on Levothyroxin for 30 years.        A recent bone scan showed that I was just "this side" of       osteoporotic.  My doctor strongly suggested that I start to take       Fosomax.  I hate to take any drug and I am worried about the possible       reaction between the two.  What do you think?                                                        

Fosomax       is an osteoclastic inhibitor that will protect against bone loss and       fracture related to osteoporosis.  It can be difficult to take, and       as a result disrupt the oral intake of levothyroxin. Otherwise their are       no other interactions between the two medicines.                                                  

I am a 52 year old female, and have recently been told I have       Osteoporosis. The test results reported a -2.5 in my left hip and 3.4       in my spine.  I am, of course, very concerned about this especially       since I am only 52.  I can't seem to get an answer on how bad this       test result actually is, and what it means to my life style.  Would       my hip result of -3.4 be considered severe osteoporosis, and would the       test results show my increased risk of fracture? The only risk factors I       seem to have is being a Caucasian female, who has low body weight,        small boned, and menopause. I exercise daily (walk, run and lift weights)       and have a family healthy diet. 
       
       Also, I need to decide about which treatment I should go with.  I       have always refused to take estrogen because of my families history of       breast caner.  I may now reconsider if I feel the benefits outweigh       the risk.  Can you tell me if Evista and Proprem are equally       effective in the treatment of osteoporosis?
       
       Do I need to make any changes in my activities, and can I expect treatment       to slow this down enough that I can expect a healthy future? I understand       the difference between a T and Z score, but are they both reported with       the same numbers, such as the -3.4?  If so, would the Z scores still       diagnose a person with osteoporosis?  If the 2.5 in my hip and -3.4       in my spine are correct, wouldn't I be feeling a lot of pain?

       The World health Organization defines osteoporosis in the setting of Bone       Density Scanning as a T score of -2.5 or less.  This is measured as a       standard bell curve and in terms of standard deviations from the average       person.  The T score population statistical test compares anyone to a       healthy population around age 30.  the Z test compares a person to       people of the same age.  If you are older than 30 than the T test is       the most appropriate test to define osteoporosis.  In general, each       standard deviation below 0 represents 2x the risk of fracture.  This       means that at -1
       a person has double the risk to fracture; -2 has 4x the risk to fracture;       -3 has 8x the risk to fracture; -3.4 approximately 12x the risk to       fracture.  A T score of -3.4 approaches severe osteoporosis and at 52       is concerning.  It is important to look for secondary causes of this       other than menopause.                                              

I am 31years old and recently was diagnosed with osteopenia       (-1.89 hip,-1.75 spine). I had a (benign) tumor in the pituitary region       removed at age 15 and have always been on replacement estrogen and       progesterone. I never started menstruating on my own.  All other       hormone function tests have been normal, except for a slightly low growth       hormone and testosterone level several years ago.  I work as a       registered dietitian, and am cognizant of getting adequate dietary calcium       (at least 3 dairy foods per day as well as calcium-fortified juice and       cereal every day). I avoid caffeine and phosphoric acid-containing foods.        I also take 800 mg of supplemental       calcium (with vit D).  I do weight-bearing exercise 3 times a week in       addition to running. Since this is my first DEXA, my physician wants to       use this as a baseline and redo it in 6 months before deciding about       starting me on any medications. This makes sense, although I am nervous       that I will continue to lose density since I feel that I'm already doing       all that I can from a lifestyle point of view--I'm also nervous because a       minor bike fall left me with a fractured wrist last fall and I fear more       fractures in my future. I'm wondering if you know of any studies in people       like myself who have always been dependent on replacement estrogen and       bone density?  Would long-term dependence on synthetic estrogen put       me at higher risk?  Would a mildly diminished growth hormone or       testosterone level increase my risk? Thanks!

You       have a very complex situation.  We unfortunately don't have long term       information about the impact of HRT on bones.  Since you are 31 we       know you have reached your peak bone mass.  Unfortunately, bone       density doesn't change dramatically from a 6 month period to the next.        In general, bone densities should be done in 1-2 year intervals leaning       more often to 2 year       intervals.  You are living a healthy lifestyle and doing all you can       to support your bones.  I would recommend seeking out an       endocrinologist who specializes in bone management to manage your special       case.                                                                             

I       am a thirty year old female that has recently been diagnosed with severe       osteoporosis. My T score is -2.96 in the neck of my left hip.  My       vitamin levels are on the low side and have had intestinal problems in the       past.  I have seen several endocrinologists, who just say to ignore       the result as they do not think I have osteoporosis.  Who do I turn       to for medication or treatment.  Desperate, please help?

                              When someone of your age and hormonal status develops osteoporosis, one         must consider etiologies out of the norm. With adequate calcium intake         and exercise as well as adequate estrogenization, the possibility of         lack of Vitamin D or lack of absorption of calcium and/or Vitamin D         comes to mind. This can be from a variety of gastrointestinal problems,         among them sprue and some inflammatory disorders. Another reason may, in         others, be steroid use for extended periods of time. The appropriate         specialist in your area may be an osteoporosis specialist. Sometimes         they are rheumatologists, sometimes endocrinologists. A         gastroenterologist may need to become involved.                                                                     

I am 61, in excellent health, but have osteo (diagnosed in '97).        Is much better now, but slipped back due to cutting out Fosamax for       a yr.  Also, had a test last mo. on a different machine & I know       they vary as was tested at 2 different facilities in '97.   Have       exercised since I was 28 daily (ran for 13 yrs, 43 mi. wk!).  I now       walk 4 mi. daily; stretch/exercise 40 min daily; lift 10 lb. weights every       other day; play 18 holes of golf 4/5 times wk & hit further than 99%       of women. I have severe osteo:  T scores 3.5 & 4.3.  Can one       go thru life without fracturing? Also can one go to 5 in a T score or       higher? Thx. for your response.                                                                

The meaning of bone densities relates to "fracture risk". With         worsening of bone densities, the "risk" of fracture increases.         One can certainly go through life with "high fracture risk" T         scores and never fracture anything. By the same token, one can have an         excellent bone density and sustain a fracture. It's all about relative         risk.                                                                      

I have fracture three different bones in less than 8         months in my right foot.  My doctor said they were stress fractures         and then asked me if I was ever bulemic or anorexic.  I told him         "no" and then he told me that people my age don't have this         happen unless they are professional dancers, distance runners,         professional football players, etc.  I am only 28 years old, but my         grandmother had terrible osteoperosis.  He is now sending me for a         bone desity test.  If for some reason my bone density is fine, is         there anything else it could be?  I am tired of fracturing my         bones!  I do not wear heels and I don't do any exercise more weight         baring then biking. 

Based upon the bone density,       there are many possibilities. If the bone density shows osteoporosis, this       needs to be evaluated and the cause found. If the bone density is indeed       normal, you will need to be evaluated by an orthopedist and/or       rheumatologist to discern the reason for the fractures.                                                             

      I am 62 and started taking fosamax two years         ago. Since then I have gained considerable bone mass -my osteoporosis         has been reclassified osteopenia.  Do I need to take fosamax         forever?  Will I suffer side effects from taking this for too long?                                                         

 Fosamax         is intended to improve bone density and quality of bone so that you         reduce your risk to fracture.  When you are osteopenic you still         have 2-4x the risk of fracture depending on your T-score.  I         generally recommend taking fosamax until the t-score is between 0 and         -1.0.  This is my opinion.                                                             

I am a 72 tear old female and I take 1200 units of calcium
       (over-the-counter) per day. A recent bone density test revealed the       following:
        Lumbar   0.953
       Total left neck   .860
       Ward triangle  0.510
       It was prescribed that I now take one Fosamax in the morning, in
       ADDITION to the 1200 units of calcium. How do I interpret the above       results? What was the reason for adding Fosamax?                                                        

Most       people would add treatment if the t-score from the Bone Density Test is       -2.5 or less.  Some would add treatment between -1 and -2.5 also in       order to prevent osteoporosis.                                                                

         Approximately 1-1/2 years ago I was diagnosed with osteopenia of hip         (-2.1), was 47, diagnosed with early menopause in perimenopausal stage.        My doctor put me on progest.  Also, lifestyle includes exercise       (moderate) 3 x week, good diet, no alcohol, light coffee, light smoking. I went and had my hip and spine reexamined (bone density) and my spine         was improved (there had been no problem with this area and I had been         taking between 1000-1500 mg. calcium w/boron, etc. during this period of         time).  My hip, however, remained unchanged.  My doctor put me         on fosamax (10 mg. in am) and told me to continue calcium.  How         long do you think it will take for my hip to show improvement?          Will this improvement ever go back to the normal stage of bone mass?                                                              

Fosamax       generally will improve bone density about 3-5% per year.  It will       decrease fracture risk by approximately 50%.                                                      

Can excessive use of aspirin and aspirin related medicines
       such as Excedrin, have a detrimental effect on bones?  Can they       accelerate bone loss?                                                                

It is the caffeine in Excedrin       that might cause bone loss. Otherwise to my knowlegde salicylic acid does       not cause bone loss.                                                      

I was given fosomax - the once a week pill after two weeks I       developed serious diarrhea,  was diagnosed with microscopic colitis -       also had two ulcers and reflux.  It took me three months to recover,       and I was down to 100 pounds from 124 pounds before the disease was       arrested with asacol. Even now I have only gained six pounds back, but       expect a slow weight gain. I am convinced that there  is a connection       between this time release drug and my health problems.  I want to at       least report this reaction to someone, and also find out if anyone else       has had this extreme reaction. How long has the time release pill been on       the market?  Any information  would be helpful.                                                                

I have not seen this       reaction thus far. The weekly dose was released 11/16/00 but had extensive       testing for a few years prior to that. Serious reactions include       esophagitis and gastritis, not colitis. Common reactions include other       gastrointestinal complaints but the weekly Fosamax has comparable       complaints to placebo, including the serious reactions. If this is related       to Fosamax, it should be considered, at this time, an idiosyncratic       reaction, one that is severe, unusual and unexpected.                                                            

I       am a 52 yr. old female. I have been diagnosed with mild osteopenia with a       BMD of 1.025 in my spine. I have been menopausal for 2 years and do not       take conventional HRT, but do use natural progesterone cream 2xday. I also       take 1500 calcium daily with  magnesium and Vit. D. and try to       exercise and do weight work 3-4 times a week. Do you feel that Traditional       HRT would be beneficial and do you think bone builders such as Fosamax       would be best?                                                         

Osteopenia is diagnosed as a BMD of less than -1.0. At -1.025, you are         just over the cusp. The hip measurement is not listed and may help         determine therapy.                There are no double-blind, randomized controlled trials on any         progesterone cream and absorption has not been documented in any         pharmacologic doses.                Traditional HRT may or may not make a difference in bone mass. It is not         approved for treatment of osteopenia or osteoporosis but may help         prevent it in many women.                Fosamax is reserved for women with at least severe osteopenia unless         there is moderate osteopenia with other risks factors. This therapy         must, of course, be individualized.                                               

      I am 45 years old.  I have had a         history of thyroid problems where first I had a hyperthyroid and now I         have hypothyroid.  I have been using medications for the last 4         years.  I have asked my physician for a bone scan since I have         heard that having this medical condition can affect my bone density.          To add to the situation I believe that I am highly at risk for         osteoporosis.  My mother and her mother both have this condition.          My Brother who is just 1 year older than has been had a bone density         test and he is in the advanced stages.  I do not believe that I am         at that stage (he has fibromyalgia).  But I believe that my         bones have deteriorated.  I have         read the book Strong Women Strong Bones.  How can I get my         physician to recommend a bone density scan?  I believe I am not too         young and that I am at higher risk than the 75% or more of the         population.  My physician has told me that I am too young and that         I will not be at risk until I am going through menopause.                                                                

                                            The information you present is compelling to get at least a baseline         evaluation with a DEXA bone density. With a strong family history and         thyroid irregularities, you have two strong risk factors. If your         physician does not agree, consider seeing an osteoporosis specialist for         a second opinion.                                                         

I       am 36 years old and have 3 children. I have a thin build and I am a       triathlete. I recently had a dexa scan of the hip and spine and the hip.       It showed  ostepenia involving the left  hip which measures one       standard deviation below the age related mean.  I have been taking       1000mg of  a calcium with ipraflavorne(citrate malate) for about a       year . I thought the
        test results would be better? I would appreciate any advice you could       recommend. I thought the exercise would help the bones? Should I be taking       more calcium?                                                               

                               It's unusual for a 36 year old to have a DEXA without adequate risk         factors. The hip result was -1.0. From your note, you indicate this is based upon         age related mean. This is referred to as a Z score. We also use the T         score to see how the DEXA compares to a 25-30 year old, considered peak         bone density. At 35, the T score and Z score should be similar.         Osteopenia can have a hereditary component as well as the very important         factor that many don't consider ..... whether or not you got to maximum         bone density in your teen years and what your exercise and calcium         intake were until age 25, the approximate point when you stop building new         bone.                With the calcium, 1000-1200 mg per day is required and some need 1500         mg. This should be in divided doses, with a maximum of 500-600 mg per         dose. Adequate vitamin D is also needed to aid in absorption of calcium.                                                               

 I       am 65 years old and am developing a hump by my neck. My bone density       tests are normal. I am on Fosamax.  What causes this humping by the       neck?  I have been told that it may be due to high levels of steroid       hormones.  If this is true, what can one do?                                                               

                                                          If your bone densities are normal, it's not clear why you are on Fosamax.               On the point of the "hump", there are a few possibilities. One         would be upper thoracic vertebral compression fractures. Another would         be Cushing's Syndrome, the one referred to with a problem in steroid         metabolism. Another possibility is a lipoma of the area, a benign fatty         tumor that can occur anywhere on the body. This needs to be evaluated by         your physician to determine the origin.                                                            

Two       years ago, I was diagnosed with hypopituitarism after a 9 year search to       find a reason for all the symptoms I was having.  Over the last       several years (since about 1998), I have been getting shorter in stature.        In the last 2 yrs., I shrank from 5 ft., 5 in. to 5 ft., 3.5 in.  I       was given a bone scan in June that showed that I have osteopenia even       though I've been on estrogen since 1990 (hysterectomy).  I have been       told to take lots of calcium and to try to be as active as possible.        Unfortunately, I have had to slowly begin to limit physical activity in       last couple of years, because of severe hip and leg pain which I was       told must be fibromyalgia.  In addition, even the smallest amount of       physical activity makes me perspire terribly and to ultimately feel faint.        The doctors I have seen have no idea why I perspire so much, but it is       getting more and more debilitating.  I would like to know if the       sweating is linked in any way to the osteopenia, and also does osteopenia       ever cause pain to occur in the hips?                                                               

                                           Estrogen does not prevent all osteopenia and it is possible that you had         osteopenia prior to the hysterectomy as many women have, but are unaware         of. Estrogen is presently not approved for increasing bone mass although         it may do just that in some women.               Sweating has not been shown to be related to osteopenia.                Osteopenia should not be related to bone pain. This may very well be         osteoarthritis.                                                           

 I       am a 48 year old white female.  I had a complete hysterectomy at age       38.  I have taken premarin 1.25mg since that time.  Osteopenia       was diagnosed two years ago by a bone density.  I began taking       fossamax and developed skeletal pain.  I was switched to miacalcin       and had no side effects.  A follow up bone density showed a T score       of 2.4.  I was put on Fossamx, one weekly.  I developed       inflammation of the esophagus.  I then was switched to Actonel and       the inflammation worsened.  (No testing was done.)  I have now       been placed on Evista.  Dr. recommends I stay on premarin in       conjunction with the Evista for one month, if I do well with Evista he       will stop the premarin.  This concerns me.  Will the Evista do       the job when the premarin did not help in the past? I've read about taking       prevocid etc. the evening before fosamax or actonel and wonder if this       should be tried.  I am concerned as I am very young and want to take       the most effective medication. Any information you can give me would be       greatly appreciated. Thank you for your time.                                                               

                     The underlying condition of GERD is not necessarily       a contraindication to using  Fosamax or Actonel.  Especially       with our recent understanding that Fosamax may be taken only once a week       and still derive similar effects as with daily use.  Many patients       with GERD opt to use a proton-pump inhibitor such as Prilosec or Prevacid       the evening before their once a week dose.  If you are losing bone       mass while on Evista, then either weekly Fosamax or alternatively Actonel       would seem like rational alternatives or additions.  Conventional       hormone replacement is
       also a viable option- all these choices must be discussed in detail with       your physician or local osteoporosis expert. Hope this is useful       information for you.

OBGYN.net Osteoporosis       Editorial Advisor.

 I       am a 36 year old women and I had a dexa test that showed mild osteopenia .       I was wondering if the product CalAbsorb is any good. It can be purchased       on the TV and is not in stores yet. I was wondering if it was just a hoax.       The product is calcium citrate and magnesium and vit d all together in a       powdered form .I am taking a pill form of calcium citrate and mag and vit       d and wanted to know which one is better?                                                                

                                            Any calcium that dissolves in a glass of vinegar within 30 minutes will         be absorbed. No study has shown that taking Magnesium with Calcium aids         in absorption or action. In your bloodstream, there is an intimate         relation between the two elements but that does not mean they must be         taken together. As far as the Vitamin D, it can be gotten in regular         vitamins and need not be combined with the calcium.                Whatever will be absorbed (see above) is fine. Vitamin D sometime during         the day is all that is required for all but the most extreme exceptions.         If you have no complaints from the least expensive supplementation,         that's OK.                Hope this helps.                                                     

Recently received test results on bone         density scan stating my spine T-score = -2.8 & my total hip T-score         = -3.3 which is statistically consistent with osteoporosis. Evaluating         doctor recommended 0.625mg of premarin as I have not had hysterectomy. I         am 58 yrs old & am postmenopausal.  My concern in starting to         take HRT now is that I am a cancer patient.  Had melanoma tumor         removed from inside lower eyelid in 1999 & "trace" cells         removed in 2000.  Underwent proton beam radiation & then         Interferon treatment for 6 weeks.  Had to stop chemo due to adverse         side effects-primarily shortness of breath problem.  I am concerned         about taking HRT with my history of cancer - do I have reason for         concern?                                                         

Questions this month have been answered by:R. Wayne Whitted, MD, MPh, OBGYN.net Osteoporosis Editorial AdvisorHarvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial Advisor

Q:  Can osteopenia be reversed       without drugs?

I am interested in knowing if my tests results indicating osteopenia       in my       spine and borderline osteoporosis in my hip can be reversed with 1500       milligrams of calcium, increased soy intake and vitamin D.  My Doctor       recommended that I walk with 5 pound weights.
       
       I am a 57 year old woman.  My desire is to heal myself without       taking       drugs and to know if these conditions can be reversed.

Exercise, Calcium, and Vitamin D are the first line therapy       in your setting.       They will assist in retarding further bone loss.  Weight bearing       exercise       stimulates bone remodeling.  Multiple studies suggest that healthy       living       can minimize bone loss but will not rebuild bone.  Second line       therapy       utilizing Hormones or Evista will build some bone and stimulate the       production of quality bone.  third line therapy consists of bisphosphonates       such as Fosamax and soon to be released Actonil.  There is also a       nasal       spray, calcitonin, which will build some bone.  It sounds as if in       your       setting you need to begin thinking of additional therapies.
       
       

               R. Wayne Whitted, M.D., M.P.H

I am a 57 year old postmenopausal female.  After 9 years of HRT, I       was taken       off and placed on Fosamax due to the results of a bone density test.        I       could       not tolerate the Fosamax due to very bad GI upset.  Now I am on       Evista and       am       having hot flashes, night sweats, sleep disturbances, and continuous sinus       problems.  I have never felt worse in my life.  I know I have       osteoporosis,       but is there a better way to manage it?  A friend told me Miacalcin       is a       nasal spray and does not have these side effects.

Osteoporosis is treated in a       multi-tiered fashion.        Firstly one must have all modifiable factors optimized.  these in       part include tobacco, caffeine, alcohol cessation, taking appropriate       calcium and vitamin D, exercise and optimizing the health from chronic       diseases.  HRT is used for bone stabilizing and a myriad of other       menopausal issues to include symptom control.  If osteoporosis occurs       while on HRT than often another       antiresorptive agent is added such as Fosamax or Miacalcin nasal spray.       Evista is not necessarily a replacement for HRT as it does not have as       good of a bone building effect as HRT in clinical studies.

What are the side affects of the Drug Fosamax?

I       have been diagnosed with osteo and have been taking Fosamax and am wondering       what are the side affects of this drug?

Side effects of Fosamax over placebo include abdominal       pain, constipation,       diarrhea, flatulence, acid regurgitation, esophageal ulcer, Musculoskeletal       pain, headache.  There may be other side effects but are not reported       at       this time.

       Do       I need a bone density test now?

My general practitioner has said I need to have a bone density test       where my spine AND my right hip need to be x-rayed.       I am 49, and had a total hysterectomy at age 42.  I have never had       children.       Do I need this test at this time?       Why?       How often is this test needed?  Why?       I am taking Estradiol and have taken ERT since three months after the       hysterectomy.

You do not mention your other risk factors for menopause.        Early menopause       is only 1 risk factor.  Since you have been treated with HRT its       importance       decreases.  There are no clear guidelines so all doctors have       different       protocols.  Since the test involves minimal radiation it is harmless.        My       rule of thumb is to have a BDS 10 years after menopause if treated with HRT.       Recommendations on frequency of the test is based on the findings of the       initial scan.

What side effects can I       expect from Miacalcin nasal spray?

What side effects can be expected with Miacalcin Nasal spray?  I have been diagnosed with       osteo arthritis and this spray was recommended as treatment for me.

Miacalcin nasal spray is used solely for osteoporosis       treatment.       Osteoarthritis is a different disease entity requiring different       treatments.       The main side-effect of the spray is rhinitis (runny nose) which can be       aggravating.

What is advisable for a person with osteoporosis       and arthritis?

My mother (like many people I suspect) has both osteoporosis and       osteoarthritis.  As a result, the very types of weight-bearing       exercise that       would help her osteoporosis would unfortunately worsen her arthritis.        What       is advisable for a person with osteoporosis who also has arthritis, other       than obvious measures such as sufficient Vitamin D and calcium intake and       possible pharmacological therapy?

Unfortunately your mother is in a catch-22 situation.        What kind of       exercises does her rheuma -tologist suggest?  Her options include       calcium and       vitamin D.  she needs to consider Evista or hormone therapy as an       adjunctive       option.  In addition, to improve bone density, she may need to consider       Fosamax or Miacalcin Nasal spray.

Concerned with what medication would be most appropriate.

I was just diagnosed with severe osteoporosis,       I've read some information on the medication, Fosamax, but it is not FDA approved.       I am 37 and         concerned with what medication would be most appropriate for me. I Am very         sensitive to most drugs, am taking inhaled Pulmicort and Bricanyl         inhalers for breathing problems. I Also get lots of headaches and am trying a         weight resistance program, but my neck and shoulders ache this I believe         brings on a headache. Also have very poor urine stream and have slight         incontinence during night time sleep, maybe not associated with         osteoporosis.

As I am a gynecologist, I feel a little out of my league in answering       this       question as it appears you are a 37 year old male. Quite honestly, I would       discuss osteoporosis with your physician, and perhaps seek out a doctor       with       an interest in metabolic bone disease, such as an endocrinologist or renal       specialist.
       
       

Paul D.       Burstein, M.D., FACOG        
       OBGYN.net

Thank you Dr. Burstein for giving me a piece of your       valuable time,       especially since this isn't your field. I  really mean that. Sometimes its       not       hard to think that Doctors are trained to be as detached  as waiters.        You probably get hundreds of messages, so I consider       myself       lucky you answered me, and wish I that I could find a Doctor like yourself.
       
       Thanks again, John

Could you please give me some information on pubic       osteoporosis and how arthritis can complicate this condition.

        I do not have a lot of information specific to the pubic bone. Cases of       "insufficiency fractures" are reported and seem to be related to       known       osteoporosis, use of Corticosteroids, and other risk factors.
       
       This is an article which may be of interest:
       
       

       Insufficiency fractures of the pubic ramus.
        Semin Arthritis Rheum 1996 Jun;25(6):373-82    (ISSN:       0049-0172)
       Schapira D; Militeanu D; Israel O; Scharf Y

       Department of Rheumatology, Rambam Medical Center, Haifa, Israel.


       Seven elderly women with insufficiency fractures of the pubic ramus are       described. The pre - disposing factors for this condition were osteoporosis,       rheumatoid arthritis, renal failure, prolonged Corticosteroid treatment,       pelvic irradiation, and mechanical changes after hip surgery. The clinical
       presentation included progressive inguinal pain, limping, and inability to       walk. Because initial radiographs were diagnostic only in four cases, bone       scintigraphy and computed tomography were necessary to confirm the       diagnosis       and detect additional fractures. In most patients, bed rest,       non-weight-bearing ambulation, symptomatic treatment, and therapy for       osteoporosis resulted in rapid improvement, and long-term follow-up showed       complete or partial recovery. In one case, no recovery was achieved       because       of noncompliance with treatment. Insufficiency fracture of the pubic ramus       should be suspected in cases of unexplained inguinal or hip-area pain and       inability to walk in the elderly. The clinical suspicion should be       supplemented by radiological investigation. Bone scintigraphy and computed       tomography are useful means for early and accurate diagnosis. The risk       factors for this condition should be identified and treated. If therapy is       initiated early and pursued, this type of fracture has a benign outcome.
        
       Hope this helps.
       

Paul D.       Burstein, M.D., FACOG        
 			OBGYN.net

Here are some articles that may be of interest to you:

 by Susan Ott, M.D., Associate ProfessorDepartment of Medicine, University of Washington

From the National Osteoporosis Foundation 

Food and Our Bones: The Natural Way to Prevent Osteoporosis by Annemarie ColbinInformation for Women about Osteoporosis and Other Bone DiseasesFrom the FDA

Questions this month have been answered by:R. Wayne Whitted, M.D., M.P.H  OBGYN.net Osteoporosis, Editorial AdvisorPaul D. Burstein, M.D., FACOG  OBGYN.net Osteoporosis, Editorial Advisor

        I am 57, female,  and after a bone density was confirmed for       osteoporosis.  My doctor told me to take calcium, magnesium and Vit.       D supplements, exercise daily, and if I didn't want to take fosamax, I       could try testosterone cream.  She said she went to a seminar and was       told women have benefited from small amts of testosterone cream who have       osteoporosis.  Have you heard of this treatment?

 I       would have to disagree. There are several treatments for osteoporosis and       testosterone cream is not one of them. There is little evidence that       testosterone except in combination with estrogen has much effect, and       testosterone given by skin creams, in many cases, is not even metabolized       by humans. I would urge to you to get better advice.                                                                    

       Is there any way to correlate DEXA Scan numbers to per cent of bone loss?        For example:  How much bone loss would a 54 year old woman have with       a -1.5 in the spine?                                                         

With the numbers you give, the answer       is that it is difficult to make such a calculation and would be       meaningless. Assuming the value you cite is a T-Score, it would reflect       bone density of 1.5 standard deviations below the mean bone density for a       young adult. The concept of a standard deviation is like high school       grades on a bell shaped curve. This is not osteoporosis. The real question       is did you lose bone mass at all or never reach that theoretical peak on       the best day of your life. One of the problems with DEXA is that it is a       snap shot of bone density on a given day. If there is not excessive risk       of fracture, it may be reasonable to maximize calcium, Vitamin D,       exercise, avoid smoking, excessive alcohol and excessive caffeine, and       repeat the test in two years. It would be a good time to discuss your       medical history with your physician and find out if you have any       conditions or take any medications that might have an adverse effect on       your bone health. Hope this helps.                                                

       What is the significance of a T score of the neck of the hip worse than       -2.5, if the rest of the hip measurements are better, so that the Total       T-scores is better than -1.0? Does the patient have osteoporosis of the       most common site of hip fracture, and need to be treated?  Or does       she not even have osteopenia?  I have several patients that fall in       this category?           

                        Although some osteoporosis experts do look at the       total hip measurements, most look at the femoral neck as the site most       likely to fracture and therefore the site of most importance when       considering therapy in that area. Presuming the DEXA machine has shown       consistent results (ruling out instrumentation error of course), we       routinely treat the worst area. In this case, we would consider that this       indicates osteoporosis and appropriate treatment with a bisphosphonate       (most likely) should be instituted. Remember       that the bisphosphonate is just, for lack of a better term, a brick layer.       Adequate Calcium and Vitamin D (the bricks) need to be taken in for       expected response to the therapy.                                                  

I have been perscribed actonel for my osteoporosis and I       was wondering is it ok to also be taking coversyl and aproxin tablets at       the same time?                                                 

Coversyl is an ACE inhibitor and goes under       the name of Aceon in the US. The are neither major nor minor interactions       with Actonel. After searching for "aproxin" and being unable to       find it on any search engine in English, I cannot comment on that drug.                                                               

                      Is it possible to experience side effects from the Fosomax 70 although none         were experienced while taking the Fosomax 10 daily?  For the         last two months I have been having headaches with pain behind my right         eye.  Most of the time they are similar to migraine headaches,         which I have not had any for some time.  For the last six weeks         this has been a daily occurrence.  Sometimes I even wake up in the         night from the pain.  My doctor had me get a CT scan, which was         normal, and he has me taking Vioxx 50 mg for six days and then 25 mg for         eight days, and then I am to see him again.  This has helped the         pain, but I still feel the pressure across my forehead.  This         morning it occurred to me that I have only been taking the Fosomax 70         for a little over two months, and I was wondering if the headaches and         eye pain could be a side effect from the medication.                I think I will skip my dose this Saturday and then talk to the doctor.  I would also appreciate your input.                Thank you.

Common       side effects of fosomax are esophagitis, gastritis and bone pain.        Headaches have been associated with fosomax.                                                        

What is the difference between taking actenol daily or one       weekly tablet. I was prescribed Fosamax for a weekly tablet and my       insurance didn't approve it but they did approve actenol daily.  I       would rather take one tablet each week and wonder if it is as effective.        Thank you.                                                               

Actonel       has not been approved for once weekly therapy.                                                             

 I was diganosed with severe osteoporsis in 1996, I was 52.  I had         two fractures - that is how we found out that I had it.  I was put         on Fosamax, high calicum and Vit D.  I had been holding my own         until this past year.  I now have a fracture in my left foot -         since August of 2001.  It is healing - but slow.  I have two         fractures in ribs on my left side.  I did not fall - just did small         simple things and got them.  I have heard of the new drug by Eli         Lilly - Forteo.  Has it been approved?

I go to my doctor the day after tomorrow - but I am very concerned.          I have seemed to have gone down hill very fast.

Any suggestions - I am also on Hormone Replacement therapy - since about         1995.  I did everything right - the doctors seem to think that my         bones just didn't develop as they should when I was young.

It       is important to do secondary evaluations for other causes of bone loss.        also, forteo has not been approved yet.                                                                          

I am a 56 year old women who had a hysterectomy, removal of the       uterus and ovaries, at age 35. I have been taking Premarin for 21 years.       My bone density is fine.
       
       I want to stop HRT because of a fear of breast cancer. My mother has       osteoporsis. I exercise five days a week, take 1200 mg of calcium daily,        and  drink milk regularly. Would it be wise for me to take       Evista?  I also take Synthroid for Hypothyroidism. What else would       you recommend to protect my bones?                                                        

Evista       has been approved for the prevention and treatment of osteoporosis.        It appears to reduce the cholesterols and to offer a reduced risk to       breast cancer.                                                      

After the studies done by the       American Medical Association- would you advise the use of ipriflavones in       combination with once a week fosamax as a good supplement in the defense       against osteoporosis? Thank you.                                                                

Ipriflavones       have not shown benefit in osteoporosis management.  They are often       used by menopausal women for treatment of perimenopause, such as hot       flushes.                                                                

        I took Fosamax last year & it didn't seem to agree with me. I don't       remember exactly what side effects I had, but I went right off it. I       happen to have Osteoporosis, pretty bad count (said the doctors, 3 of       them). I took Actonel a few weeks ago & again side effects:       Nightmares, muscle pain, stomach aches. I have Khrones, Illeitis,       cholyotis & IBS. All of the above are not active now. I take       Azulfidine & Folic Acid. I started Foxamax again 2 weeks ago.

Everything seemed to be O.K. until yesterday when I took       the 3rd pill. (70 mg) My tongue is burning at the tip, my neck started to       bother me, my ears are ringing (nothing new) but somewhat magnified. My       mother had osteoporosis (never took anything for it, fell in a super       market, lived to be 82). To take or not to take the Fosamax? Thank you so       much for your concern.

 The       treatments for osteoporosis are varied.  Fosamax and Actonel improve       bone density and reduce fracture risk but have SE such as stomach pain,       bone pain, headache, etc.  Evista, a selective estrogen receptor       modulator, improves bone desity, reduces fracture risk, improves the       cholesterols, and appears to reduce the risk of breast cancer.  It is       an oral tablet and generally well tolerated.  Calcitonin nasal spray       is approved for the treatment of osteoporosis but has limited benefit in       the long term.                                                       

I am a 35 year old white female, 5' 6'', 120 lbs with       osteoporosis.  I had a child by c-section almost 5 years ago.        After delivery I could not walk for four months due to a compression       fracture in my spine.  Osteoporosis was due to prednisone usage for        medication for ulcerative colitis.  I would like to have another       child.  My bone density is only slightly better than it was when I       had my child.  Will I do any permanent damage to myself if this       fracture was to re-occur in my next pregnancy?  I am taking Fosamax       and ortho tricyclen currently.                                                               

It         is always best to prevent fractures.  It is important to stay with         fosamax.  It reduces fracture risk by 50%.  The fracture that         has occurred is still there and hopefully not bothersome.                                                                

A 41 year old female friend of mine, first diagnosed with osteo at       30, just had a bone scan, nuclear imaging, which turned up eight fractures       including one in the lower spine - pars, lumbar - was told she has the       bone density of a 65 year old.  Any comments or advice I can pass on       will be greatly appreciated.                                                                

She       needs to be evaluated for secondary causes of osteoporosis. These include,       but are not limited to: thyroid disease, parathyroid disease, adrenal       disease, and a variety of other rare diseases like leukemia, multiple       myeloma, paget's disease of the bone, etc.                                                                    

I       am 69 yrs. old and have been unable to take hormone therapy due to       fibrocystic breast. I have been diagnosed  with osteoarthritis which       is a family trait. I am taking  100mg of Celebrex, which doesn't seem       to control it, but does help. I recently had a bone density test done and       am now taking Actonal. Will this help to lessen the arthritis pain and       stiffness? Thank you for your answer.                                                        

Actonel doesn't impact the       symptoms of arthritis.                                               

I       am a 54 year old female and I have osteoporosis.  I have been on       fosamax for the last two years, 10mg. per day.  I was having back       pain and went to my dr.  He says that a bone in my back is       compressed, but that it isn't real bad.  He put me on naprasion and       an anti-inflammatory.  Will this heal on its own or will it remain       the same?  I just don't know if he is doing all that he can and if I       should be going to a special back doc.                                                                

  First Answer from Dr. Marchbein:  Taking the information you have provided from your doctor, if there is         indeed a bone causing compression of an area, an anti-inflammatory agent         would be highly recommended. This must be differentiated from a compression fracture in the spine caused by osteoporosis. Depending upon         the exact location and nature of the compression, the expectation of         resolution of your symptoms may vary. If you are concerned that your         doctor may not be doing everything necessary or may no be diagnosing the         full story, an appropriate choice for another opinion might be a       rheumatologist.

          As an aside, you may wish to discuss with your doctor the newer dose of         Fosamax - 70 mg once a week taken with the same set of rules and         precautions. Hope this helps and please write back for more information         as the situation presents itself.

Second       Answer from Dr. Whitted:  It         sounds as if you have osteoporosis and now had a compression fracture.          Fosamax is important because it reduces subsequent fractures          incidence.  There are treatments that can stabilize the existing         fracture.  These involve injecting a cement like substance into the         vertebra.   Maybe you can ask your physician about this.

Would       it be harmful to take a second hip density scan within a few weeks of the       last one.  I just want to make sure there wasn't a mistake in the       reading, some results are hard to accept.                                                               

              Although not dangerous, most experts find this type       of re-testing unnecessary. In addition, it is not likely that your       insurance would reimburse you for this repeat test.                                                                    

       I am a 54 year old female that has been         diagnosed with osteoporosis.  I had a complete hystorectomy with         the doctor leaving me the cervex because she said I had too many         adhesions to take it out.  I was put on .9 premarin at the time         (1997).  After a year I had a bone density test and it showed         osteoporosis so the doctor put me on fosomax.  After being on it         for a month I went to the hospital because I thought something was in my         throat.  This type of abnormalady had been happening often.          They put a scope down my throat and determined that I had gerd and that         the fosomax was making me just "feel" like I was choking.          The doctor took me off from the fosomax and put me on Evista (the         hospital doctor).

So I started on the Evista and when I         went to my family doctor he told me to get off the Evista because I was         already taking premarin and did not want to get too much hormone.          I am totally afraid to take anything if the doctors cannot make up their         minds.  I have a gynochologist and a family doctor and my family         doctor gets all my results from everything that I have         done.  What shoul I do concerning my bone loss and do you think         that the weekly dose of fosomax would be better for me?

                            Since Evisa has anti-estrogenic activity in certain       areas of the body and estrogenic activity in other areas, there is no       logic in treating with both medications simultaneously. The GERD that you       had with Fosamax is not unheard of but was most likely when the dose was       10 mg daily. There is now a 70 mg pill taken weekly that may be better for       you. In addition, Actonel, a "cousin" if you will, to Fosamax is       available and may be better for you in particular, with respect to the       GERD. Actonel is now daily but approval for weekly Actonel is expected       this summer.                                                            

I am a 45 year pre-menopausal diabetic female.  I had a         hysterectomy over 14 years ago, all was removed with the exception of my         ovaries. As far as I know, I have not gone through menopause.          If I have, I have not recognized the signs.

In January 2001, I fractured both my right and left ankle.  In         September 2001,  I obtained two stress fractures on the top of my         left foot (I was told it was from powerwalking 4 days a week.          I had worked my way up to 4 miles each walk.)  Then         recently on January 13, 2002, I fell down my long flight of steps landing         abruptly on the sixth step down, fracturing.  Per Dr. George         Mathews, my Neurosurgeon and Dr. Clayton Walker, I severely fractured my         11th vertebrae.  My neurosurgeon believes that  the         severity of my back fracture came from the osteopenia, he has         me wearing a thorasic corset. for my back fracture.  The         neurosuegeon has also recommended that I have an injection inserted         into my vertebrae to "cement" the vertrabrae and to quicken         the healing process.

The week before fracturing my back, I had seen my diabetic doctor.          At that time I requested that she prescribe a bone         density test be performed.  Initially, she was very reluctant         because she did not believe that I was a candidate for the bone         density test.  The reason for her reluctency was because         I had not yet reached the post menopausal stage.  At least I did         not believed that I had and as of this day, not one of my doctor's has         stated that I have.  I do not know the signs of menopause and         because nothing "hormonal" has changed since my hysterectomy,         I thought I had nothing to worry about.

Upon expressing my deep concerns in regards to wanting this test         and after she reevaluated my recent fractures and loss of height,         she decided it was in fact the best route to take.  I         have also loss 3/4 of an inch since a year ago.  When I         told her that, she then agreed that is was the best route to take.          The stress fractures have not healed as of this day and upon         falling down my flight of steps I have refractured my left ankle.

After waiting over three weeks, I decided it was best for me to call         both my diabetic doctor and my orthopedic doctor.  The diabetic         doctor's nurse explained that it wasn't serious enough to be seen by my         diabetic doctor until my visit in April.  My orthopedic         doctor said that was something that surely needed to be monitored         and that it was on the verge of osteoporosis.  Because I am a         diabetic,  I am very concerned as to how osteopenia relates to         osteoporosis.  My diabetic doctor's nurse stated that the         osteopenia is not serious, however, the orthopedic doctor said it is         right on the edge of osteoporosis and that she would like to see me when         her office could schedule an appointment for me, the earliest         appointment available is scheculed in April.

I have do some research on osteopenia, but have found that I am         receiving mixed messages.  How serious is osteopenia?  Is         there anything that I should start taking now prior to seeing my         physicians that might be helpful in preventing or slowing down the         process of osteoporosis?  In all of my research, I have not yet         found how diabetes relates to osteopenia or osteoporosis, is there any         additional data that I could research?  In some of the research I         have done, I have found that estrogen is sometimes an option.  I am also         concerned about the use of estrogen especially in how it relates to breast         cancer.  My maternal grandmother and aunt were both put on estrogen         after menopause and within 10 years both have lost a breast from         cancer.  Are there any new estrogen related medications that are         not harmful or linked to breast cancer?

                    Menopause can be       defined by doing a blood test called FSH.  In addition an estradiol       level can be obtained in correlation. Osteopenia is early bone loss and is       defined by the WHO as a T-score of -1.0 to -2.5.  Chronic medical       conditions can predispose a person to bone loss in addition to lifestyle       issues and menopause.  It is important to sit with your doctor until       all areas are fully explained and you are comfortable with the       explanations.                                                        

My       mother in law is 64 years old and 10 years ago she had an adenoma of the       parathyroid removed with a calcium result of 16.0 before the surgery.        She also has had breast carcinoma and has osteoporosis.  My question       is:   How is the blood calcium affected when a person has       osteoporosis.  She runs a 10.8 /11.3 calcium at this time.        Also, does the blood calcium fluctuate at different times of the day.        Her calcium can run high normal to slightly elevated. Any information you       have would be appreciated, thank you.                                                       

                    The blood calcium is not affected by     osteoporosis. Rather, blood calcium and the intake of calcium affects     osteoporosis. Many of the body's chemicals show fluctuation throughout the     day although minerals remain relatively stable.                                           

I     am a 42 year old female, I have been on Actonel for seven months now     and seem to be on a steady weight gain, 10 to 15 pounds with no change of     eating habits and on the same exercise program. Although I don't see weight     gain on any of the info on side affects I have read, I can't help think     that this drug seems to have slowed down my metabolism, not just my boneloss,     is that possible? And if it is, is there anything I can do about     it, short of stopping the prescription.                                                

                    Bisphosphonates such as Actonel and Fosamax have     no known effect on weight, whether loss of gain.                                             

Questions this month have been answered by:R. Wayne Whitted, MD, MPh, OBGYN.net Osteoporosis Editorial AdvisorHarvey S. Marchbein, MD, USA, OBGYN.net Osteoporosis Chairman and Editorial AdvisorPaul D. Burstein, MD, FACOG, USA, OBGYN.net Osteoporosis Editorial Advisor