Related Women’s Issues
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Osteoporosis in Men [posted
10/21/98]
Question: My husband, John, has been given a testosterone shot once a month at the
V.A. for osteoperosis. Another doctor there has told him to question whether he wants to
take this since the increase for prostate cancer is great. Is there something natural he
could take for his bones?
Answer: Men can also take Fosamax or Miacalcin for osteoporosis.
Osteoporosis in Children [posted
10/20/98]
Question: My daughter, age 5 1/2, has a rare form of anemia and has been on
prednisilone since 6 weeks of age. She has had osteoperosis at different points in her
life because of the steroids. Can fosamax be given to children on steroids who have
osteoperosis?
Answer: It is certainly given to adults. There is no obvious reason that it
could not be given to children. However, it was not and will not be tested in children for
ethical reasons. I’d try it.
Osteoporosis [posted 10/6/98]
Question:I am 45 yrs, female, First bone density done 6 yrs ago showed my bone
density to be equivalent to that of an 80yr old woman. I personally initiated the need for
this test as I was asymptomatic. Hormone profiles are all normal, the only improvement was
seen after taking Fosamax for 12 months. I closely adhered to a strict regimen of
increased calcium intakeplus vit D dispersed throughout the day, plus lots of tennis and
ensured a higher than average exposure to sunlight. Bone mass returned to almost normal
levels. After a second year of taking Fosamax and suplements on a much looser schedule
retesting showed my bone density worsened. I am still pre-menopausal and since this retest
in June I have returned to Fosamax daily. Why not couple Fosamax intake with Miacalcin
usage since only 10% of Fosamax is absorbed at best??? Is the injectable form prefered
over the nasal spray(blood calcium levels and kidney ultrasounds have all been negative
and will continue to be monitered). I do not smoke, drink, use steroids and felt a bone
density test was a good idea after hearing about at a medical symposium when I was 36 yrs
old working in medical research. I would also like to know of any other human trials
presently underway.
Answer: Several possibilities, first ensure that there is not a secondary reason
for your osteoporosis. That is, thyroid levels normal, parathyroid levels normal and 1,25
Vit D(the activated Vit D) are ok. These are commonly overlooked. Secondly, check your
urinary calcium excretion to ensure you aer not a hyperexcreter, these respond to small
doses of thiazide diuretics. Lastly, you probably need to increase the Fosamax to 20 mg or
higher. Combination with Miacalcin is fine, but, many people have this problem and it
usually responds to higher dosing.
Osteoporosis & Fosamax
[posted 10/2/98]
Question: Is it true that fosamax is approved for treatment of osteoporosis but not
for prevention of same? My doctor is putting me on a combination of Raloxifene and
Fosamax. Is that redundant or will the two work together?
Answer: They work fine together, at least theorectically. No direct test to this
point. Fosamax is used by most physicians for prevention as well as treatment. We’re
usually ahead of the FDA on these issues. Judge by your bone densities, but, the combo is
probably fine.
Osteoarthritis and Osteoporosis
[posted 8/6/98]
Question: My mom is age 79, has one replaced hip from 5 years ago. She has
osteoarthitis, osteoporosis, recent allergies (dust, mold and cat) and recently diagnosed
COPD and asthma, which are under control via medication – inhalers. She feels she is
getting worse with arthritis and pain. She has taken allergy shots since October, 1997.
Could there be any connection between her feeling worse in her hip and knee joints and the
allergy shots? She feels there is a connection. Her mobility is getting less and less. I
am very concerned. She asked her doctor about physical therapy and he said it would not
help. I find that hard to believe as she is getting weaker and weaker due to doing less
and less. She is on tylenol 2 one at night, naprosyn 500 mg twice a day, one premarin a
day, hydrochlorothiazide 25 mg one a day, Diovan 80 mg one per day, one aspirin a day,
glucosamine chondroitin twice per day for a couple of months at her doctor’s suggestion,
but he does not believe in it, and inhalers. I am desperate to help her. She lives alone
and is heading downward due to this.
Answer: Don’t know why there should be. However, physical therapy is often very
helpful-especially if there is any element of muscle weakness. For example, that is how
most professional trainers treat joint injuries – by improving surrounding muscle
strength. It works for the elderly also.
Osteoporosis Medications [posted
7/29/98]
Question: I am a 57 year old female with osteoporosis of the spine and hip. The
bone density scan results: spine 2.9% and hip 1%. My family doctor recommends estrogen and
progestin pills. He said if I don’t take the pills, I will be paralyzed in 10 years.
Because of risk factors linked to estrogen/progestin pills (even though slight), I would
like to know more about other medications for osteoporosis and what their risk factors
are. The medications that I am interested in knowing about and In knowing their risk
factors are: (1) fosamax (2) nasal miacalcin (3) the estrogen patch – does it have the
same risk factor for breast cancer as the estrogen pill and secondly does the patch have
the progestin? (4) what does the over the counter glucosamine and citondroitin do for
osteoporosis, if anything? Lastly, should I be seeing a bone specialist? I have never had
the need to be on any medication all of my life. Recently had a blood test – results
excellent. I also had a mammography and pap smear, which indicated no problems. The bone
density test, however, did indicate osteoporosis.
Answer: It seems your long term risk of cardiovascular disease is small. This
means that your quality of life will depend on several things. One of the major risk
factors for quality is osteoporosis. Between fractures and bone pain, this can really
reduce the “golden years”. Prevention of fractures would be important. However,
most studies show that estrogen replacement after menopause must be begun without
interruption. That is, an interruption of over 6 months or so causes osteoporosis that is
irreversible. I would prefer some of the newer “designer” estrogens that do not
appear to have breast cancer risk, but might help osteoporosis. However, you need to take
Fosamax (or miacalcin if you cannot tolerate the GI side effects of Fosamax). Estrogen
might do some good, but is unpredictable at this point. Also, ensure your Vitamin D intake
is adequate (some would check the blood level of 25, Vitamin D to ensure proper
metabolism/absorption), continue weight bearing exercise, and adequate calcium intake.
Have your doctor check your thyroid levels, PTH levels, to ensure there are no additional
risk factors for osteoporosis/osteomalacia. The estrogen patch probably has the same
overall risks as oral estrogen. Glucosamine, etc., would be of no help with osteoporosis –
possibly osteoarthritis.
Glucocorticoid Induced Osteoporosis
Question: What treatment do you suggest for glucocorticoid induced osteoporosis? I
am 43 years old and pre-menopausal. However, in February 1995 I was involved in an MVA.
Following the use of pain medication, I was prescribed cytotek (to prevent a stomach
ulcer) which caused me to hemorrhage badly by starting up a 13-day period (no such
experience in the my past). My BP dropped to 60/40 and no hospital beds were available so
I was told to go home and drink lots of water and return to my family doctor in 2 days.
For 8 months the best BP reading I would get was 85-90/60. I felt tired and nauseated all
the time, even with the aid of a support hose. I changed to another family doctor who
immediately sent me to a specialist in internal medicine. He prescribed florinef acetate
and atenolol (my pulse was quite rapid) for 11 months, as well as cylert to help with my
concentration. I had seen a neurologist who had told me that my symptoms indicated a
post-concussion syndrome. Two months ago, I finally got my turn for testing to further
understand why I have suffered from dizziness and nausea since the accident. The tests
showed normal hearing, normal auditory brainstem, but benign right-beating positional
nystagmus. I can only access the recommended physiotherapy in another 3-4 months because
of another waiting list. When I was taken off the florinef and atenolol the internal
medicine specialist ordered a bone density test. He told me this was just to get a
baseline from one year to the next. The results came in and I have advanced osteoporosis.
I have to wait yet another month to see the specialist. Of course with the nystagmus and
nausea, I have been unable to do much physical activity. My doctor will not let me drive
and I need a personal aid for care at home. I also take 0.075 mg synthroid per day. Any
suggestions for what I can do myself and what type of medication would be best to treat my
osteoporosis?
Answer: The suggestions I have are several. First, why did your blood pressure
get so low? Florinef is a good treatment, but healthy adults don’t need replacement. Did
your adrenal axis get tested? When did you start on thyroid? In other words, did the MVA
damage your pituitary gland causing adrenal insufficiency? Did this get tested? Second,
osteoporosis would be very rare in a 43 year old. There are several potential causes.
These include hyperparathyroidism, Vitamin D deficiency, and hypothyroidism. It is
possible that your hypothyroid state (if untreated for several years), could cause the
problem. It really sounds like somebody needs to become your advocate in the medical
system. A good GP , family doctor or internist can do this. I’d really focus on the reason
for your problem. It hasn’t been answered satisfactorily in my opinion.
Osteoporosis treatment
Question: I am a 68 year old male undergoing treatment for osteoporosis of the hip.
The treatment is dual in nature. Use of Fosamax and use of testosterone by injection.
Treatment is working well after one year. The problem is that I am moving to Fort Meyers,
Florida. My doctor’s recommendation is to contact an Endocrinologist for Osteoporosis
hormone treatment with testosterone. Do you have any suggestions?
Answer: Off hand, I am not aware of any specific physicians. However, this is
relatively straightforward and any Internist or Endocrinologist could continue this
treatment. A specialist in osteoporosis is not necessary at this point.
Osteoporosis
Question: What is the latest information on Fosamax as a treatment for
Osteoporosis? I am an active 52 year old woman whose bone density test shows bone
deterioration in the spine and hip. What are the side effects and long term effects of the
drug?
Answer: Fosamax is an effective treatment for women(or men) with osteoporosis.
The drug is poorly absorbed (10% or so) and must be taken on an empty stomach and with no
other food or medicines for 30 minutes or so. Side effects are mainly GI. Some patients
experience severe inflammation of the esophagus and/or stomach. It is critical to take
this with a large amount of water to avoid any slowing of transport through the esophagus.
Some patients experience abdominal gas, diarrhea and other GI side effects. About 90% of
my patients have absolutely no side effects what so ever.
Osteoporosis
Question: Which is more effective for treating osteoporosis – fosomax or
calictonin?
Answer: It’s not really clear since they haven’t been compared in a head to head
study. We have used calcitonin for years and fosamax for about one year. I’m so far more
impressed by the bone density numbers of fosamax. However, these drugs need to be compared
in a head to head study of bone fractures before any meaningful comparison can be made. In
the meantime, I favor fosamax unless the woman has GI problems. If this is the case use
nasal calcitonin.
The “Tens Unit”
Question: My 76 yr old mom has Osteoporosis. She also has 3-4 compression fractures
of the vertebrate. She is a widow & lives by herself. She has help during the week and
I (who lives 50 miles away & have Fibromyalgia)try to help as much as I can on the
weekend when I am not at work. I have heard of TENS units and wonder if this device would
be of help to my mom for her pain. She has heart disease, Diabetes(not Insulin dependent),
and has had 2 heart attacks (which were not detected at the time of occurance). She is on
Fosomax and for pain- Tylenol with Codiene. Her Dr. does not want her on anything stronger
as she lives alone. That is why I have wondered if the TENS unit might be of help but
wanted to get an expert’s opinion before getting her hopes up.
Answer:Compression fractures of the spine and hip are a common source of pain
and disability to women-especially, post-menopausal women. There are several things to try
and relieve pain from compression fractures. 1.Tens units. These emit an electrical signal
that somehow blocks the pain fibers by literally overloading the system so fewer signals
get through. In my experience, this is helpful about 20% of the time. But, they’re
relatively cheap and non-invasive. 2.Calcitonin. Injections of calcitonin or more recently
inhalation of calcitonin in a nasal spray will sometimes help the pain. Presumably by
“healing” the fracture. 3.Local measures. Do not overlook such tried and true
remedies as heat, ice, Ben Gay and other salicylate creams and Zostrix cream. Zostrix was
initially used to treat the pain from shingles-but, often helps any local pain such as
arthritis or fractures. It will need to be used at least three or four weeks before you
can determine if it is of help. 4.Braces. Truncal support braces to decrease the weight of
the body on the fracture area are of occasional use. Last but not least. Ensure that your
grandmother’s physician has checked her vitamin D levels and her parathyroid levels.
Disorders of either(a common problem) will impair the healing and lead to other fractures
and subsequent disability.
Cracking Knees
Question: My knees have been cracking and creaking for at least four years. They
only make this racket, however, when I bend and stoop. Should I be concerned? Does this
mean I’m more prone to osteoporosis? I am very young, sixteen to be exact. Please
help!
Answer:If you are not having pain or instability, I wouldn’t be too concerned.
The joints can produce lots of noise without meaning there is excessive wear. Excessive
wear will be demonstrated by pain.
Miacalcin Nasal Spray
Question: Recently, I was prescribed Miacalcin nasal spray for osteoporosis. I also
take Synthroid (.1), 5 Tums tablets, 1 vitamin w/minerals, and 1 Vitamin E gel tablet. I
take the Synthroid in the morning before eating, the vits. after eating, 3 of the Tums
after lunch, and the Miacalcin and 2 Tums before bed. Is this the best way to take this
chemical soup?
Answer: Since the Miacalcin is a nasal spray it can be taken at any
time-alternate nostrils on alternate days. The rest really don’t matter much, if there is
iron in the multivitamins it could hinder the thyroid absorption-more an academic problem
than a real one at the usual doses of iron in mvi. There doesn’t seem to be much limit on
calcium absorption and it appears to be absorbed by 2 hours or so.
Fosamax
Question: I am a premenopausal paraplegic (T-10, 6 yrs) with osteoporosis in my
legs. Would treatment with Fosamax (or other bisphosphonate) or other drugs used for
osteoporosis provide a benefit in preventing leg and hip fractures? I realize this is not
currently an approved indication, but would it be expected to work?
Answer: I certainly would if I was your physician. Get bone densities as a start
point and reassess them in one year or so.
Fosamax
Question: I’ve been reading your informative page with interest. My question is
this: I’ve been diagnosed with very mild osteoporosis (from a bone density scan) and
my doctor has recommended that I take fosamex. Almost everything I see related to this
drug involves women. I am a 47 year old male. Any comments or suggestions?
Answer: Why did he do a bone density in the first place? Risk factors for males
include testerone deficiency, thyroid disease, Vitamin D deficiency, long term steroid use
and hyperparathyroidism. The most common reasons for males is steroids or the lack of
testerone-are you on supplements? If none of these conditions exists than either you don’t
need the drug or you need to see a bone metabolic specialist. The next step is usually a
bone biopsy.
Prevention
Question: I am female, 50 yo, in the beginning stages of menopause, caucasian,
small boned. I recently had a bone density scan and the results say that I have moderately
severe osteopenia in the hip and osteopenia in the spine. My 74 year old mother recently
found out that she has osteoporosis after suffering a compression fracture of a vertebra
while horseback riding. I feel that if bone density testing had been available when she
was 50, she might have been able to take more actions to prevent osteoporosis and I would
like to avoid being in her situation when I am in my 70’s. My doctor’s recommendations are
that I get 1200 mg of calcium daily from foods and Tums, and that I have another bone
density test in a year. I also intend to continue my exercise regimen which includes
weight bearing exercise. Is there more that I should or could be doing? What about
estrogen replacement or a drug such as fosamax?
Answer: You don’t mention whether your periods have ceased or not. In any case,
you should take estrogen replacement unless there is a strong family history of breast
cancer. Calcium is a good idea and you should ensure that your Vitamin D levels are
normal. This is best done by testing 25, Vit D levels(ask your doctor to order this).
Also, there are other medical conditions which will exacerbate bone loss. Ensure that your
thyroid levels are normal and your parathyroid levels are normal. Regarding Fosamax,
research is in progress to determine if high risk women should take small doses(or larger)
to prevent osteoporosis. However, my bias would be to take the Fosamax at least until the
research is done(2-3 years probably). Continue exercising-low impact weight bearing-and
ensure that you get mammograms and colon cancer screening to ensure that you don’t get
another major problem while you are focusing on bone density.