Reader questions osteopenia meds

Dear Dr. Gott: I read your column every day and have learned many helpful things, but I’ve never written before. I am concerned about a decision I have to make soon regarding Reclast or Forteo for my osteopenia. I’m not sure I want to take either one, but my DEXA (dual energy X-ray absorptiometry) scan indicates I should.
I’ve always taken calcium with vitamin D and magnesium. I’ve also taken Evista and calcitonin daily.
I take Protonix for reflux, and I learned from your column that acid pills affect absorption. I have no major health problems, but I do have allergies to antibiotics, some foods and trees. Therefore, I’m afraid of all the chemicals in allergy shots.
I am 88 and still walk on my own. What would you suggest? I’ve talked to an endocrinologist once. Thanks for any help you can provide.
Dear Reader: Bone-mineral-density testing measures the level of minerals in bones. Readings classify how strong and dense bones are. The DEXA scan you refer to is a bone-mineral-density test similar to an X-ray. Some individuals have osteopenia (loss of bone calcium and phosphorus) without a loss of bone density because of disease, specific treatments or other conditions.
Osteopenia itself refers to levels lower than the normal range, but not low enough to be classified as osteoporosis. If osteopenia is diagnosed, the probability of advancement to osteoporosis is likely. Bones don’t reach their greatest density until about the age of 30. As we age, our bones lose density naturally, become thinner and weaken, thus increasing the risk of fracture.
Proper diet begun at an early age is vital. Consuming foods with vitamin D and calcium, weight-bearing exercises and the avoidance of excessive alcohol and cola begun at an early age will work toward maintaining healthy bones. The condition is not confined to women. Males are also susceptible; however, they are generally diagnosed at a later age.
Reclast is administered intravenously on a yearly basis. If diet is inadequate, the medication should be supplemented with calcium and vitamin D. Common adverse reactions include headache, arthralgias, pain in the extremities and fever.
Forteo is administered as an injection under the skin of the stomach or thigh. It should not be used for longer than two years without specific advice from your physician. Common adverse reactions include nausea, vomiting, constipation, muscle weakness, rapid heartbeats and a feeling of lightheadedness during the administration. The FDA placed a black-box warning on this product a few years ago because of the prevalence of an increase in malignant bone tumors performed on rats.
These, as with all medications, run the potential of unwanted side effects. Therefore, I recommend you have a frank discussion with your physician regarding both drugs. Express your concerns, and listen carefully to the responses. I don’t want you to suffer any fractures, but quite frankly, at your wonderful age of 88, I would be surprised if he feels strongly that you should take medication to ward off osteoporosis. My recommendations would be to eat well, continue to take calcium supplements with added vitamin D, and exercise to the extent you are capable. Then tell him you will discuss the issue again in five years.
To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dr. Peter Gott is a retired physician and the author of the book “Dr. Gott’s No Flour, No Sugar Diet,” available at most chain and independent bookstores, and the recently published “Dr. Gott’s No Flour, No Sugar Cookbook.”

Copyright 2009, Newspaper Enterprise Assn.

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