DEAR DR. GOTT: I am interested in the graduation of osteoporosis – mild to medium. I broke my little toe recently and it healed fine. I was diagnosed with osteoporosis recently and take a multi-vitamin and calcium supplement (500 mg calcium, vitamin D 200) as part of my treatment. I was told I definitely have osteoporosis from breaking my toe according to a bone density test. I wonder after it healed fine how severe it is and whether a medication like Boniva or similar drugs are a good idea only in medium to severe cases.
DEAR READER: Osteoporosis, (OP) is a common bone disease that affects more women than men; however, men can be diagnosed with the disorder, also. Because bone is living, the body is continually replacing old bone with new. When the body fails to form sufficient new bone or when too much bone matter is reabsorbed by the body, osteoporosis results. If a person’s dietary habits fail to include adequate calcium or when supplements provide inadequate amounts of calcium and vitamin D, bones can become brittle, increasing the risk for fracture. Other causes of bone loss include being bedridden, specific medical conditions, some medications, low body weight, drinking in excess, and a family history of osteoporosis.
Unless a physician orders a bone mineral density test, some patients may be clueless that they have any degree of bone loss unless they experience a fracture, loss of height, stooped shoulders, kyphosis (a dowager’s hump) or back pain caused by a compression fracture. A simple X-ray may reveal a compression fracture; however, the testing will not be an indication of osteoporosis. To answer your question, the initial stages may be inconsequential, while the later stages will be more pronounced and will be accompanied by pain.
Boniva, Fosamax, Reclast and Actonel are in a class of drugs known as bisphosphonates and are the primary drugs prescribed that work by helping prevent bone loss. According to the National Osteoporosis Foundation, if a person has an osteoporosis-related fracture, he or she is probably at a higher risk for future fractures than the person without the fracture. Having said that, only your doctor – with the help of the DEXA (bone density test) – can determine if you are at high risk and should be prescribed a bisphosphonate or if your risk may not be as high and a supplement might do the trick. It should be noted that drugs in this category can cause osteonecrosis (death) of the jaw bone. Extended use has also been linked with non-trauma related femur fractures.
Your DEXA has a read-out that clearly defines the severity or lack thereof of your condition. Without access to that information, I cannot begin to determine the stage you are at. However, what I do know is that adults under the age of 50 should include 1,000 mg of calcium and up to 800 IU of vitamin D to their daily regimens. Women from the ages of 51 to 70 need 1,200 mg of calcium and between 400 and 800 IU of vitamin D daily, while men in the same age bracket only require 1,000 mg of calcium and up to 800 IU of D. Because you have been diagnosed and indicate your calcium intake is 500 mg with 200 units of D, I feel you may not be properly protected. Speak with your physician regarding the possibility of increasing those amounts with an OTC to what I have recommended.
You should also incorporate exercise into your daily routine and might include tai chi, walking, jogging, biking, dancing, working out with light weights, and almost anything else that doesn’t stress the body too much but rather, keeps it moving.
The average adult may also neglect to give appropriate thinking time to making our houses safe to walk through. We might consider the use night lights, remove scatter rugs and extension cords that are tucked under the edge of carpeting, avoid medications that may have a sedating effect if we have to be out and about, and plan to stay indoors if sidewalks are icy.
Readers who would like related information can order my Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
