Daily Column

DEAR DR. GOTT:
I am a 54-year-old female. One year ago I had a DEXA scan which showed severe osteopenia. I have GERD and a hiatal hernia and cannot take biphosphonate pills so my doctor put me on Boniva IV.

My question however, doesn’t have to do with the medication. Just before having the DEXA scan, I noticed several enlarged bones in my right foot and ankle. I was tested for Paget’s disease but the results were negative. At my last physical exam, my doctor noticed that my left shoulder blade had enlarged. I have seen several doctors and none can tell me what is causing my bones to enlarge. Do you have any ideas?

DEAR READER:
Because you do not say what type of testing you have had and what types of doctors you have seen I can only give you general suggestions. If these are repeats of what has been done or said, I apologize.

First, I would like to say that I hope along with your Boniva you were told to increase your calcium and vitamin D intake. Boniva and other osteoporosis medications were not designed to treat osteopenia but have been increasingly given to individuals with this pre-osteoporotic condition. If you are not already, I urge you to take 1000-1500 mg of calcium and 600-800 mg of vitamin D daily. This can be achieved through supplements or by increasing your fortified milk, cheese, and yogurt and dark leafy greens intake. Tofu is also often fortified with calcium and vitamin D to round out vegan (no animal products) diets.

Second, I suggest your seek another opinion from an orthopedic specialist who can order testing to determine if you do indeed have Paget’s disease. This condition is defined by abnormal bone break-down and re-growth. The process is sped up in sufferers and often causes bone enlargement. Despite the enlarged bones, they often are weak and brittle which is why Paget’s is often known as “soft bone disease”.

Testing can include X-rays to pinpoint bone enlargement, show re-absorption and other abnormalities. Another valuable test is a bone scan in which a material is injected to show bone better. In Paget’s disease, the affected areas show up darker than healthy, normal bone. A final step is a blood test done to determine the level of alkaline phosphatase. In most individuals with this condition, the levels are elevated. Because I don’t know what testing you have had, I cannot determine if you have had all or some of these.

Treatment for Paget’s disease is similar to that of osteoporosis. It includes biphosphonates such as Fosamax, Boniva and others, and calcitonin. Therapy is aimed at improving bone strength and mineral content.

Therefore, even if you have Paget’s disease, you are already receiving proper care; however, you need to have a diagnosis. If you don’t have Paget’s disease after having thorough testing, you need to know why you are having spontaneous bone enlargement. Ask your primary care physician for a referral to an orthopedic specialist and go from there.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.