Q: My gynecologist prescribed Evista 60 mg. In fact, he kept urging me to take it. I would appreciate your advice on this.
A: Evista (raloxifene) is prescribed to prevent and treat osteoporosis, a condition in which bones become thin, weaken and subject to fracture.
Side effects of raloxifene your physician is urging you to take can include sudden headache, chest pain, edema of the hands or feet, severe lower back pain, hot flashes, difficulties with vision and balance, nausea, flu-like symptoms, and more. The drug should be discontinued at least 72 hours prior to extended periods of immobilization and not resumed until the individual is completely ambulatory. While infrequent, cardiovascular effects have been reported and are known to include very serious medical events such as DVT (deep vein thrombosis [blood clots]), pulmonary embolism and retinal vein thrombosis. Risk factors include the use of alcohol and tobacco, having high cholesterol levels, or a history of heart disease.
Evista oral is taken by mouth once daily either with or without food, or as directed by a physician. It is recommended calcium and vitamin D be included in the diets of those prescribed this medication. It should not be taken by women prior to menopause, nor should it be prescribed for children.
Osteoporosis is primarily seen in post-menopausal women, followed by those with a sedentary lifestyle, on steroids, with chronic alcoholism, or with certain conditions to include DVT and related disorders. It can, however, affect men and women of all races. Risks that remain out of our control include having a family history of osteoporosis, the aging process, being female, and even the size of a person’s frame. It appears those individuals we consider “small boned” have less bone mass from which to draw as they age. From a dietary standpoint, low calcium intake contributes to low bone density, early bone loss and an increased risk for fractures. Those individuals who have undergone gastric bypass surgery or partial intestinal bypass also appear to have a limited ability to absorb nutrients, to include calcium.
Bones are living tissue in a constant state of change and are regulated by two types of cells, osteoblasts and osteoclasts. Early on, osteoblasts form bone tissue. Osteoclasts, on the other hand, destroy older bone. Bone resorption occurs as the mineral content from old bone is returned to the body. When this normal balance of formation and resorption gets out of whack, osteoporosis results. Symptoms include loss of height, a stooped posture often referred to as a dowager’s hump, back pain that is caused by collapsed or fractured vertebra, or bone fracture.
Diagnosis for osteoporosis can easily be determined through an X-ray known as dual energy X-ray absorptiometry (DEXA). This non-invasive, painless test can measure the density of bones in the areas of the body most commonly affected by osteoporosis such as the spine and hips.
Treatment is often provided with bisphosphonates such as Boniva, Reclast, Fosamax and others. There are side effects for some individuals on these drugs that can include abdominal pain, headache, fatigue, nausea, difficulties swallowing and more. On the home front, I might suggest calcium with vitamin D which is available over-the-counter. The recommended dosage of calcium for men between the ages of 51 and 70 and pre-menopausal women is 1000 mg. Post-menopausal women should take 1000 – 1500 mg and 600-800 IU of vitamin D daily. Ask your gynecologist why he prefers a prescription drug over this recommendation and if it can be tried for a period of time, rather than the Evista. The calcium/D is much safer and will likely be cheaper especially if you don’t have prescription insurance. It is also vital that you stop smoking (if you do so) and begin exercising to include light weights.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, M.D. Health Report, to PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
