DEAR DR. GOTT:
I just read in the New York Times that long-term use of biphosphonates for osteoporosis could lead to weaker bones in some people who use them. Since I suffer from the disease, I am very concerned and question whether I should discontinue my medication. I can’t get an appointment with my own physician for more than a month, so am turning to you for an answer.
DEAR READER:
You are referring to a small study reported in The Journal of Orthopaedic Trauma, disclosing patients with low-to-no-trauma fractures. A large portion of those in the study had been on long-term Fosamax therapy for an average of 6.9 years. Of particular interest is that all of the breaks occurred straight across the bone and some were preceded by weeks or even months of unexplained aches and pains.
In the past Fosamax has been associated with osteonecrosis of the mandible (destruction of the jaw bone) in some users. When this information was made public, I recommended all my patients on the drug switch to something else for control of their osteoporosis. With this newest report, I can only state my personal opinion which is to stay away from Fosamax and consider other options.
While research is ongoing and positive strides are being made, it often takes years before we know the full story on any medication. For example, biphosphonates are available in weekly and monthly doses through oral tablets, or annually by injection. Personally, I feel it is too soon to know of any possible long-term consequences that could develop while on these drugs. To compound the issue, by the time complaints are made and stories are correlated for similarity, years may have passed and the damage to bones might already be done. It’s a difficult dilemma.
Calcium supplements for men and pre-menopausal women should be 1000 mg with a vitamin D supplement of 400 IU daily. For post-menopausal women, the appropriate dosing is 1500 mg of calcium and 600 IU of vitamin D daily. The easiest way to accomplish this is to purchase a calcium supplement that also contains D, such as Citracal + D or Caltrate + D.
I want to include a quick note about vitamin D, since overload can cause poor appetite, constipation, confusion, mental changes, vomiting, and heart rhythm abnormalities. While too much D is unlikely for the average individual, normal ranges are 200 IU daily for individuals up to 50 years of age, 400 IU for those from 52-70 and 600 IU for those over 70. The tolerable upper limit for individuals over one year of age is 50 mcg or 2000 IU. Be sure to read the recommended serving size on labels, since you may have to consume two or more pills daily to get the proper supplement amount.
If you are concerned about taking too much vitamin D, you can easily take a plain calcium supplement with a separate vitamin D supplement to ensure you are not getting too much or too little of either.
Eating well-balanced meals that include broccoli, kale, mustard greens, legumes, and shellfish will help maintain strong bones. Healthful foods should be a part of everyone’s lifestyle.
Take your concerns to your primary care physician. If you haven’t had a bone density X-ray (DEXA) in the last two years, requests your physician’s office set up an appointment. Determine how severe your osteoporosis is and work out a plan together as to which control might be best for you.
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 120 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
About Dr. Gott