My recent bone density exam showed a T-score of negative 2.6 for the femoral neck. The previous one was negative 2.2. My T-score for L1-L4 is negative 1.2 and the one before was negative 1.1. My question to you is, what can I do to improve my bone density?

DEAR READER:
You don’t say if you are taking calcium plus vitamin D supplements. If you are not, you should be. I recommend you take 1500 mg of calcium and 400-600 IU of vitamin D daily. The vitamin D aids calcium absorption.
You need to know why you are continuing to lose bone mass despite treatment. It is vital this is done before serious injury occurs. You are at an increased risk of spinal compression fractures which can occur without trauma. You are also at risk of breaking a hip or leg due to minor falls or accidents. Given your relatively weak bones, this could mean months or even years of painful and slow healing.

I urge you to return to your primary care physician and request a referral to an endocrinologist. He or she can order additional testing to see if there is another cause for your worsening bone density, such as thyroid disease. You may also benefit from an alternative medication such as Calcitonin which is derived from thyroid hormones.

Another option is Forteo. This drug is a daily injection that is reserved for severe cases that do not respond to other medications. It should not be used for more than a maximum of two years because of the increased risk of side effects. Forteo also has a black box warning because it has been shown to increase the risk of developing a type of malignant bone cancer is rats. It is unknown at this time if this holds true for humans as well.

As a final note, if you are on any other medications, it is important that the physician or specialist review them to ensure they are not interacting with or counteracting the Boniva. It is also necessary to find out if worsening bone density or calcium loss is listed as a side effect for any of them.

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 mention the title.

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.

DEAR READER:
As I originally reported, Actonel is ordinarily a beneficial drug. However, some people suffer side effects. Most are mild and do not justify discontinuing the drug, yet some are extremely serious. Chest and back pain, esophageal stricture, joint pain, nausea, diarrhea, back and abdominal pain, hypertension, urinary tract infections and more have been reported. As I’ve said in the past, all biphosphonates can cause osteonecrosis of the jaw, destruction and death of bone tissue. Therefore, any decision to begin a trial of a drug should be discussed in depth with your physician.

You appear to be extremely sensitive to this class of drug. Your physician has correctly stated enough is enough. Try taking 1200 mg of calcium combined with 600 IU of vitamin D daily as an alternative. You should also eat more healthful meals, including foods that are high in calcium. Exercise to the extent of your capabilities to maintain strong, healthy bones.

I currently take Evista with 1200 mg of calcium. I am a healthy 53-year-old menopausal woman. Is there another drug that I should be taking in lieu of Evista? My doctor has recommended the drug (Boniva, I think), after which you have to be able to stand longer than one to two hours. I’m not thrilled with the idea of that drug either.

DEAR READER:
Every drug has side effects — even non-prescription ones. As I have mentioned before, whether a patient takes a medication or chooses not to do so, the person needs to know about the risk/benefit factors.

Biphosphonates, such as Fosamax and Boniva, do carry the rare risk of osteonecrosis of the jaw. This is increased in individuals with cancer, poor dental hygiene, and more. Evista’s possible risk of premature heart disease is some women is a far more concerning side effect.

If you have moderate to severe osteopenia (bone weakness) or any stage osteoporosis, the choice of medication is up to you and your physician. There will still be a possibility of side effects regardless of the treatment you choose. If you have mild osteopenia, you may be able to prevent worsening by increasing your daily intake of calcium and vitamin D. Speak to your gynecologist or primary care physician about possible options.