DEAR READER: Yes, you can. Your physician can strongly recommend a medication or course of treatment and indicate why he feels it is necessary, but the bottom line is that it’s your body. I am sure that he has your best interests at heart, but perhaps a calcium plus vitamin D supplement will suffice. Therefore, before getting into any shouting match, I suggest you speak with him and review all options.

My dentist has now warned me that he would never pull a tooth because of the Fosamax. He says he would do a root canal and cap the tooth however. Could you give me any advice regarding this medication? My gynecologist told me that there were no bad side effects unless the Fosamax were given by injection. Thank you.

DEAR READER: Your dentist is on the cutting edge. Fosamax (and related bisphosphonate medications) can rarely cause mandibular necrosis (destruction of the jaw bone). Tooth extraction, local infection and delayed healing following dental procedures put individuals with osteoporosis at higher risk of developing this disorder. It generally affects cancer patients who are treated with the IV biphosphonates. Individuals who are taking corticosteroids, are receiving chemo or radiation treatments, have existing dental disease or poor dental hygiene, anemia, infection or abnormal blood coagulation while taking Fosamax are also at higher risk. Dental surgery may worsen the condition, but it is not known if stopping the medication before dental procedures will reduce the risk. Even more rarely, women with postmenopausal osteoporosis and no other risk factors will develop mandibular necrosis.

This is a rare disorder but because it can be so detrimental, physicians are now taking precautions, such as your dentist has done and some are using prescription osteoporosis medications only as a last resort. Increasing calcium and vitamin D intake can help slow the bone loss and if started before significant loss has occurred, it may even prevent osteoporosis.

Because you have taken Fosamax for several years without side effects, I recommend that you continue. For you, the benefits outweigh the risks. If, however, you develop jaw pain, joint or muscle pain, stomach upset, cramps or bloody stool, see your physician immediately. Fosamax and similar medications can cause ulcers (rarely bleeding), esophageal stricture (narrowing) and other problems. To rule out more serious disorders, your physician should order X-rays and other imaging studies. If the Fosamax is to blame, he should switch your medication or discontinue it completely.

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