DEAR READER: Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bones falls out of balance. The condition is difficult to detect in its early stages, but the first clue is often a bone fracture, loss of height, back pain, stooped shoulders or through a routine bone density (X-ray) study.

There are a number of prescription medications; however, as you may be aware, several can lead to osteonecrosis of the jaw and other serious complications.

The recommendation for people 51 and older is 1,200 milligrams of calcium per day. Vitamin D is of equal importance in order to utilize the calcium and should not exceed 2,000 IU daily for healthy people. Therefore, in answer to your question, it all depends on how much calcium and D is present in the vitamin regimen you are taking. Read the ingredient label. If necessary, switch to combinations of calcium and D available at your local pharmacy in single-tablet form.

Beyond that, don’t smoke, avoid alcohol, maintain good posture, eat well, and exercise.

To provide 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 No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I have a question that I cannot seem to find an answer to. Can calcium and fish oil be taken at the same time? I find it easier to remember if I take all my pills at once but worry that I am not getting all the possible benefits.

DEAR READER:
As far as I know, there is no problem taking fish oil and calcium together. The benefits should not be adversely affected. If you are worried about taking medications together, I suggest you speak to your pharmacist who will be able to help. He or she should know of any possible dangers or complications that may occur between two or more medications taken at the same time.

DEAR READER:
I am unaware of any authority that states only 300 mg of calcium can be absorbed at a time. However, I see no harm in your friend’s practice.

I am unfamiliar with any calcium marketed in a lower dose than 600 mg. This is probably due to the fact that the daily recommended daily dose is 1200 mg. Most people would prefer to take one or two pills rather than three or four every day.

I also recommend you to take a calcium supplement with vitamin D added. This vitamin is important for the body’s absorption of calcium. The daily recommended dosage is 400 international for those 51-70 and 600 international units for those over 71. This amount can often be achieved by taking two calcium plus D supplement pills.

If you still have concerns, speak with your primary care physician or gynecologist.

Is it possible for me to get enough calcium from my diet without taking the over-the-counter kind? I enjoy all kinds of vegetables and dairy products. I run and take aerobics classes (which includes weights) about three times per week.

DEAR READER: I recommend that you have a bone density exam. This test will let your doctor know how well your bones are absorbing calcium. If you have minor deficiencies (osteopenia) but not osteoporosis, increasing your calcium intake with calcium and vitamin D supplements may stop or slow bone loss. If you have osteoporosis, you should start one of the medications available on the market as well as including extra dietary calcium and vitamin D.

Whether or not you need calcium/vitamin D supplements, they are relatively inexpensive and won’t hurt you. (Incidentally, just because you are slim is not reason enough to assume that you are a candidate for osteoporosis.) As a preventive you may wish to start taking supplements even if you have no problem.

If you decide to take calcium supplements, be sure that you take one that includes vitamin D. The vitamin D works with the calcium in your body and aids absorption. Without it the amount of calcium used by the body is minimal.

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.

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.