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.

DEAR READER:
As I am sure your doctor mentioned, osteoporosis means “porous bones” and refers to the loss of bone density and bone mass that commonly appears as we age. Mild bone loss is known as osteopenia. Osteoporosis occurs when the loss is so extreme that the bones cannot perform their supportive function. As a result, they can easily break.

The condition is commonly found in postmenopausal women, but can affect men as well. Hunched shoulders and a stooped posture are often attributed to the aging process, but may actually be the result of osteoporosis. Other signs are kidney stone formation, gum recession, tooth plaque, joint pain, thyroid disorders, and lower back pain.

Hormone therapy for women using patches, creams or vaginal rings, was once the gold standard for treatment. Unfortunately, because of safety concerns, this is no longer the case.

Biphosphonates may preserve bone mass and increase bone density in the spine and hips. This treatment can be beneficial for men, younger adults, and those individuals with osteoporosis induced by therapeutic steroid use. Biphosphonates can be taken orally or intravenous infusion. Side effects can include bone, joint and muscle pain (mild to debilitating), severe abdominal pain, nausea and osteonecrosis of the jaw (destruction of the jaw). Those with a history of ulcers or acid reflux should avoid this class of drugs because of the possibility of esophageal inflammation and esophageal ulcers. Common biphosphonates include Fosamax, Actonel and Boniva.

Zoledronic acid (Reclast) is in the bisphonate class and was approved by the FDA in 2007 as the first once-a-year drug for osteoporosis. It is also indicated for the treatment of Paget’s disease (“soft” bone disease) in both men and women. It should be avoided by those with kidney disease. Adverse reactions include bone, joint and muscle pain and osteonecrosis of the jaw. Reclast is given intravenously in a physician’s office.

Raloxifene (Evista) mimics the beneficial effects of estrogen for post-menopausal women only. It is not approved for men or pre-menopausal women. Those with a history of blood clots should not take this drug as there is an increased risk of deep vein and retinal vein thrombosis and pulmonary embolism. Adverse reactions include hot flashes, leg cramps, flu-like symptoms, peripheral edema (leg swelling), and joint pain.

Teriparatide (Forteo) works by stimulating new bone growth. It is an injection given once daily under the skin in the thigh or abdomen. The medication has been found to cause an increased risk of a certain malignant bone cancers in rats and it is not known at this time if it affects humans in the same way. There is a black box warning on this product’s packaging and, in my opinion, the product should be avoided.

There is no practical way to restore bone mass. However numerous treatments to slow the process of deterioration are available. For example, a new emerging therapy without prescription medication shown to significantly reduce back pain and improve posture is known as weighted kypho-orthosis (WKO). It is a harness with attached weights that is worn twice daily for 30 minutes at a time. It is combined with back extension exercises.

Given the drugs now available, it is rather difficult to determine which therapy might be appropriate for every person. Because I am not your personal physician and we have never met, it makes that job even harder. I don’t know your age, current medications, exercise habits, weight, family history, and more. Therefore, I cannot determine the best choice.

I strongly urge you to speak with your physician who knows you and your medical history and can make an appropriate choice. I know this sounds as if I am taking the easy way out, but osteoporosis is an extremely important and complex issue. Were I put on the spot and forced to make a decision, I would probably recommend you take 1200-1500 mg calcium combined with 400 international units (IU) of vitamin D daily. When combined with regular exercise and a nutritious diet high in calcium containing foods, such as yogurt, fat free milk and dark leafy greens, this can be an excellent preventive step and may stop further bone loss if started early in the disease. To determine if it is working, be sure to have a bone density study one year after starting therapy. Bypass all oral and injectable prescription drugs as long as possible or until more time has passed and additional research can be done.
To give you related information, I am sending you copies of my Health Reports “Osteoporosis” and “Consumer Tips on Medicine”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER: Forteo is a synthetic form of parathyroid hormone. It increases bone density and bone strength. It is used for both men and women at high risk of fractures. Forteo is given as a daily injection under the skin of the thigh or abdomen. Your physician will show you how to use the medication-dispensing pen to ensure proper dosing.

Forteo should not be used for more than 2 years by those who have bone disorders other than osteoporosis, have ever had kidney stones, bone cancer or radiation treatments involving bones, those with hyperparathyroidism, an allergy to teriparatide, and those with high blood levels of alkaline phosphatase or calcium. It may be harmful to unborn babies and it is not known if it can be passed through breast milk. Avoid alcohol and tobacco smoke while on Forteo since these substances can decrease bone density. Certain medications, such as digoxin should not be taken with Forteo.

Side effects can include allergic reactions, lightheadedness/fainting, rapid/forceful heartbeat during injection, nausea, vomiting, constipation, muscle weakness, mild dizziness, leg cramps, joint pain, headache/neck pain, and pain, swelling, itching, bruising or redness at the injection site and more.

Forteo has also been found to cause an increased risk of osteosarcomas (malignant bone tumors) in male and female rats that was dependent on dose and duration of treatment. It is not known if this risk is valid in humans. The recommended dose is 20 micrograms daily.

I have no experience with Forteo but based on the information I have, I likely would not prescribe it.

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.