DEAR DR. GOTT:
I was just diagnosed with osteoporosis. Would you please tell me, in your opinion, the best route to go? Everyone is pushing this new IV treatment.

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.