Is nasal spray the answer for osteoporosis?

Q: I’ve read in your columns about Atelvia, Actonel, Fosamax and Boniva for osteoporosis but never anything about Fortical. It is a nasal spray used once a day and was recently prescribed by my physician. It seems to have few side effects but is it as effective as the other medications?

A: Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bone fall out of balance. When the loss is greater than the gain, low bone mass results. The average individual begins to lose bone strength by the time he or she is in the mid 30s. Of the millions of men and women diagnosed with osteoporosis, post-menopausal women head the list, followed by people with small frames, those that lead a sedentary lifestyle, are on corticosteroids, or diagnosed with hyperthyroidism and rheumatoid arthritis.

Fortical is a polypeptide hormone used to prevent and treat osteoporosis. The active ingredient in the product is calcitonin-salmon, a manufactured form of the hormone calcitonin that occurs naturally in the thyroid gland. It is available both as an injectable and as a nasal spray. The injectable form treats osteoporosis, Paget’s disease and seriously elevated blood calcium levels, while the nasal form is used for osteopenia and is licensed for women diagnosed with osteoporosis who have been post-menopausal for at least five years. The nasal form should be used in conjunction with calcium and vitamin D and will be discussed here since this is what you have been recommended. According to some researchers, the nasal form is less popular because of its relatively modes effect on bone mineral density and weak anti-fracture efficacy compared with bisphosphonates and parathyroid hormone.

Side effects are generally uncommon or mild but may occur and might include severe nasal irritation, tremors, and a feeling of passing out. Less serious issues include epistaxis (nose bleeds), headache, back pain, nausea, a runny or stuffy nose, tremors, redness in and around the nose, dryness/itching/tenderness/general discomfort of the nose, and crusting lesions inside the nose.

There are several drugs known to interact with Fortical. Some of the more common medications are Tagamet (cimetidine), and morphine; however herbals, vitamin and other over-the-counter products should be reported to your physician prior to beginning the medication.

Calcitonin-salmon is a protein, implying a systemic allergic reaction can exist. As such, your physician may choose to perform an allergy skin test prior to prescribing your first dose of Fortical Nasal Spray. As such, he or she should be informed of any nasal deformities, nasal pain, chronic infection or other sinus problems you may have. The spray will deliver a fine mist into the nose and is good for 30 sprays. At the end of the 30 sprays, the dispenser should be discarded, even if medication remains in the bottle. Fortical is sprayed into one nostril only daily, rotating the next day to the opposite side. Other nasal sprays you may be on should be discontinued unless you have been given the okay by your physician to continue them.

Following menopause, the rate of bone loss accelerates. Fortical is not intended to prevent osteoporosis, but rather acts as a treatment that works by slowing bone loss and reducing a person’s risk of bone fracture. Lifestyle changes can also go a long way toward promoting healthy bones. Individuals should limit alcohol intake, discontinue smoking, eat well-balanced meals containing calcium and vitamin D, and stay active by exercising as much as allowed based on pother possible medical conditions.

I wish I could answer your question regarding Fortical but I do not have access to your medical records and don’t know what other conditions you might have or what medications you may be on. I do not know how severe your osteoporosis is. Some medications for osteoporosis are associated with an increased risk of femur fractures. Selective estrogen receptor modulators can increase the risk of developing blood clots, and hormone therapy can increase the risk of heart attack, stroke and uterine cancer, so it’s a tough call. I can only recommend you speak in depth with your physician and perhaps even get a second opinion before making the decision. In the interim, eat well, take calcium with vitamin D, and exercise.

Readers who would like related information can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Strontium for fighting osteoporosis

Q: I want to learn the truth about the effectiveness of strontium. My endocrinologist says strontium available in the United States does nothing to increase bone mass like the strontium sold in Europe does. She also said it will never be approved safe in the US. Am I wasting my money buying strontium? I am 68 and have osteo caused by a bad parathyroid. I go to the gym three times a week and take calcium and vitamin D.

A: Strontium was discovered in 1808 and named after a town in Scotland. It is reported to have been used safely as a medicinal substance for more than 100 years. Natural strontium is a non-radioactive element, of which almost 100% in the human body is concentrated in our bones; however, there are several different forms of the element. Radioactive strontium-89, for example, is administered intravenously to some patients diagnosed with prostate and/or advanced bone cancer. Strontium ranelate is being tested to determine if it can be taken orally in pill form to treat bones that are thinning from osteoporosis. Research suggests it may have the capability of jump-starting the formation of collagen and cartilage in joints. Strontium chloride which is an ingredient in some dietary supplements is the most common form; however, there isn’t sufficient scientific information available regarding its effectiveness. Strontium chloride hexahydrate is an added ingredient in some toothpastes to reduce sensitivity issues and is also found naturally in public drinking water sources in relatively high levels.

One 1959 study by researchers at Mayo Clinic investigated the effect of the element in 32 individuals with a diagnosis of osteoporosis. Each patient received 1.7 grams per day as strontium lactate. Eighty-four % of the patients involved reported marked relief of bone pain, while the remaining 16% reported moderate improvement. No appreciable side effects were reported, even three years into the program. X-rays taken from the beginning of the project to the end revealed a “probable” increase in bone mass in 78% of the cases. Keep in mind that a measurement of bone mass 54 years ago may not have been as sophisticated and revealing as CT scanning or a DEXA, (dual photon absorptiometry) is today; however, at the time the research was considered breakthrough.

Another study involved almost 1,650 post-menopausal women with osteoporosis who received either the real thing coupled with calcium and vitamin D or a placebo for three years. The results on those on strontium? Fewer fractures, a risk reduction of almost 50% in the first year of treatment and 41% during the full three year study period. Lumbar bone mineral density figures were up by 14.4% and an increase of 8.3% in the femoral neck density was noted.

Based on numerous studies, The Bone and Cartilage Metabolism Research Unit, University Hospital in Liege, Belgium, indicates strontium in doses up to 1.7 g/day appears to offer a safe, effective and inexpensive approach to preventing and reversing osteoporosis and may be of benefit in patients with osteoarthritis and cancer with bone metastases, as well as possibly helping with dental cavities.

FDA scares of exposure from nuclear medicine scans and radioactive strontium 90 fallout following nuclear testing in our country years ago may be why your endocrinologist indicates strontium is unavailable in our country, so let’s consider a different tack. Dietary strontium can be found in whole grains, leafy and root vegetables, legumes, and seafood. Were I you, I would prefer to eat a well-balanced, healthful diet and leave the supplement on the shelf. Take your calcium supplement with vitamin D added and stay active. You might be glad you did.

Other readers who are interested in related information can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Oral anti-osteoporosis drugs preferred over others

Q: I have read your columns on medications such as Boniva, Actonel, etc. and the recent one on Atelvia. What is your opinion on the one-year Reclast infusion?

A: Reclast (zoledronic acid) is in a group of medicines known as bisphosphonates. The medication is administered intravenously annually by a physician or nurse and takes about 15 minutes to complete. Calcium and vitamin D supplements are recommended to those on the drug. Reclast was designed to treat and prevent osteoporosis in women and Paget’s disease in men. The benefits of the drug are believed to last a year, yet the side effects will not last that long. Flu-like symptoms, muscle or joint pain, nausea, vomiting, diarrhea, fever and headache may appear within three days of the infusion but will generally dissipate in about two weeks. Fluids should be ingested prior to receiving the IV to help reduce the incidence of kidney difficulties that may lead to hospitalization that can be extremely serious. It is also used by people who expect to take steroid medication for a year or longer.

There are unwanted potential side effects, to include non-traumatic femur fracture, kidney damage when specific medications such as anti-virals, injected antibiotics, drugs for pain, arthritis and chemotherapy are used. Osteonecrosis of the jaw has been reported with side effects of jaw pain, loose teeth, anemia, clotting disorders, numbness and inflammation. Risk factors for developing osteonecrosis include being on chemotherapy for cancer, or the use of radiation and steroids. Individuals who should not use Reclast include those with low levels of calcium (hypokalemia), and those who are pregnant or are breast feeding because of potential harm to the baby.

You don’t indicate your age but I am guessing you are attempting to treat or prevent osteoporosis. Bisphosphonates to include Fosamax, Actonel and Boniva have been prescribed for more than 10 years. With time comes knowledge. For example, when an individual takes an oral medication for osteoporosis, only a portion of the drug gets into the bone where it is needed. Thus, the frequency of oral usage. It is believed that with infusion, the medication bypasses the stomach, passes through the bloodstream, and ends up in the bones where it increases their density. Reclast was first introduced into the market in August 2001. Because of its annual simplicity of dosing and FDA approval, it quickly became one of the most popular bisphosphonate medications in our country. However, on the downside, recent studies suggest that prolonged treatment of zoledronic acid’s pharmacodynamics may be linked with the risk of those femur fractures, kidney disorders and osteonecrosis mentioned above.

Suffice it to say I am a skeptic. We might think 12 years on the market would tell it all. In my view, the drug is, in some respects, in its infancy. I am not privy to your medical history or any other drugs you may be on. Therefore, I defer to your primary care physician. If he or she feels strongly that it is better for you than over-the-counter calcium with vitamin D taken daily, go for it. If any question remains, take the easy road and hold off. This is no reflection on the drug itself, only on the unknown.

Readers who are interested in learning more can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Should woman take gynecologist’s advice on Evista?

Q: My gynecologist prescribed Evista 60 mg. In fact, he kept urging me to take it. I would appreciate your advice on this.

A: Evista (raloxifene) is prescribed to prevent and treat osteoporosis, a condition in which bones become thin, weaken and subject to fracture.

Side effects of raloxifene your physician is urging you to take can include sudden headache, chest pain, edema of the hands or feet, severe lower back pain, hot flashes, difficulties with vision and balance, nausea, flu-like symptoms, and more. The drug should be discontinued at least 72 hours prior to extended periods of immobilization and not resumed until the individual is completely ambulatory. While infrequent, cardiovascular effects have been reported and are known to include very serious medical events such as DVT (deep vein thrombosis [blood clots]), pulmonary embolism and [Read more...]

Vitamin D supplement not necessary?

Q: My 80-year-old friend is very healthy, swims 40 laps in the pool every day but has such terrible leg and hand cramps, she hasn’t had a full nights sleep in years. She takes 1000 mg calcium daily but not vitamin D. She says she gets all she needs from the sun. Her skin is brown like saddle leather. Please help me.

A: Your friend should probably be on a vitamin D supplement. Those over 65 may not get adequate amounts from their diets or enough sunlight exposure. Individuals with darker skin also do not absorb as much sunlight into the skin and the body’s production of vitamin D may be reduced.
[Read more...]

On treating osteoporosis

DEAR DR. GOTT: I have been told I have osteoporosis and have a few questions. I’m 66 years old. My bone is 3.5, whatever that means. My doctor told me about Reclast but no way do I want that in my body or in my bones.

I had breast cancer in ’04, so far so good. I’ve had chemo and six weeks of radiation treatment.

Thank you for your help in this area. When you’re told if you fall you will break a hip, that’s not good. Bad feeling.
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Are drugs necessary for osteoporosis?

DEAR DR. GOTT: I am interested in the graduation of osteoporosis – mild to medium. I broke my little toe recently and it healed fine. I was diagnosed with osteoporosis recently and take a multi-vitamin and calcium supplement (500 mg calcium, vitamin D 200) as part of my treatment. I was told I definitely have osteoporosis from breaking my toe according to a bone density test. I wonder after it healed fine how severe it is and whether a medication like Boniva or similar drugs are a good idea only in medium to severe cases.

DEAR READER: Osteoporosis, (OP) is a common bone disease that affects more women than men; however, men can be diagnosed with the disorder, also. Because bone is living, the body is continually replacing old bone with new. [Read more...]

Rare side effect causes intense pain

DEAR DR. GOTT: This is to warn people with poor bone density of the severe side effects of taking a Reclast injection.

I have poor bone density and was advised by my doctor to have a Reclast injection. This would supposedly help rebuild my bone density. I was provided with a pamphlet that said a person might get fluid symptoms or joint pains that might last from one to two weeks. As of today, four months later, the pain remains and has turned my life into a living hell and me into a recluse. I was once an active 83-year-old woman who enjoyed going on trips and riding my stationary bike five miles, three times a week. Now, I am an 83-year-old who is limited to making short trips to the store, doctor and church and can no longer ride my bike because of the amount of pain I am in. [Read more...]

33-year-old stricken with degenerative bone disease

DEAR DR. GOTT: My 33-year-old son has been diagnosed with permanent bone degenerative disease in his lower spine, possibly due to an old injury in high school. He’s been told there is nothing that can be done to stop the continuous damage.

What’s the difference between his condition and osteoporosis which is reversible? He’s in great pain with no hope. Thank you for any suggestions.

DEAR READER: Degenerative disc disease refers to the normal changes in spinal discs as a person ages. Healthy spinal discs are flexible, cushioned and can withstand compression. These discs can be compared with shock absorbers on a car that help ease bumps and bends in a road. [Read more...]

Fosamax substitutes

DEAR DR. GOTT: I have been taking Fosamax for years to treat post menopausal bone loss. About three weeks ago my femur bone broke and I also had a benign tumor at the site of the breakage. I spent two weeks in the hospital getting that repaired. They put a steel rod in my leg and I developed severe post surgery colitis.

My question is — is Prolia a good alternative for Fosamax?

DEAR READER: Prolia (denosumab) is a monoclonal antibody designed to identify and destroy only certain body cells. It is prescribed for the treatment of osteoporosis in postmenopausal women who are at high risk of bone fracture by working to slow bone loss and increase bone strength. [Read more...]