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Daily Column

December 11, 2008 By Dr. Gott

DEAR DR. GOTT:
I am a Caucasian woman, 78 years old, 5’ 2 ½” tall, weight 112 pounds and am in good health. I walk every morning and ride my bike and hike whenever I can. I am not sedentary. My problem is that my bone density is not improving. I was on Fosamax for five years with no results so my doctor changed me to Boniva two years ago. There is still no improvement.

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. [Read more...]

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Daily Column

October 4, 2008 By Dr. Gott

DEAR DR. GOTT:
I am a healthy, active 70-year-old female. I take vitamins and 120 mg of calcium with vitamin D. I would like to know if I should be taking Fosamax plus D also. I weigh 127 pounds and am 5’ 2”. I don’t want to take anything I don’t need.

DEAR READER:
Fosamax plus D is an osteoporosis medication that also contains vitamin D which aids calcium absorption into the bones. Unless you have had testing that shows osteoporosis, you do not need this medication.

I would also like to add that I was unaware that calcium came in 120 mg tablets. Perhaps you miswrote, but if not, you should take 1200 mg of calcium and 600 IU of vitamin D daily to prevent osteoporosis.

I recommend you speak to your primary care physician or gynecologist if you have further questions regarding osteoporosis and treatment. [Read more...]

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Daily Column

September 29, 2008 By Dr. Gott

DEAR DR. GOTT:
I have been taking calcium plus vitamin D tablets three times a day. I have recently heard on the news that this could cause hardening of the heart arteries. What should a person take to strengthen the bones? I also take Actonel once a week.

DEAR READER:
You are one of many people who have written to me asking the same question. Calcium (or calcium plus D) supplements DO NOT cause hardening of the arteries. The way that the media portrayed the issue caused near panic for thousands of individuals taking these supplements.

The information reported was that arterial plaque caused by excess calcium could lead to heart attack and stroke. While this is true, the problem does not lie in how much calcium in ingested but rather with the body itself. [Read more...]

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Daily Column

September 23, 2008 By Dr. Gott

DEAR DR. GOTT:
I am a 54-year-old female. One year ago I had a DEXA scan which showed severe osteopenia. I have GERD and a hiatal hernia and cannot take biphosphonate pills so my doctor put me on Boniva IV.

My question however, doesn’t have to do with the medication. Just before having the DEXA scan, I noticed several enlarged bones in my right foot and ankle. I was tested for Paget’s disease but the results were negative. At my last physical exam, my doctor noticed that my left shoulder blade had enlarged. I have seen several doctors and none can tell me what is causing my bones to enlarge. Do you have any ideas?

DEAR READER:
Because you do not say what type of testing you have had and what types of doctors you have seen I can only give you general suggestions. If these are repeats of what has been done or said, I apologize. [Read more...]

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Sunday Column

August 17, 2008 By Dr. Gott

DEAR DR. GOTT:
I just read in the New York Times that long-term use of biphosphonates for osteoporosis could lead to weaker bones in some people who use them. Since I suffer from the disease, I am very concerned and question whether I should discontinue my medication. I can’t get an appointment with my own physician for more than a month, so am turning to you for an answer.

DEAR READER:
You are referring to a small study reported in The Journal of Orthopaedic Trauma, disclosing patients with low-to-no-trauma fractures. A large portion of those in the study had been on long-term Fosamax therapy for an average of 6.9 years. Of particular interest is that all of the breaks occurred straight across the bone and some were preceded by weeks or even months of unexplained aches and pains. [Read more...]

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Daily Column

July 22, 2008 By Dr. Gott

DEAR DR. GOTT:
My doctor advised me to take at least 1500 mg of calcium daily to treat advanced osteoporosis. Calcium supplements containing 400-600 mg of calcium also contain 100% of the recommended Daily Value (rDV) of vitamin D in each pill. A single multi-vitamin pill can also contain 100% of the rDV of vitamin D as well. Therefore it is possible to get 400% of the rDV of vitamin D daily. This worries me so I spoke with my doctor and pharmacist but each has a different opinion about overdosing. What is your opinion?

DEAR READER:
Vitamin D is necessary for the body to absorb calcium. It is present in fish, liver, egg yolks and fortified cereal, margarine and milk. It is also made by the body when skin is exposed to sunlight. Therefore, it is not necessary for most healthy individuals who consume an appropriate diet to take a vitamin D supplement. [Read more...]

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Daily Column

June 26, 2008 By Dr. Gott

DEAR DR. GOTT:
I’m writing regarding your past column concerning the side effects of Actonel. I’ve taken Fosamax and Boniva for osteoporosis and had a terrible reaction to both. The first one put me in the hospital for five days because I was having the same symptoms as a heart attack. The Boniva that I was switched to gave me the same reaction, just not as bad. Still, it was enough to scare me. My doctor said we would never try those medications again.

DEAR READER:
As I originally reported, Actonel is ordinarily a beneficial drug. However, some people suffer side effects. Most are mild and do not justify discontinuing the drug, yet some are extremely serious. Chest and back pain, esophageal stricture, joint pain, nausea, diarrhea, back and abdominal pain, hypertension, urinary tract infections and more have been reported. As I’ve said in the past, [Read more...]

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Daily Column

June 2, 2008 By Dr. Gott

DEAR DR. GOTT:
Can you please give me some information on estradiol and if it can cause breast cancer? None of the articles I have read have information about this subject.

I am 70 years old and have been taking estrogen (1 mg estradiol daily) since having had a complete hysterectomy 25 years ago. A few years ago I asked my gynecologist if I should quit or reduce to a half dose but she advised I would lose my protection against osteoporosis. I now have a new gynecologist who is urging me to taper off and eventually stop the hormone altogether. I don’t agree with him.

Are there any natural hormones I can take?

DEAR READER:
Estradiol is an estrogen replacement medication. It is used for the treatment of moderate to severe vulvar and vaginal atrophy, symptoms of menopause, to replace estrogen after removal of the ovaries, treatment of osteoporosis (when non-estrogen medications are inappropriate) and palliative (comfort) treatment of breast cancer in certain women.

Estrogen therapy is associated with an increased risk of cardiovascular disorders such as heart attack, stroke and blood clots, endometrial (uterine lining) and breast cancers, dementia, gallbladder disease, visual disturbances, and hypercalcemia (high blood calcium).

In my opinion, your current physician is correct. At 70 you no longer need estrogen therapy. You may experience symptoms of menopause once off the medication, but slowly tapering will likely reduce them.

There are several varieties of plant estrogens (Estroven, and others) available on the market that may be suitable. They are available without a prescription. To the best of my knowledge, these are very effective for some individuals but not others. They provide relief from menopausal symptoms, such as hot flashes, night sweats and more without the increased risk of cancer and other side effects. Before starting any new medication, discuss this with your physician.

Other options to control menopausal symptoms (especially night sweats and hot flashes) include black cohosh (see package instructions), ginger (one 1-inch piece as needed), vitamin E (800 IU daily), acupuncture (2-3 times weekly), increased soy intake (50 grams daily), and exercise (20-30 minutes 4-5 times weekly). Ginger is also beneficial for the treatment of motion sickness.

As for osteoporosis protection, there are several things you can do. First, take calcium (1200-1500 mg) and vitamin D (400-800 IU) supplements daily. Weight bearing exercises are also beneficial. If you develop osteoporosis there are several prescription medications available, such as Fosamax, Boniva and others.

Follow your doctor’s advice. Don’t be afraid to ask his opinion about alternative options such as those I mentioned above. If you are taking any other prescriptions be sure that there are no known adverse reactions between the alternative drugs and modern medications.

To give you related information, I am sending you copies of my Health Reports “Menopause” and “Osteoporosis”. 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(s).

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Daily Column

May 28, 2008 By Dr. Gott

DEAR DR. GOTT:
You are sadly mistaken and you must reconsider your endorsement of Life Line Screening. It’s a big rip off! Let me explain.

For a modest cost they perform several “screening” tests that look very attractive. This is a misrepresentation because “screening” means to separate good from bad results. These tests are cheap, fast, and vastly inaccurate.

During one of these screenings my wife was diagnosed with low bone density. We brought the results to our family doctor who recommended an expensive and thorough test (I don’t remember the name), which showed the density to be fine. Another female acquaintance also failed the Life Line bone density test. Her doctor put her on Fosamax, an expensive medication. When informed of my wife’s results, she opted for the expensive bone density test and guess what? She was fine, too.

I have written to my senior center about this and they have stopped using Life Line testing. Please don’t recommend this cheap, inaccurate testing and false representation by Life Line.

DEAR READER:
Perhaps I should have done more research before giving a blanket endorsement for bone density screening through Life Line. I have received several letters similar to yours but have not heard of any discrepancies in the cardiovascular screenings. In contrast, the test for osteoporosis seems somewhat unreliable. In defense, I personally know physicians who use heel bone density screening units in their offices and appear satisfied with the machine printouts. Patients who receive an abnormal result should see their own doctor and request a hospital based X-ray bone density screening. In fact, this happened to me and I, too, needed the special testing which showed normal bone density.

Physicians are not on site when this mobile testing is performed by the technicians. All results should be forwarded to the doctor for interpretation. In actuality, the technicians who perform the tests should only give you a risk factor for osteoporosis, not a diagnosis. I had hoped the inexpensive testing would catch a variety of problems early on and would make people more aware of potential medical problems. I would like to hope Life Line testing for stroke, cardiovascular disease and abdominal aortic aneurysms is substantially more accurate with results that are reliable.

While cost may be an issue for some people, it appears, at least in this case, you certainly got what you paid for. Thank you for sharing your experience. I regret any misdirection I might have shared with my readers.

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.

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Daily Column

May 26, 2008 By Dr. Gott

DEAR DR. GOTT:
I read one of your articles about a lady taking Actonel. I am a 77-year-old lady taking Atenolol. Is this the same medication? I, too, have lots of back pain and cramps.

DEAR READER:
No. Actonel is for bone weakness due to osteoporosis. Atenolol is used to lower blood pressure.

Atenolol does not, to my knowledge, cause back pain and cramps. I urge you to see your doctor to discover the cause of your pain. Perhaps it is due to another medication you are taking or the result of a pinched spinal nerve or herniated disc. Your physician can order appropriate testing or refer you to a specialist.

To give you related information, I am sending you a copy of my Health Report “Hypertension”. 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.

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