Osteoporosis medication helpful and doesn’t present many risks
Dear Dr. Roach: I’m a 72-year-old woman, still working, and I stay very active by walking and lifting weights in the gym. I have been taking anastrozole for breast cancer, and my bone density has decreased during the past five years, with a T-score in my hips of -1.5 and -3.3 in my spine. My doctors want me to take Fosamax once a week. I am apprehensive due to the warning about esophageal reflux. My brother died of cancer of the esophagus. Am I foolish to wait a year for the next test? — J.F.
A: Many women in their 70s will develop osteoporosis, but those using a medication such as anastrozole (Arimidex), which inhibits aromatase (a necessary enzyme to make estrogen), usually see faster and steeper drops in estrogen and, consequently, bone strength. This leads to increased risk of an osteoporotic fracture. The recommendation for treatment of osteoporosis is more aggressive for women taking these drugs.
Your spine is now at -3.3; anything worse than -2.5 is when treatment is recommended. I say start treatment now, not in a year.
The risk of esophageal reflux with alendronate (Fosamax) is low if it is taken properly. The risk for esophageal cancer does not appear to be increased in people taking alendronate.
In people who have a reason not to take Fosamax, onceyearly zoledronic acid (Reclast or Aclasta) is effective and is given intravenously.
I think your benefit is likely to be large.
Dear Dr. Roach: I suffered from constipation for years, and after consulting with a specialist, I was prescribed MIRALAX. I take it every morning and have added fiber to my diet. The program has been successful. How wise is it to take MIRALAX indefinitely? — Anon.
A: MIRALAX is a non-absorbable chemical called polyethylene glycol. It passes through your system, bringing water with it, which makes stool less hard and easier to pass. It is very safe for short-term use. If you are taking in enough fiber, it should be possible to decrease the MIRALAX without worrying about constipation. It’s OK to use MIRALAX as needed.
Dear Dr. Roach: How often does a healthy person with perfect vision and no eye concerns need to see an eye doctor? — D.S.
A: A periodic eye exam in someone with no symptoms involves a screening test for vision changes related to aging and other eye diseases. There are several common-sense reasons for screening, but there has not been good evidence to support its use.
The American Academy of Ophthalmologists recommends a baseline exam at age 40; visits every two to four years from age 40 to 54; every year to three years from age 55 to 64; and annual exams for people 65 and older.