Don’t let bad on­line re­views de­lay os­teo­poro­sis treat­ment

The News Herald (Willoughby, OH) - - YOUR DAILY BREAK - Keith Roach Con­tact Dr. Roach at ToYourGoodHealth@med. cor­nell.edu.

DEAR DR. ROACH » Iama 63-year-old woman with os­teo­poro­sis. A few years ago, I had os­teope­nia, and my doc­tor put me on an oral med­i­ca­tion that I was un­able to tol­er­ate. Since then I have tried to eat many cal­cium-rich foods, do weight­bear­ing ex­er­cises and walk. But now she wants me to try Re­clast or Boniva. I went on­line to find re­views about their ef­fec­tive­ness, and for ev­ery pos­i­tive re­view, there were 10 or more bad re­views. My con­cern is that once it’s in my sys­tem, there is no go­ing back if I have a bad re­ac­tion. With the hor­rific side ef­fects some of these women re­ported, there was no way of turn­ing it around. I trust that my doc­tor only wants what is best for me and that she is con­cerned that I will start to have is­sues with breaks and frac­tures.

When I spoke with my GP, she didn’t seem very con­cerned about the side ef­fects, and said that she didn’t have any­one tell her of any is­sues with the treat­ment.

I’m hop­ing you can give me an ed­u­cated and un­bi­ased opin­ion as to the ef­fec­tive­ness of these treatments. I am sure a lot of women are go­ing through the same process, and could use the same advice. — C.T. DEAR READER » Os­teo­poro­sis is a net loss of bone min­er­als that leads to an in­crease in frac­ture risk. It is very com­mon, es­pe­cially in Asian and white women. How­ever, it can hap­pen to any­one — in black women and white men it hap­pens, but at an older av­er­age age.

There are two main mea­sures of os­teo­poro­sis: the T-score and the Z-score. The T-score is more com­monly used, and it com­pares the per­son’s bone den­sity at a par­tic­u­lar site (usu­ally the hip or spine) with what it would be in a young, healthy per­son. A T-score of 0 means the per­son’s bone den­sity is the same as a young, healthy per­son. A neg­a­tive score means the bone den­sity is lower. A Ts­core be­tween -1 and -2.5 is called low bone mass, or os­teope­nia. This is not a di­ag­no­sis; rather, it in­di­cates risk of de­vel­op­ing os­teo­poro­sis in the fu­ture, and at this time, advice on diet and ex­er­cise is ap­pro­pri­ate. A Ts­core of -2.5 or lower is os­teo­poro­sis; how­ever, os­teo­poro­sis may be di­ag­nosed at a more nor­mal T-score in some­one with a frac­ture due to frag­ile bones.

The Z-score com­pares a per­son with some­one of the same age and sex. It’s use­ful to iden­tify peo­ple with a cause other than age for os­teo­poro­sis. These in­clude use of pred­nisone or sim­i­lar steroids, low body weight, smok­ing and ex­cess drink­ing, kid­ney or liver dis­ease, celiac dis­ease, early menopause, hy­per­thy­roidism and nu­mer­ous other rarer causes. Iden­ti­fy­ing a sec­ondary cause, if present, is im­por­tant.

The lower the T-score, the more im­por­tant treat­ment be­comes. Treat­ment is ap­pro­pri­ate for peo­ple with a low T-score who have not re­sponded to diet and ex­er­cise.

The prob­lem with web­sites that so­licit in­for­ma­tion about side ef­fects is that peo­ple with side ef­fects are a lot more likely to re­spond to them. The over­all ef­fect looks hor­ri­ble. The data from placebo-con­trolled tri­als shows that the side ef­fects for Boniva (a pill taken usu­ally once a month) are barely higher than placebo. Only stom­ach up­set and limb pain are sig­nif­i­cantly higher, and only in about 2 per­cent of peo­ple. Re­clast (an IV in­fu­sion, usu­ally given once yearly) can cause a flu­like syn­drome for a few days af­ter in­fu­sion.

These medicines will leave the body af­ter stop­ping them, but slowly. Don’t take them for more than three years with­out a thor­ough re-eval­u­a­tion.

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