Osteoporosis meds can be misused

ear Dr. Roach: I am a 79-year-old woman with osteoporosis. My doctor has prescribed alendronate (Fosamax) for me. My understanding was that this medication was to prevent a hip fracture, but she now says that it will also strengthen other bones in my body, including those in my back. Is this true?

Answer: Alendronate and similar medicines are the most used initial treatment for osteoporosis, a condition of loss of bone and bone strength. Although we often focus on hip fractures, which are associated with increased risk of death, vertebral fractures are more common, and cause a great deal of pain and reduce the quality of life. Your doctor is correct that when properly used — meaning, both in the right patient and for the right length of time — Fosamax and other medicines reduce the risk of both hip and spine fractures.

Part of the reason these drugs have gotten an undeservedly bad reputation is that they have not always been used correctly. Doctors who are not expert in treatment of osteoporosis have sometimes prescribed these drugs for women and men who do not have osteoporosis, but only low bone density, and for those who are not at a high risk for fracture. If a drug has little potential for benefit, then even a small risk of harm leads to the drug being worse than useless.

Further, this is not a drug that a person normally stays on the rest of their life. Most commonly, a person is on it for three to five years before a thoughtful reevaluation of the continuing need for the medicine. Staying on the medicine too long leads to risk for a different kind of fracture, called an atypical femur fracture.

The fact that the medication can be misused is not a reason to avoid it. Women and men at high risk for fracture due to osteoporosis and other risk factors benefit from the reduced risk of hip and spine fractures with low risk of adverse events.

Dear Dr. Roach: A large number of sports injuries are reported every day, for men and women and for every sport that comes to mind. Body building is a focus of most, if not all, athletes in sports from golf to baseball, etc. The injury rate seems to be getting higher, or maybe there is more in-depth reporting. In any event, how does taking weight training “to the limit” affect the risk or odds of an injury? Also, is there a practical limit for a given athlete, and how is it determined?

Answer: Strength-building exercise using resistance has many benefits to the body, including benefits that are difficult or impossible to attain through aerobic activity that does not involve resistance, which is why essentially elite athletes incorporate weight training.

The risk of injury in resistance training is low, on the order of one per 1,000 hours of training at the Olympic level. This is far lower than in contact sports.

For nonelite athletes, the biggest risk is probably trying to lift too much, too soon. I strongly recommend getting a professional coach. This will help to minimize injury risk.

Any athlete will develop a plateau in performance over time, but it’s impossible to predict what that might be in an untrained person. Steadily increasing resistance will lead to greater strength, along with improved bone strength and reduced insulin resistance.