Reclast infusions bring on rare side effect of severe joint pain

DEAR DR. ROACH >> For the last few years, I have been taking yearly Reclast infusions for osteoporosis, because I have trouble taking oral medications of any kind. The infusion was given in February 2022, and over the next several months, I developed severe joint pain so bad that I could hardly get around. My muscles were weak, and I had trouble walking. As the months go by, I am improving little by little.

Have you ever heard of this infusion causing this side effect? It is almost time for another infusion, and I don’t want to go through another year like the last one. I am 84 and very active.

— J.A.S.

DEAR J.A.S. >> Yes, I have heard of this. Severe bone, joint and muscle pain are rarely reported after taking both pill and infusion forms of bisphosphonate drugs. People who have had this kind of reaction should not take bisphosphonates again. This includes not only infusions like the zoledronic acid (Reclast) you took, but oral bisphosphanates like alendronate (Fosamax). There are other types of treatments available, including other types of injection treatments, that you can discuss with your doctor.

DEAR DR. ROACH >> Between walking outside and walking indoors on a treadmill, is one better than the other?

— M.S.

DEAR M.S. >> Walking outdoors uses additional muscles compared to walking on a treadmill. This is especially true on a trail or in open country, since you need to watch where you put your feet and use muscles to support movements that are different from foot placements you do without thinking (like on a treadmill or a paved road).

On the other hand, many people using a treadmill do so precisely because they don’t want to worry about watching their feet. So what’s best for you depends on who you are and what you like to do when exercising.

Exercising out in the world is a very different experience from being on a treadmill. Elite level athletes often do treadmill training, but will also do other exercises, since treadmill walking really only helps a limited set of muscles.

DEAR DR. ROACH >> I had a biopsy on a lip sore that came back as “squamous mucosa.” I was told nothing needed to happen. Shouldn’t the lasting bump be cut off? I thought squamous signified cancer, but I guess it hasn’t turned to that.

— J.D.

DEAR J.D. >> The word “squamous” comes from the same Latin root word as scales — the cells that line the skin (including the lips) are flattened like fish scales. These cells are excellent at limiting fluid loss and protecting underlying tissues from mechanical damage. On the inside of the lip, the lining of the skin is capable of making mucus to lubricate the inside of the mouth. So, squamous mucosa is considered the normal lining of the inside of the lip.

All cells that grow have the potential to have cancer, and squamous cell cancer is a cancer that starts from squamous cells or their precursors. But a result of squamous mucosa without further clarification suggests a normal biopsy result.

There are numerous causes for the lip to have benign sores or bumps with a normal biopsy, but I can’t speculate on what the cause could be in your case.