Med without long history best at reducing fractures

Dear Dr. Roach: In the past, I have been treated for osteoporosis, but still had a spinal fracture last year that required surgery. My endocrinologist suggested Tymlos because it encourages bone growth more than a bis-phoshonate drug, which only stops further bone loss according to him. It requires a daily injection for two years. I am concerned about taking a new drug without a longterm history.

– B.S.

Answer: The standard first-line treatment for osteoporosis in both men and women for decades has been a bisphosphonate drug (such as alendronate or risendronate), based on long-term safety and effectiveness data when used properly in appropriate patients. However, when it doesn’t work, another option is appropriate, and I agree with your endocrinologist that a different class of medications might be better. (Absorption of bisphosphonates is tricky. They cannot be taken with any other medicine or food, only plain water. Some mineral waters have enough minerals in them to reduce absorption!)

Tymlos works similar to your body’s parathyroid hormone in stimulating bone growth. Your endocrinologist is right that bisphosphonates reduce the activity of cells that reabsorb the bone, but there is still a net increase in bone growth due to natural bone activity. A similar medicine, Forteo, has been used for more than 20 years.

A head-to-head trial of Tymlos and Forteo showed that Tymlos was slightly better at reducing fractures. About 0.6% of the Tymlos group got a fracture compared to 0.8% in the Forteo group, both of which were better than the placebo group – 4.2% of whom got fractures. You could certainly ask your endocrinologist to prescribe the timetested Forteo, but the side effect of low calcium, which can be a problem, was also lower in the Tymlos group (3.4% versus 6.4%).

Dear Dr. Roach: I have heard that food (especially meat or fish) should not touch aluminum foil when cooking because the aluminum will leach into the food, which is bad for our bodies. Is this true? Also, what about the pots and pans that are made out of aluminum?

– L.J.W.

Answer: Aluminum is a very common element naturally found in many foods, including fruits, vegetables, wheat and other cereal grains. It comes from the soil, and your body is able to excrete the aluminum you normally take in as long as you have normal-functioning kidneys. Baking food in aluminum does increase how much of it you ingest. This has been tested in chicken, fish and beef, but the amount is still well below the range that causes any problems, even in people with kidney disease.

To put it into perspective, the amount of aluminum in a single serving of fish, chicken or beef cooked in aluminum foil is about 1.2 mg. A single tablet of an aluminum-containing antacid, like Gaviscon or Mylanta, has 108 mg of elemental aluminum. Most of this aluminum is not absorbed, and what is can be excreted by healthy kidneys. I recommend against aluminum-containing antacids for people with chronic kidney disease.

Similarly, aluminum pots do leach a small amount of aluminum into food, but the amount is so small that your body can get rid of it. However, those with severe chronic kidney disease may want to avoid uncoated aluminum pans.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.