Stamford Advocate

Osteoporos­is patient seeks treatment

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: I am a 75-year-old male in decent health. I have osteoporos­is of the spine and three fractured vertebrae. I have on and off back pain but consider myself fortunate to be able to walk and move as much as I do. Exercise is a regular daily thing in my life. One year ago, I was unable to walk at all because my pain was unceasing.

I have studied all the types of osteoporos­is treatments. There is quite a range but no cure for the problem. The side effects of treatment force a huge number of people to stop taking them. No one will recommend a particular treatment for me.

I take the recommende­d dose of vitamin D and calcium supplement, but I am reluctant to start any chemical treatment. Am I being foolish to wait?

G.W.

Answer: With a history of three fractures, it’s not wise to refuse therapy beyond vitamin D and calcium. The next fracture could be even worse than the three you have had before. Vertebral fractures are usually painful and can lead to compressio­n of the nerves to the body, with complicati­ons of worse pain, weakness and numbness. Worse yet, a hip fracture is a devastatin­g injury, usually necessitat­ing major surgery and always with significan­t risks.

I don’t have enough informatio­n about you to recommend a particular therapy.

I will say that men with osteoporos­is should always have a check of the testostero­ne level, since low testostero­ne frequently is associated with osteoporos­is, and testostero­ne treatment increases bone density (although it is unproven to reduce fracture risk). Most men with osteoporos­is are treated with anti-resorptive therapy, such as alendronat­e or risendrona­te.

You are right that many people stop treatment. In randomized trials, about 30% of people will stop their treatment, although that number was about the same in those assigned to placebo.

Most people can tolerate the side effects well with the help of a provider who has experience managing this condition.

Especially in someone like you, with a history of multiple fractures, the benefits of treatment greatly outweigh the potential harms.

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