Therapies rebuild weak bones at a cost

Capricorn, look for a win-win situation

Dear Dr. Roach: I recently had a bone density test and was advised that I have osteoporosis in the wristand hip. I amnow77 years young. My doctor has advisedme to begin taking 70 mg alendronate every seven days. I am not happy about this, as the side effects Ihave read about aremany. Is there something else that you are aware of that can be beneficial? I have not started the Fosamax yet. — J.T.

There are many treatment options for osteoporosis. Before starting treatment, however, your doctor probably checked your vitamin D level andPTHlevel, as too little vitamin D and too much PTH can cause osteoporosis, and these should be treated directly. Celiac disease should be considered in people with osteoporosis, as it can affect bone strength in absence of GI symptoms.

Alendronate (Fosamax) is in the class of medicines called “bisphosphonates,” and they work by preventing the osteoclasts fromoverdoing their job, which is breaking down bone.

This allows the osteoblasts, which build up bone, to bring bone density back up. The osteoclasts and osteoblasts need to be balanced so that the bone is constantly reformed to refill the holes left behind with new, healthy bone.

Of all the medicines that treat osteoporosis, the strongest evidence for preventing fractures is with alendronate and medicines like it. They do have side effects, including damage to the esophagus, if they are not taken with great care, and bone pain, especially if there isn’t enough dietary calcium. However, they are well tolerated by most people.

Estrogen and estrogenlike drugs are still used, but have side effects.

There are non-medication options aswell.

Weight-bearing exercise, smoking cessation and adequate dietary calcium are very important and often overlooked.

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu

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