Osteoporosis apart from fibromyalgia

Dear Dr. Roach: I am a 63-year-old female. I was diagnosed with fibromyalgia several years ago, and I’m starting to think that there is a link between it and my other ailments. I take 300 mg of gabapentin three times a day, and recently started taking 20 mg of amitriptyline once a day. I have had GERD and migraine-associated vertigo, and recently was diagnosed with osteoporosis. What more can I do to prevent any more bone issues, and could there be a fibromyalgia link?

I had GERD for two years and took everything — including omeprazole, Tagamet, Protonix and then Nexium. — L.A.

Gabapentin often is used as a way of reducing pain, including for fibromyalgia, and it sometimes is used for hot flashes, but its FDA indication is as an anti-epileptic drug. However, the risk of osteoporosis from gabapentin is low.

Many women with fibromyalgia also have osteoporosis; however, it may be that there are some shared risk factors, and it is probably not that fibromyalgia causes osteoporosis.

Many people with fibromyalgia have difficulty exercising, and may not get enough vitamin D, both of which are risk factors for osteoporosis. Although you have been taking lots of calcium in diet and supplements, the data that show this protects against osteoporosis are surprisingly weak. Calcium through the diet is better than supplements, as supplements increase kidney stone risk (dietary calcium protects against stones) and may increase risk for blockages in the coronary arteries.

The biggest issue I want to identify, though, is the omeprazole, Protonix and Nexium, all of which are well-known to increase bone density loss, putting women (and men) at risk for osteoporosis. These are very effective medicines, but shouldn’t be taken for the long term if there are alternatives.