Sue Katz: Consenting Adult: Osteoporosis: Do All the Miracles Turn into Assaults?

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07 December 2010

Osteoporosis: Do All the Miracles Turn into Assaults?

For years now there seems to be a consensus among those who take a professional interest that I have osteoporosis. This despite the unfortunate fact that there has been such a plethora of errors in the taking and reading of my bone density tests that no one can figure out anything quantitative.

One year, vertebrae were compared with unlike vertebrae because a machine or technician lined up the previous year’s x-rays incorrectly. Those errors, however, have never been excised from my record, which therefore is in a state of chaos, with subsequent comparisons showing a variety of conflicting and unreliable results.

A couple weeks ago I took a bone density test which caused my physician to write me an email that started with, “Now this isn’t really an emergency, but go get all your dental work done right away so that we can talk about starting you on Fosamax.” Many post-menopausal women in this country are on Fosamax, some of them a long time, even though the data on this powerful drug is contradictory: Some doctors say one needs to take Fosomax for five years consecutively, but that’s all. Some say that the effects (both direct and side) of Fosomax persist whether the woman continues use of the drug or not.

Anyway, my doctor then wrote to my rather cool endocrinologist to report on the situation, a fact I learned when the endocrinologist’s office called to make an appointment with me, suggesting a day less than a week away. “When are you generally booking for?” I asked her assistant. And as I suspected, she said about 4 or 5 months ahead.

This non-emergency faster-than-a-speeding-bullet arrangement was a bit stressful. Not the least because I don’t want to take Fosomax. They admitted ages ago that it can cause serious gastrointestinal ulceration, but now it turns out that in old women it is causing spontaneous thigh bone breaks. But most off-putting, in a small percentage of people (admittedly mostly but not exclusively in people getting the drug intravenously as a cancer treatment) it causes necrosis of the jaw – i.e. the jaw bone disintegrates after you’ve had dental work and part of the jaw needs to be amputated. I have crap teeth and they will be requiring all sorts of expensive and therefore delayed attentions in the coming decades. I’m never going to be able to “finish” my dental work – I’m in a continuous state of buying some dentist or other a nice summer home.

So here you have a drug meant to prevent fractures that (sometimes) causes the jaw bone to liquefy when provoked and the thigh bone to splinter without provocation. No thank you. I’ll take calcium.

While my own physician can’t quite understand my reluctance to ingest Fosomax, the endocrinologist was with me 100%. First, she said, she was going to get a colleague of hers who she considers the best in the business to read the x-rays correctly so we actually know what’s going on.

Second, I should start drinking milk and eating cheese and looking up “calcium-rich foods” on the internet and stuffing them in my mouth. That seems a small price to pay to avoid what sounds to me like another one of those drugs which, while purporting to do something or other for women, ends up doing something worse. From thalidomide to hormone replacement therapy, all the miracles turn into assaults.

I know that milk products are fattening and should generally be avoided – or so they’ve been saying for years – but now I’m no longer going to feel guilty about my sharp cheddar and the price of Jarlsburg. It is, after all, medicine for a condition I may or may not have to one degree or perhaps to another.

PS: I only got such a swift appointment because there happened to be a cancellation that minute.

Posted at 19:21 in Science | Permalink

Comments

Sue....Have them check your vitamin D3 level. You need to have a blood 25OHD test done. The level must be above 35 which is the minimum level for your body to be able to absorb the calcium you are ingesting. (You should be supplementing with 1200 mg of calcium daily....count your calcium sources to make sure you are getting enough). Hopefully your vit D level is above 50 and is preferably as high as 80-100. I am betting you are vitamin D deficient and will need some serious supplementation (prescription strength) to boost it into the therapeutic range. Calcium cannot be absorbed without the presence of vit D. Let me know if I'm right....Max

Posted by: Maxine Cook | 07 December 2010 at 21:57

No, Max, I believe she said my Vit D tests were stellar, but I'll check (they're listed online I bbelieve). Thanks - I knew you'd have something intelligent to say about it! And while we're talking, what's your take on Fosomax?

Posted by: Sue Katz | 08 December 2010 at 06:55

Sue,

I'd also refer you to a book I read aeons ago buy the nutty Adelle Davis. She may have been a proponent of supplementation for everything. However she made the point that for proper absorption you should have the calcium and vitamin D in your stomach at the same time. She then made the point that natural milk comes with levels of vit D that will satisfy this condition. However, often by the time the milk gets to us the vitamin D has been destroyed by light or heat or age. What I took from this was that it's probably a good plan to take your cod liver oil capsule at the same time as your milk. When I did my teacher training with the YMCA they taught that bone density is improved by exercise that pulls on the bones, stressing them slightly. I'm sure you know all about that, and my solution to that: dance on babe!

Posted by: Mike Evans | 08 December 2010 at 07:37

For 20 years before I retired 2 years ago, I worked with Dr. Barbara Campbell, an ortho surgeon who specializes in bone mineral density, bone densitometry reading and dx/tx of osteoporosis and other bone demineralizing diseases. I still work with her on her ongoing writing projects. She is on the Education and Communications Committees of the Ruth Jackson Orthopaedic Society, the women orthopod's sub-society of the American Academy of Orthopaedic Surgeons. She has taught, written and spoken on these subjects to orthopods & family practitioners for years.

Fosamax was the first bisphosphonate approved for use in osteoporosis and had to be taken every morning. If you took it for 2 years, you could go off it for a couple of years and still enjoy the effects of the bone rebuilding action. There are newer and possibly better meds on the market today, even some with different delivery systems such as IV delivery once or twice yearly. If one is sensitive to the oral route (GI upset), there are other choices. Some of the oral meds are more irritating than others to the esophagus/stomach. Also, depending on the severity of demineralization, there may be better drug options. If you were recommended to take Fosamax by your doctor, there may be a better choice for you, considering your ongoing dental procedures. I will ask her opinion this week on a better/different treatment for you and let you know.

I'm not sure that your vit D levels are 'stellar'. I'd like to know your numbers. Unless you spend a lot of time year-round in the sun, and/or eat a lot of foods containing absorbable D, and/or take supplements, I'm betting you are like 90% of those living in northern latitudes and are low. Find out your level and let me know.

Posted by: Maxine Cook | 08 December 2010 at 10:21

Sue,

I refuse to take Fosamax or any other "bone-building" drug. I think it's a scam. Considering the scandals involving drug companies pushing unsafe but profitable drugs, it seems like the prudent thing to do. Here is a good book book that lists some other supplements that are beneficial - http://www.goldivas.com/articles/article.aspx?id=57

Posted by: Rita@Goldivas | 08 December 2010 at 10:26

By goodness, I'm not surprised, but how very erudite you all are. I have been taking calcium and Vit D for years (instead of Fosomax) and I will check what my Vit D level is, but she just looked at it and both my GP and the endocrinologist said it was excellent. There are a lot of smart suggestions and explanations from all of you and I'll certainly check out these various links. Thanks so much for being smart and for giving a shit.

Posted by: Sue Katz | 08 December 2010 at 14:03

i took myself off fosomax when i needed dental surgery and heard about necrosis. no thanks, i do, whenever i remember, take calcium and D3 and Vitamin K2. my pcp told me that recent studies suggest that taking fosomax does not make a significant difference in terms of osteoporosis. the best one can do is take supplements, exercise and eat well.

Posted by: eleanor | 09 December 2010 at 12:32

Eleanor, I know that you're like me - very demanding money-sucking teeth. That was my first reason for quitting Fosomax, but all the subsequent scare stories just add to it. I just wish the Calcium pills weren't as big as a jumbo hot-dog but harder to swallow.

Posted by: Sue Katz | 09 December 2010 at 12:37

I took Fosomax for about 10 years, although you're right that you're supposed to take it for 5 only. My doctor discussed the risks/benefits and the benefits outweighed the risks in my case.

Even with the drug and my exercise habits, I shattered my shoulder badly in a simple fall last summer -- a real wake-up call about how fragile my bones are. It was painful, horrible, and scary. What if, instead of reaching out my arm to break my fall, I had broken hip or spine?

I feel so young in mind and spirit that it's an affront that my body keeps reminding me that it's 67 years old and fragile.

Posted by: Joan Price | 09 December 2010 at 12:47

That's so horrible, Joan, it must have been a nightmare. But this seems like further evidence that Fosomax does not necessarily prevent fractures at all.

Posted by: Sue Katz | 09 December 2010 at 13:05