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Doctors' Answers to "Frequently Asked Questions" - Osteoporosis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An indi vidual patient is always advised to consult their own physician.

[posted 04/6/2000]
Question: I am a 50 year old female, post-menopausal. My recent dexascan has shown that my osteoporosis has advanced although I have followed a strict regimen of Fosamex (10mg), calcium supplements, no smoking and increased exercise. What other treatments may be available?

Answer: Increase the Fosamax to 20 mg this usually works if you don't have gi toxicity. Also, addition of miacalcin to the current dosage of Fosamax may be helpful, but not researched currently.

[posted 03/10/2000]
Question: Does early menopause(46) combined with infertility problems
(did conceive at 36) along with hypothyroidism and recently
diagnose osteoporois suggest any underlying condition?
My doctor prescribed fosomax for osteoporosis but wants me to
remain on prempro Is this overkill?
The fosomax prescription says wait 1/2 hr to eat or drink
after taking the drug, yet I just read some info that says 2
hrs are needed for maximum absorption after taking fosomax
which is correct?

Answer: Forty six is not too early, it would depend a lot on your mother's age of menopause since it does run in families. However, the pituitary would potentially control both. If your TSH has ever been up, the pituitary is ok(at least as far as the thyroid is concerned). As to the osteoporosis, it would depend a lot on the initial bone densities. Most would prefer that you start above the 50% percentile since you are so young. What are your densities and T scores? Thirty minutes is the usual recommendation.

[posted 02/5/2000]
Question: I have been taking Fosomax for 4 years to treat osteopenia. The first 3 years showed steady, but small, improvement. This year, I had a 5.5% loss in my hip. I have 3 related questions:
1) Can Fosomax lose its effectiveness over time?
2) What is the new information about Lipitor showing an improvement in bone density?
3) Can I ask my endocrinologist to switch me to Lipitor (or any other drug that works better than Fosomax)?
Thank you, Deborah Martin

Answer: Fosamax will not lose it's effectiveness but it is very hard to absorb. Ensure you are following the directions very closely(take it first thing in the morning after you arise with no other food or medication for at least 30 minutes). Increasing the dosage is an option if you are taking it correctly. Lipitor is for cholesterol and would have no effect on osteopenia that I am aware of. Lastly, ensure that some other metabolic issue has not intervened. That is, check your serum PTH, Calcium, Vitamin D levels and thyroid levels. These are all other metabolic issues that can cause bone loss unrelated to the basic underlying osteopenia.

[posted 08/18/1999]
Question: I have been prescribed Fosamax because my bone scan came back less than what it should be for my age. I read somewhere that some patients take the drug in the afternoon instead of first thing in the morning. Due to my irregular sleeping times due to my job I want to know what constitutes an empty stomach? If I need to take the medication in the afternoon how may hours after eating or drinking anything other than water should I take the medication?

Answer: Usually no intake for four or five hours. I have patients that take it in the late afternoon-ensuring that they take in nothing but water since lunch.

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