Impossible to pick the best osteoporosis medicine


DEAR DR. DONOHUE: I have osteoporosis. I was never told to take Fosamax. Why have my doctors prescribed Miacalcin? Do you think Fosamax would be better? I have taken Miacalcin for many years without much success. My bone density tests always say I have osteoporosis and to continue taking Miacalcin. I have recently been getting pains in my shoulders and the back of my neck. Would you suggest Fosamax? — P.W.

 ANSWER: Four drug families are valuable treatments for osteoporosis. No comparisons have ever been made among these four families, so it’s nearly impossible to say which is the best. The best one for any given patient is the one that costs the least, works the best and has the least side effects.

 Your medicine Miacalcin (calcitonin) stops bone from breaking down. It comes as a spray or an injectable.

 Bisphosphonates (Fosamax, Actonel, Boniva and Reclast) come as oral pills, taken daily, weekly, monthly or as a yearly infusion. They stop the action of bone cells called osteoclasts, which are involved in bone demolition.

 SERMS, selective estrogen receptor modulators, imitate the female hormone estrogen in preserving bone strength. Evista is the brand name. It doesn’t have any of the downsides of estrogen, like the promotion of breast cancer in postmenopausal women.

 Forteo (teriparatide) acts like parathyroid hormone by encouraging calcium entrance into bone and new bone formation. It is given by self-injection.

 I don’t know if you should switch drugs. You can talk it over with your doctor. You realize, don’t you, that you also should be taking calcium and vitamin D in addition to osteoporosis medicine — 1,200 mg of calcium a day and 1,000 IU of vitamin D daily? You also need to exercise.

 I don’t believe that your shoulder and neck pain comes from osteoporosis. Something else is at work.

 TO READERS: The booklet on cervical cancer and Pap smears explains both and how the Pap smear is such a boon to women’s health. Readers can order a copy by writing: Dr. Donohue — No. 1102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

 DEAR DR. DONOHUE: I have had a problem with my food tube closing at times. Sometimes it closes so tightly that water won’t go down, and I almost choke. I saw a throat doctor, but he wouldn’t do anything because I have a heart valve replacement. The heart doctor says I can’t have any procedure because my heart isn’t strong enough. Can’t something be done for me? — W.M.

 ANSWER: Talk to the heart doctor again, or, better, have the throat doctor talk to the heart doctor. The heart doctor might believe mistakenly that some sort of surgery is planned. All you need are some diagnostic tests that ought not to strain your heart.

 Swallowing a gulp of barium, the thick material used to outline organs for an X-ray exam, is one such test. That’s not particularly strenuous. Scope exams of the esophagus are another way of arriving at what’s causing a swallowing problem. It’s a little more involved, but should not be off limits to you. Unless you have some of these diagnostic tests, doctors will never get to the root of your problem and will have to treat you blindly.

 DEAR DR. DONOHUE: I am a 26-year-old female, stand 5 feet 5 inches and weigh 125 pounds. For several months, I tried a running program so that I could run 5 kilometers (3 miles). I would be fatigued and out of breath after a quarter-mile. My doctor thought I might be anemic, and lab tests confirmed it. He put me on iron, and I can now run with no problems. I used to donate blood. I read where frequent donations can make you anemic. Should I start donating again? I am in training to join the military. — S.B.

 ANSWER: Regular blood donation ought not to make a person anemic. The Red Cross routinely tests for anemia before donation. Talk to the Red Cross and see what it thinks. You have to make up your own mind. Perhaps spacing donations further apart would be a safe compromise.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from