Osteoporosis drugs — good or bad?


DEAR DR. DONOHUE: I am a 55-year-old woman, 120 pounds and 5 feet 4 inches tall. I exercise regularly, both with weights and aerobically. I take calcium and vitamin D. Three years ago, my bone density test was -2. Recently, I had another test; it was -2.3. I know that -2.5 is considered osteoporosis. My doctor recommends that I take something to prevent further bone loss. I hear so many negative things about these drugs. Do the benefits of the drugs outweigh their side effects? — R.G.

ANSWER: People are going to think I’m fixated on this subject. I just answered similar questions a week or so ago.

I believe the benefits of osteoporosis drugs far outweigh their downsides. The bone density test — DEXA, dual-energy X-ray absorptiometry — isn’t the only consideration given when prescribing medicines. A history of previous bone breaks, a family history of osteoporosis, early menopause, a history of cigarette smoking and illnesses, like diabetes, that add to the danger of breaking bones are some of the other factors that are taken into account before prescribing medicine.

The most-prescribed osteoporosis medicines are the bisphosphonates: Fosamax, Actonel, Atelvia, Reclast and Boniva. Their worst complication is the death of part of the jawbone — osteonecrosis. It happens infrequently. Osteoporosis fractures, on the other hand, happen frequently. For me, the decision is easy. Take the medicine. Other drugs are worth consideration. Evista acts a bit like estrogen, but without the danger of breast cancer that comes with estrogen. Forteo is similar to parathyroid hormone, the hormone that directs calcium into bones. And the newest drug, Prolia, greatly lessens the breakdown of bones.

Although all these drugs have side effects, their promise of strengthening bones greatly tips the scales in favor of their use.

TO READERS: Colon cancer is something no one likes to think of. The booklet on it explains it and its treatments. Readers can order a copy by writing to: Dr. Donohue — No. 505, 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 an arachnoid cyst of the spine. What can I expect from it, other than it may end up paralyzing me? I consulted a neurosurgeon, who told me to wait until I become paralyzed before having surgery. Isn’t this waiting too long? — P.E.

ANSWER: The arachnoid is one of the coverings of the brain and spinal cord. Sometimes cysts, fluid-filled sacks, form in it. They often have been present from birth.

Treatment depends on their size, their location and the symptoms they’re causing. If they aren’t producing any symptoms, they can be watched until they do. Paralysis isn’t the first symptom. Peculiar sensations, hints of muscle weakness or pain are early signs of trouble, and the cyst can be treated then. You should be followed at regular intervals to see if the cyst is enlarging. Treatment is cyst removal.

Something must have gotten mistranslated between you and the neurosurgeon. If you’re quoting his exact words, I’d see a different doctor.

DEAR DR. DONOHUE: After a vasectomy, are you at greater risk of developing prostate cancer? I just had one, and two people have told me about the prostate cancer link. Is this true or false? My wife also wants me to ask you if breastfeeding lowers the chances of breast cancer. — J.L.

ANSWER: Some time ago, a few, scattered reports suggested that vasectomy might be associated with prostate cancer. This has been proven to be false.

Breastfeeding reduces the risk of breast cancer and ovarian cancer.

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 www.rbmamall.com.