Osteoporosis medicines stick around for a long time


DEAR DR. DONOHUE: I recently had a bone density test, which showed that I needed to be on medication for osteoporosis. My doctor gave me a prescription for Actonel. This medicine is taken once a month. I would like to know how a medicine can stay in your system for one month and how it affects the rest of your body. What do you know about Reclast, which is a once-a-year, intravenous medicine for osteoporosis? — V.D.

ANSWER: Bones undergo daily remodeling. A crew of bone cells called osteoclasts demolishes sections of bone. Another crew of bone cells, osteoblasts, immediately repairs them. In osteoporosis, the demolition crew outpaces the repair crew.

The family of medicines that have the greatest effect in reversing osteoporosis is the bisphosphonate family. Actonel (risedronate) is a member of this family. It can be given daily, once a week or monthly. Higher doses are given when it’s used less frequently.

Bisphosphonates are incorporated into the bone. They slow down the demolition cells. The fact that the medications become part of the bone explains why they last so long. They’re protected from being metabolized.

Reclast (zolendronic acid), another bisphosphonate, also has sanctuary in bone and is very, very slowly metabolized. It acts on bone for an entire year.

How do these drugs affect the rest of the body? The oral bisphosphonates’ side effects include things like diarrhea, stomach pain and esophageal irritation if they get stuck in the esophagus. The intravenous bisphosphonate can produce joint and muscle pain, fever, chills and fatigue. These effects are transient. The most feared side effect is jaw osteonecrosis, death of a small portion of the jawbone. This happens mostly when bisphosphonates are used in high doses for the treatment of cancer that has spread to bone. It’s rarely a side effect of osteoporosis treatment, but it has happened to a few.

DEAR DR. DONOHUE: I am ill with anemia and asthma. Please provide information on these and on a diet that’s good for blood. — R.D.

ANSWER: Anemia is a deficiency of red blood cells. Treatment for anemia — and there are many different kinds of it — depends on its cause. A common cause is lack of iron, and that’s most often due to blood loss. Blood contains most of the body’s iron. Frequently, the blood loss is hidden and doesn’t produce symptoms. The site of bleeding has to be discovered and treated. Iron is then given to spur blood cell production. A lack of vitamin B-12 is another cause of anemia, and treatment consists in providing that vitamin, usually through shots. Normal red blood cells live for 120 days. An immune attack on red blood cells causes their premature death and another kind of anemia. Its treatment is complicated. These are only a few of the different kinds of anemia. There is no one good diet for all types of anemia.

Asthma consists of sudden attacks of airway (bronchi) narrowing, with the production of thick mucus. Both block the flow of air into and out of the lungs. Wheezing, coughing and shortness of breath are its symptoms. Asthma is controlled with medicines that keep the airways open and soothe airway irritation.

The booklet on asthma provides greater details on this illness and its treatment. To obtain a copy, write: Dr. Donohue — No. 602, 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: If a person has pancreatic cancer and catches it early, does an operation give a person a chance for longer life? Patrick Swayze chose not to have the operation. — J.E.

ANSWER: Pancreatic cancer rarely causes signs or symptoms until it has grown large and has spread. If the cancer is relatively small and confined to the pancreas, surgery is a potential cure. Such a cancer is found in only 10 percent to 15 percent of patients. However, even small cancers, treated with surgery, can recur.

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.