DEAR DR. DONOHUE: I am a 41-year-old female with a freak case of osteoporosis. When I was 32, I broke my humerus by falling in the shower. My mother insisted I get a bone scan. I did, and that’s when the diagnosis was made. I have since suffered a stress fracture of my foot and a broken rib five weeks ago. I have taken Fosamax for eight years, and my OB-GYN doctor put me on Yasmin because my bones need estrogen. These medicines scare me. I fear that Fosamax might give me osteonecrosis of the jaw and that Yasmin will put me at risk for heart attack, stroke and breast cancer. Can I strengthen my bones without these medicines? – M.Z.

ANSWER: The onset of osteoporosis before menopause is a special case, and a diligent search for causes, other than aging, has to be conducted. An overactive adrenal gland, too much thyroid hormone, overproduction of parathyroid hormone (the hormone that regulates the blood calcium level), a deficiency of estrogen, liver and kidney disorders and cortisone medicines can bring on premature osteoporosis. Each of these is treated differently.

Yasmin is a birth-control pill, and it contains estrogen. Your doctor feels it’s necessary. Estrogen replacement at your age doesn’t pose the threat of a heart attack, stroke or breast cancer.

Fosamax is one of the bisphosphonate drugs – powerful anti-osteoporosis medicines. These drugs have been implicated as causing death of a section of the jawbone in a few users. Most often, that happens when the drugs are taken in large doses for treatment of cancer-related bone disease. However, there are drugs other than bisphosphonates that are effective for osteoporosis. Forteo is an example. Ask your doctor if it is a drug you could use.

Things to do for yourself include getting 1,500 mg of calcium and 800 IU of vitamin D every day. Those doses are higher than the usual doses, but you need them. You should be doing resistance exercises – weightlifting. The weights don’t have to be all that heavy, but weightlifting exercise is the best kind of exercise for building strong bones as well as strong muscles. And it would be wise to locate an instructor to develop a program for you and show you how to lift weights safely.

DEAR DR. DONOHUE: I recently had a blood test that showed I am borderline anemic. I don’t know much about anemia except that it has something to do with red and white blood cells. Can you give me some information on it and how it’s treated? – D.G.

ANSWER: Anemia is too few red blood cells. Red blood cells carry oxygen to all parts of the body. Oxygen is needed for the life of every body cell and organ. Without enough oxygen or without the trucks (red blood cells) to deliver it to all body sites, people are chronically tired out. They become breathless upon slight exertion.

You’re not anemic. You’re on the borderline. Most people don’t develop any signs of anemia until they cross the border into definite anemia territory.

Anemias come in many varieties, and each has its own special treatment. Iron-deficiency anemia is common among menstruating women because of the blood they lose during menstruation. Too little vitamin B-12 causes a different kind of anemia. A lack of folic acid, another B vitamin, produces yet another anemia. A failure of the bone marrow to make red blood cells creates an entirely unique kind of anemia. I could go on, but I believe you get the idea. The cause of anemia must be found before the right treatment can be prescribed.

Your doctor can tell you which anemia border you are on and what you need to do to stay farther away from crossing the border.

DEAR DR. DONOHUE: I am a diabetic. Acesulfame potassium is in some of the foods and soda I use. Have you heard of this product, and is it safe? – B.G.

ANSWER: Acesulfame-K (acesulfame potassium) is a sweetener that is 200 times sweeter than sugar. It’s been used as a sugar substitute by millions of people since 1988, when it was approved by the Food and Drug Administration. More than 90 studies support its safety. It can be used for cooking, since it doesn’t break down. Brand names are Sunett and Sweet One.

DEAR DR. DONOHUE: This is the third time I have asked these questions. What can be done for raw, dry youth? I have scoliosis. I walk two miles three days a week. Is that good or bad for scoliosis? – K.T.

ANSWER: “Raw, dry youth”? Huh?

Walking shouldn’t make scoliosis worse. It is good for you, and you can continue doing it.

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