DEAR DR. DONOHUE: I have some questions about osteoporosis and how it’s detected and treated. I am 64 but will turn 65 in three months. My doctor says I should be screened for osteoporosis then. Is that standard practice? I don’t have any symptoms. How is one screened? What’s the best drug to take for it? Do you take it for life? – M.C.

ANSWER:
Osteoporosis is a weakening of bones. They become porous and fragile. Fractures of the hip and backbones are common. The bones have lost their strength because they’ve lost most of their calcium. Partly this is from aging, and partly it’s from the diminished production of estrogen that comes with menopause.

The most recent guidelines for detection tell doctors to screen their female patients at age 65 and their male patients at age 70. It doesn’t matter if you have no symptoms. Most have none until they suddenly break a bone or until one of the vertebrae collapses. If a woman has several risk factors for coming down with osteoporosis, then screening should take place earlier, around age 50. Risk factors include a past hip fracture, cigarette smoking, prolonged used of oral cortisone medicines, rheumatoid arthritis, liver disease and excessive alcohol use.

The screening test is DEXA, dual-energy X-ray absorptiometry. It measures bone density by measuring the penetration of X-rays through bone. Test results are given as T-scores. A score of -2.5 or lower indicates osteoporosis, and treatment should be started. Women with scores of -1 to -2.5 also are considered for treatment if they have other risks for osteoporosis.

Bisphosphonates are the drugs most often used for this condition. There are five such drugs. The two most often used are Fosamax (alendronate) and Actonel (risedronate). They have been on the market the longest and have had good results.

How long treatment should last is a matter of debate. Many doctors give the drugs for five years. The drugs have a residual effect for the following five years. Some doctors favor a 10-year course of therapy.

DEAR DR. DONOHUE: My daughter has hepatitis C. She was first diagnosed three years ago. She got treatment for it and appears to be quite healthy now. She works and is an active runner. She sees her doctor every six months. On her last visit, she told me that the doctor said her tests showed a “sustained virologic response.” She was so happy about it that I couldn’t bring myself to ask her what that meant. What does it mean? Is she cured? – R.S.

ANSWER:
Doctors are reluctant to speak of cure when it comes to hepatitis C. However, a sustained virologic response is about as close as one can get to proclaiming a cure. No virus is detectable in her blood.

Your daughter has every right to be happy about this news.

The booklet on the hepatitis viruses, A, B and C, tells their story and their treatments in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 503, 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 trouble swallowing food. Most of the time solids are the most troublesome, but sometimes it’s hard for me to get liquids down. My husband thinks this is in my head. Could it be? – N.D.

ANSWER: Not likely.

Dysphagia – difficulty swallowing – is just about never a psychological problem. When solids are the issue, then the swallowing tube usually has a mechanical difficulty. By mechanical, I mean something is physically blocking the passage of food – a growth or a narrowing of the esophagus. When solids and liquids are bothersome, then the cause is a defect in the muscles of the esophagus; they aren’t working properly.

You should see your doctor soon.

DEAR DR. DONOHUE: What can you tell me about cystic fibrosis? My son is 12 and has had constant diarrhea all his life. His doctor suspects cystic fibrosis. He also has asthma. He gets short of breath after exercising or running. What can be done for this, and what will the outcome be? What can I do to improve his lungs? – T.H.

ANSWER:
To improve your son’s lungs, demand that the doctor give you a definite diagnosis. The question about cystic fibrosis has to be answered now.

Cystic fibrosis takes its toll on many organs, but the two principal ones are the lungs and the pancreas. Quite often, the diagnosis is made in infancy, but the illness can be less than typical and somewhat mild and, therefore, can escape detection until adolescence or early adulthood.

Cough, recurrent lung infections, including pneumonia, and shortness of breath when active are signs of cystic fibrosis. People with the disorder produce thick, sticky mucus that plugs airways and sets them up for repeated infections.

The pancreas suffers from the same kind of plugging. It’s the body’s main digestive organ. Without the enzymes that the pancreas produces, food isn’t absorbed. People suffer from diarrhea, poor growth and substandard nutrition. Much of this is correctable by taking digestive enzymes in tablet form, along with vitamins and minerals. The pancreas is also the place where insulin is made.

The diagnosis of cystic fibrosis can be confirmed by measuring the chloride content of sweat. It’s a standard test done everywhere. DNA tests detect the gene mutations that bring on this disorder. These tests are widely available. Your son should have the tests done quickly so the diagnosis can be confirmed and treatment started.

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.


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