DEAR DR. DONOHUE: Please provide information on arthritis of the spine and how it is treated. I especially need to know how to retard its advance. — F.L.

ANSWER: Spinal arthritis comes in many varieties. For successful treatment, the exact variety has to be determined.

Rheumatoid arthritis is a difficult kind of arthritis, but as far as the spine goes, rheumatoid arthritis is limited to the neck vertebrae (backbones). You didn’t mention neck pain, so we can eliminate that arthritis variety.

Osteoarthritis is the most common kind of arthritis and affects almost everyone as they grow older. It comes about from a degeneration of joint cartilage and adjacent tissues. It does affect the spine, especially the lower back. Heat in the form of warm showers or hot baths can limber the spine. A trial of Tylenol for its pain-relieving properties is useful. If it doesn’t work for you, then the nonsteroidal anti-inflammatory drugs might, drugs like Advil, Aleve and many others.

Drugs shouldn’t be given all the attention. An exercise program is most helpful. It has to be supervised by someone with knowledge of arthritis. A physical therapist is such a person, and these people are found at all hospitals. Some are in private practice. On your own, you can walk. It’s within the capability of most with spinal osteoarthritis.

A special kind of arthritis, ankylosing spondylitis, is back arthritis that comes on at early ages. It usually makes its appearance before age 40. Stiffness of the spine is a salient feature, and the stiffness can gradually work its way up to and including the neck. This kind of arthritis, in its extreme forms, requires special medications.

The booklet on back pain touches on most causes of spinal pain, including arthritis. Readers can obtain a copy by writing: Dr. Donohue — No. 303, 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’m an 85-year-old man who has just been diagnosed with osteoporosis. I asked my doctor for a bone density test, which he tried to talk me out of since I have no symptoms and exercise regularly. He had me get some blood tests to see if I have any vitamin deficiencies. I have been on hormones (leuprolide or triptorelin) for prostate treatment for eight years. I suspect they could be the cause. I would appreciate your thoughts. — R.B.

ANSWER: Men do get osteoporosis. Partly it comes from aging, and partly from a diminished production of male hormones. The two drugs you take depress testosterone production even more in order to prevent recurrence or spread of prostate cancer. Your doctor has done a wonderful job with that problem. However, those drugs are involved in osteoporosis development.

All your T-scores (the scores that indicate the bone’s calcium content) indicate you have osteoporosis. It should be treated with calcium, vitamin D and a drug that incorporates calcium into the bone. A new drug, Prolia, is suited to someone like you.

DEAR DR. DONOHUE: What can you tell me about collagenase for Dupuytren’s contracture? — L.B.

ANSWER: Dupuytren’s contracture is a bending of one or more fingers down toward the palm. Strands of scarlike tissue have encircled the tendon to pull it downward and lock it in that position. The little and ring fingers are the ones usually involved.

Collagenase is an enzyme that softens and digests the scarlike tissue, which happens to be collagen. The day after the injection, the doctor manipulates the hand and fingers to break the collagen bands. The success rate for this treatment is high. Two or three injections might be needed.

Xiaflex is the name of the enzyme product.

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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