DEAR DR. DONOHUE: I was told I have polymyalgia rheumatica nine months ago. The doctor put me on prednisone. Now I am down to 10 mg a day because of the damage prednisone can do to bones. I have a lot of pain beginning around 3 a.m. every day. I was given a pain reliever, but it doesn’t work. Is there anything you can suggest? The doctor thinks I might have temporal arteritis, too. Will you shed some light on that? — J.H.

ANSWER: Polymyalgia rheumatica strikes at older ages. Most cases arise in people’s 70s. Inflammation around joints is the basis of the illness, but its cause remains unknown. Stiffness and pain of the shoulders, hips, lower back and neck are its signs. Discomfort often worsens at night and wakes people.

Prednisone, one of the cortisone drugs, is the medicine chosen for treatment. No one likes to stay on a cortisone medicine for prolonged periods. It has too many side effects. One of them is osteoporosis. Since you’re still having pain in spite of treatment, you need to either raise the dose of prednisone in spite of side effects or split the dose so you take half in the morning and the other half at night. If you don’t respond to an increased dose, another medicine, like methotrexate, can be added to your program.

Temporal arteritis, also called giant cell arteritis, is an inflammation of arteries. Headaches, scalp tenderness and jaw pain during chewing are some of its sign. The most feared complication is blindness due to inflammation of the artery supplying blood to the eye. Prednisone is its treatment also, but higher doses are used. Temporal arteritis often goes hand in hand with polymyalgia.

Osteoporosis can be a side effect of long-term prednisone. That can be prevented by getting enough calcium (1,200 mg/day), enough vitamin D (1,000 IU/day) and daily exercise like walking. Some doctors put their long-term prednisone patients on medicines designed to treat osteoporosis, such as Fosamax, Actonel or Boniva.

DEAR DR. DONOHUE: I am a nutritionally oriented dentist and an avid reader of your column. You wrote about vitamin D and stated that D-2 and D-3 are equal. Nothing could be further from the truth. In a study from Creighton University, D-3 was shown to be significantly more efficacious because it is more potent, has a longer half-life and is more bioavailable. — G.S., D.D.S.

ANSWER: Vitamin D comes in two forms, D-2 and D-3. D-3 is formed in the skin when sunlight strikes it. D-2 comes from some fatty fish, eggs and many fortified foods. Both D-2 and D-3 are transformed by the liver and kidney into the active vitamin.

For the reasons you mention, many feel D-3 holds an advantage. The longer half-life is especially beneficial for those who take the vitamin less than once a week.

Others argue that either form of the vitamin is OK for daily use, and that both have equivalent biologic activity.

Your letter was so well-written and made the argument so politely that I might be converted to your side without much more persuasion.

DEAR DR. DONOHUE: My doctor has prescribed Fortical, a nasal spray, for my osteoporosis. I also take vitamin D and calcium. I don’t ever remember reading about Fortical in your column. Will you give some comments? — L.H.

ANSWER: Fortical is calcitonin, a hormonelike substance made by some special cells found in the thyroid gland. The commercially available calcitonin is derived from salmon. It’s available as a nasal spray. It’s also available in an injection form.

It has actions similar to other osteoporosis drugs. It stops the accelerated breakdown of bones that occurs after menopause.

It’s not the most often prescribed osteoporosis medicine, but it’s an approved and accepted treatment. I think taking it as a nasal spray might be a turn-off for some people.

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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