DEAR DR. DONOHUE: Please enlighten me and others who have osteoporosis about the possibility of the thigh bone suddenly breaking with little pressure applied. I saw two news pieces about Fosamax and its generic that reported many women had this happen. I stopped taking Fosamax when I heard this. I had taken it for five years. My doctor was OK with my decision. — S.S.

ANSWER: Fosamax (alendronate), Actonel (risedronate), Reclast (zoledronic acid) and Boniva (ibandronate) are members of a family of drugs called bisphosphonates. They are the most often prescribed drugs for the prevention and treatment of osteoporosis, and they are quite effective.

Recently articles have appeared implicating these medicines as contributing to breaks in the thigh bone (the femur). Osteoporosis breaks of the femur usually occur higher up in the bone, near the hip joint. The medicine-associated fractures haven’t happened to many users, but they have happened to enough people to make doctors and patients more circumspect about the use of these drugs. It has occurred when a person has been on long-term therapy.

Solutions for the prevention of these bisphosphonate-associated fractures have been suggested. One is to take a rest from the drugs after five or 10 years of treatment. For women at high risk of osteoporosis fracture, the decision to continue their use depends on the woman’s degree of fracture risk from her osteoporosis. Programs are available to determine that risk.

Women in great danger of an osteoporosis fracture can continue taking the bisphosphonates without a rest. Or they can take osteoporosis medicines that are not related to those drugs. Forteo (teriparatide) and a new drug, Prolia (denosumab), are two such drugs.

And people have to be sure they are getting enough vitamin D and calcium. The new recommendations are for a calcium intake of 1,000 mg a day for those 70 and younger, and 1,200 mg for those 71 and older. For vitamin D, it’s 600 IU for those 70 and younger, and 800 IU for those 71 and older.

DEAR DR. DONOHUE: I have seen a specialist for jock itch. I was told there is no cure. Why not? Men in service during the wars must have had this. — W.K.

ANSWER: Men and women in and out of service get tinea cruris, jock itch, a fungal infection of the skin in the groin. Cure is possible. The infected skin is red to brown and has a raised, scaly margin. It’s often itchy. In another part of your letter, you mentioned an antifungal drug that is effective. Stick with it. It can require a month or more of treatment, and you should keep treating for one full week after all signs of it have gone. Other effective medicines are miconazole (Micatin) and clotrimazole (Lotrimin AF), both available without a prescription. If your current medicine or these medicines don’t make a dent, then you might have to go on prescription oral medicines. In that case, considerations of conditions that look like jock itch should be assessed, things like erythrasma, a bacterial skin infection, and psoriasis.

DEAR DR. DONOHUE: I will be 75 in three days. My heart doctor said I have no blockages but I have a leaky valve. I had bad pains in my left side down to my hip and ankles. X-rays showed degenerative arthritis. I am getting pains around my heart and chest, and they get worse when I eat. What are these three things: leaky valve, degenerative arthritis and chest pain? — P.M.

ANSWER: The significance of the leaky valve depends on how great the leak is. Yours must be minimal, or your doctor would have told you otherwise. At present, nothing needs to be done. Degenerative arthritis is osteoarthritis, the most common kind of arthritis, and the kind that appears at older ages. Its pain often can be controlled with Tylenol. Chest pain around the heart has to be explained. You have had many heart tests, including an echocardiogram, and you were examined by a cardiologist. It’s safe to say that your heart isn’t causing the pain. Since it worsens with eating, it could be a digestive problem. Let your family doctor handle this problem.

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.

Copy the Story Link