DEAR DR. ROACH: I recently had a bone density test and was advised that I have osteoporosis in the wrist and hip. I am now 77 years young. My doctor has advised me to begin taking 70 mg alendronate every seven days. I am not happy about this, as the side effects I have read about are many. Is there something else that you are aware of that can be beneficial? I have not started the Fosamax yet. — J.T.

ANSWER: There are many treatment options for osteoporosis. Before starting treatment, however, your doctor probably checked your vitamin D level and PTH level, as too little vitamin D and too much PTH can cause osteoporosis, and these should be treated directly. Celiac disease should be considered in people with osteoporosis, as it can affect bone strength in absence of GI symptoms.

Alendronate (Fosamax) is in the class of medicines called “bisphosphonates,” and they work by preventing the osteoclasts from overdoing their job, which is breaking down bone. This allows the osteoblasts, which build up bone, to bring bone density back up. The osteoclasts and osteoblasts need to be balanced so that the bone is constantly reformed, with the osteoclasts breaking down potentially weakened areas of bone and allowing the osteoblasts to refill the holes left behind with new, healthy bone. Of all the medicines that treat osteoporosis, the strongest evidence for preventing fractures is with alendronate and medicines like it. They do have side effects, including damage to the esophagus, if they are not taken with great care, and bone pain, especially if there isn’t enough dietary calcium. However, they are well tolerated by most people.

Other medication treatment options include teripartide (Forteo), an analog of PTH, which increases bone formation. It usually is used for men and women with severe osteoporosis. Estrogen and estrogenlike drugs are still used, but have side effects I have often written about. Denosumab (Prolia) prevents bone resorption, but is seldom used as first-line treatment. Calcitonin and strontium ranelate are relatively weak agents.

There are non-medication options as well, which can be used alone if the disease is mild or in combination with medication. Weight-bearing exercise, smoking cessation and adequate dietary calcium are very important and often overlooked.

DEAR DR. ROACH: Some years ago, my psychiatrist, a psychiatry resident and I went into a small room. The psychiatrist asked me why I was speaking so fast, and I replied that I wasn’t. I asked the resident if he heard me speaking quickly, and he said yes. Why couldn’t I hear myself speaking fast? — P.R.V.

ANSWER: We use the term “pressured speech” to describe the rapid talking that people with some psychiatric disorders, especially those who are bipolar, have during the manic phase of their illness. During these times, the brain works extraordinarily quickly, so your speech comes out sounding normal to you, but it can be hard for others to catch up to how fast your thoughts are communicated. I wonder if everybody else’s speech sounded slow to you.

In mild forms of bipolar disorder, people can become what we term “hypomanic,” where they are capable of enormous amounts of productive work in a short period of time. A classic description is a person who cleans the house at 2 in the morning. In fully developed mania, the thoughts move so quickly that people are rarely capable of actually getting things done; I have seen people with five different pens in their hands but unable to write anything down.

There are many effective treatments for bipolar disorder.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.


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