DEAR DR. ROACH: I’m 86, and was finally, after a few false starts, diagnosed with two compression fractured vertebrae, which were very painful. This was followed by a diagnosis of osteoporosis. The doctor who diagnosed it told me that it was a disease mainly of the northern part of the planet, affecting folks living in the Scandinavian countries and also places like Ireland, where I came from originally. I had never heard of such a disease, have you? — V.V.M.
ANSWER: Osteoporosis is a very common condition in adults older over 50, effecting women more than men, whites and Asians more than Black, and people living far from the equator are at higher risk than those in or close to the tropics. I see people at risk for osteoporosis nearly every day in my clinic, and treatment is ideally to prevent the fracture from happening in the first place.
The best diagnosis tool for osteoporosis is measuring bone density with a specialized X-ray called a DEXA (dual-energy X-ray absorptiometry). Osteoporosis is defined as a VERY low bone mass or by a history of a typical fracture consistent with, and in addition to, low bone mass.
Compression fractures of the vertebrae — when the weakened bone is crushed by the weight it supports — are more common than the even more serious hip fractures, but are probably less well known. I see them too frequently.
Primary preventive care for osteoporosis includes a diet containing adequate calcium, with enough vitamin D from food, sunlight or supplements; and exercise, particularly weight-bearing or higher-impact exercise, if possible. People who continue to have low bone mass or osteoporosis benefit from medication treatment to reduce fracture risk.
DEAR DR. ROACH: I am 59 years old and work out with weights. Can I still gain muscle, or am I too old? Either way I will continue working out. — C.D.
ANSWER: People at any age can gain strength, and muscle mass from exercise. Fifty-nine is very young! People in their 80s and beyond not only gain strength, but can reduce risk of falls and fractures through regular exercise. I do recommend getting a professional to help if you are not familiar with the equipment and techniques.
DEAR DR. ROACH: Cholestyramine was prescribed by my family doctor. What is your experience or knowledge of the effectiveness of this drug? High triglycerides are the reason, according to the doctor. — J.P.
ANSWER: Cholestyramine works by binding bile, which means that cholesterol is excreted though the gut into the stool. It has been used for many years to lower cholesterol, but is not often used now, because there are other drugs better able to lower cholesterol, and they have been proven to reduce the risk of heart attack, whereas the benefit from cholestyramine and similar drugs is not as well proven.
People taking cholestyramine may notice nausea, bloating and cramping. These can limit the usefulness of the medication. What has me confused, though, is that cholestyramine often has the effect of INCREASING triglyceride levels. In fact, there are warnings against using cholestyramine in people with very elevated triglycerides, who are more often treated with other classes of medication, the fibrates and statins. Very high triglycerides can cause inflammation of the pancreas.
Cholestyramine has other uses. I’ve had remarkable success treating people with chronic diarrhea using cholestyramine when the diarrhea is caused by problems with excess bile salts. For example, it can be used in Crohn’s disease or for some people with gallbladder removal and celiac disease.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.