DEAR DR. ROACH: I am a 79-year-old woman with osteopenia. I had the FRAX assessment and was told my 10-year probability of major osteoporotic fracture percentage is 19.4%, with a hip fracture probability of 5.7%.
Unfortunately, I broke my wrist in a traumatic fall backward last year, landing on a concrete patio. My doctor has said that it is a “fragility fracture,” by which she means I have osteoporosis and that I need alendronate. I feel that the broken wrist is a traumatic injury, rather than a fragility fracture.
Unfortunately, I have a small hiatal hernia. Due to family stress, I have stomach issues. My doctor then said that I should have Reclast infusions rather than alendronate. I have read horror stories from women who have had the infusions. Do you agree that I should have Reclast infusions? Could I try alendronate and see how it goes? — E.R.
ANSWER: Osteopenia, now more commonly called low bone density, is a precursor to osteoporosis, which is a condition of abnormally weak bones. Everyone with osteoporosis or even low bone density should get counseling on diet, including calcium intake; vitamin D supplementation; exercise; and smoking cessation for smokers.
Medication treatment is indicated for those at high risk for fracture: low bone density (such as a T score below -2.5); a FRAX score with a 10-year risk of major osteoporotic fracture of greater than 20% or hip fracture greater than 3%; or a history of a fragility fracture. This is defined as a fracture caused by fall from standing height or less. Your doctor is correct based on the definition, even though some people with normal bones might still get a fracture if they hit their bones the wrong way. You meet two out of the three criteria for medication treatment.
A hiatal hernia alone isn’t necessarily a reason not to get an oral bisphosphonate like alendronate (Fosamax), and I don’t have enough information about your stomach problem to say whether oral alendronate is safe for you. But people with difficulty swallowing pills are good candidates for intravenous bisphosphonates like zoledronic acid (Reclast). The oral drugs work exactly the same way as the IV drug, and while the IV drugs don’t have the stomach side effects that some people get with oral treatment, the IV treatment can cause some flulike symptoms for up to three days. Both oral and IV treatments have the potential for serious side effects, such as osteonecrosis of the jaw.
Accordingly, these drugs should be used ONLY when the benefits outweigh the risks. Your risk of a major fracture is high enough that medication treatment is generally recommended.
DEAR DR. ROACH: I was diagnosed with a hydrocele of the scrotum. How dangerous is this, and what can be done about it? — E.
ANSWER: A hydrocele is a common and usually benign condition of fluid buildup inside the scrotum. It usually doesn’t cause any symptoms, and if it doesn’t, then it doesn’t need treatment. Surgery can be done for the occasional man with symptoms that are bad enough to warrant surgery.
Many men with a hydrocele worry about fertility, but this is not usually affected.
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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.

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