To Your Good Health: Bone-Density Reduction Calls for More Than Calcium

Dear Dr. Roach: My physician has prescribed me Fosamax to treat osteoporosis of the spine. My latest bone density test shows osteoporosis of the last lumbar disc in the tailbone area. My T score in the spine is -2.6. (In 2006, it was -0.3; the change is unbelievable!)

After extensive research, I am extremely fearful of taking this drug for even one year. The side effects are tremendous.

I am 69 years old and in excellent health. I have participated in weight-bearing exercise programs my entire life. I am very sensitive to all medications. I already have occasional acid reflux and often am nauseated in the morning. I also take Advil when needed for a shoulder problem. All of these (plus many more) are indicators that I should not take this medication.

Is it possible to avoid taking this toxic drug and increase my bone density by increasing my calcium intake from food? The research I have done indicates that Fosamax does not build bone, but only stops the loss of bone and actually kills off the natural bone builders in your body. — C.G.

Answer : Osteoporosis is a disease in which bones lose their density, making them more susceptible to fractures and breaks. A T score is a measurement of the density of bone relative to that of a young, healthy woman. “Normal” is a T score of 0: If you are on the minus side, you have less bone density than normal; on the plus side, you have more than normal. A T score below -2.5 indicates osteoporosis.

Fosamax and drugs like it work by reducing the activity of the bone-remodeling cells (osteoclasts), not the bone-building cells (osteoblasts). However, this can lead to problems, since there should be a balance of bone remodeling and bone rebuilding.

Fosamax has some complications, but having a hip fracture is worse. Fosamax can be used safely with a lot of care and attention. Zoledronic acid (Reclast) is a medicine that works the same way as Fosamax and Actonel, but is given via a once-yearly injection, which makes it a good choice for people with reflux problems.

An alternative is Forteo (terapartide), which works in a completely different way. Denosumab, strontium, estrogen and raloxifine all can be used to treat osteoporosis. You do indeed have many other options, but an increase in calcium alone probably is not a good one. Make sure your vitamin D level is normal. Exercise helps bone-building as well, so continue that. Given how fast your bone density dropped, I would recommend talking to your physician about a treatment that’s stronger than the calcium that you are comfortable with.

Dear Dr. Roach: My grandson loves to throw babies and small children up in the air and catch them. Is there a danger to their bodies other than the chance that he might drop them? — S.J.

Answer: Very small children and babies are more delicate, and have relatively larger heads and brains than adults. Very vigorous tossing and catching can cause damage. On the other hand, tossing less than a foot in the air is unlikely to cause problems.

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 write to P.O. Box 536475, Orlando, FL 32853-6475.