Frequently Asked Questions
Osteoporosis
| Q. I don't seem to have any of the major risk factors that I have seen listed that occur in association with osteoporosis. I am 56 years old and have recently gone off of my Premarin because of problems with vaginal bleeding. How can I be sure as to whether I have osteoporosis or not? |
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A. The definitive way to diagnose osteoporosis is by obtaining a dual energy x-ray absorptiometry (DEXA) scan of the lumbar spine and femur. Even in patients who do not appear to have one or more risk factors, a DEXA scan may reveal evidence of osteoporosis. This is especially important since you are not currently taking estrogen therapy and may need another medication to prevent resorption of bone once you have been off the estrogen for any length of time. |
| Q. My doctor recently told me that my DEXA scan was abnormal and in the osteoporotic range, yet I am not having any symptoms. I prefer not taking any of these medications which are expensive for me. Am I running any risk? |
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A. Yes. If you have an abnormal DEXA scan and indeed have osteoporosis, then you risk the possibility of a fracture of one of the bones in the spine (vertebrae) or a fracture in the hip or elsewhere. If you develop a fracture in the spine you may permanently lose height. If you have a fracture in the hip you may need to undergo surgery and may run the risk of not regaining your former functional status. So as you can see these are not insignificant consequences of not treating your osteoporosis. |
| Q. I was started on Fosamax recently but I am not sure if I am taking it correctly. I get up at 6 AM so that I can take the pill with water and give it time to be absorbed. I normally get up at 7 AM, so after I take my Fosamax I usually go back to sleep for one hour and then get up and start my day. A friend of mine told me that this is wrong, however. Am I making a mistake? |
| A. Yes. It is very important that you get up after you take your Fosamax and not lie flat in bed. One of the side-effects of Fosamax is gastroesophageal irritation. This appears to be avoidable for the most part if you drink a large glass of water and stand up or sit up after taking this. It is true that you need to wait at least thirty minutes before you eat food or take other medications, but is still essential that you not lie down during this time period. |
| Q. I am on Fosamax and am wondering if it is helping me. How often do I need to repeat a DEXA scan to see if it is working? |
| A. Ideally you would like to get a DEXA scan one year after starting on the medication to see if it is beneficial. Improvements in bone density take time to accomplish and if this test is done too frequently it may be interpreted incorrectly. Medicare is reimbursing for follow-up studies every two years and on a case-by-case basis at more frequent intervals. |
| Q. I was worried about getting a DEXA scan because I was concerned about x-ray exposure. I have had a fair number of x-rays for different medical problems. Am I right to be worried? |
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A. The x-ray exposure from a DEXA scan is trivial and much less than that from a chest x-ray study. Thus, although I understand your concerns about the x-irradiation, a DEXA scan should not alarm you as far as the amount of x-ray exposure you will receive. |
| Q. How much calcium does a person take before and after the menopause? |
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A. The current thinking is that before menopause a person should take 1,000 mg of elemental calcium and then after the menopause this increases to 1,500 mg of elemental calcium per day. Calcium citrate is absorbed better than most forms of calcium and so the amount of calcium citrate (Citracal) that is needed is less than traditional forms of calcium such as oyster shell calcium and calcium carbonate. Citracal due to its increased absorption may only require 800 to 900 mg per day to have the same effect as 1,500 mg of oyster shell calcium. |