Dr. Roach: Medicine may be vital in osteoporosis case

Keith Roach
To Your Health

Dear Dr. Roach: I’m a 57-year-old female, and I have osteoporosis. My average T score is -3.3. My L4 is -4.1. My doctors have told me that it is genetic and that calcium, vitamin D and estrogen are of no help. They have suggested that I try Prolia or Forteo. These medicines, as you know, are injectable and very expensive. My insurance company excludes Prolia. I’m writing you in hopes that you will have a suggestion for building bone a more natural way.

J.A.S.

Dear J.A.S.: The optimal treatment for osteoporosis depends on many factors, but the level of the T score is very important. A T score is a measurement of how much mineral there is in the bone (which is a fair estimate of how strong the bone is) compared with a healthy young woman (or man). A T score of 0 means you have the same bone mineral density as a healthy young woman, but the minus sign means less bone density. A T score below -2.5 means osteoporosis, and a score of -4.1 is very low, with a high risk of fracture (L4 is your fourth lumbar vertebra). That is why your doctors have wanted to use powerful medicines that act quickly. If your T score weren’t so low, then you would have more options. I am absolutely a believer in natural treatments, when they have been proven to work (as in osteoporosis), but I think you really should consider medication, as well.

It isn’t true that calcium, vitamin D and estrogen are of no help; in fact, they help a lot. Calcium is the essential mineral that needs to go into your bones, so you need to be taking in enough. Vitamin D helps your body absorb calcium and put it into the bones, so that also is critical. Estrogen is another treatment for osteoporosis, but because it increases blood-clotting risk and may have adverse effects on heart disease and breast cancer (in combination with progesterone), it is less frequently used, but sometimes is used either by itself or in combination.

I received a letter recently from a woman who is an instructor for an exercise program called Strong Women/Strong Bones, who reminded me to emphasize the importance of weight-bearing exercise to strengthen bones, with or without drug therapy. Because of your very low T score, however, I would discuss with your doctor the best form of safe exercise.

Forteo, by the way, is a “natural” product in that it is an analogue of parathyroid hormone, the body’s primary regulator of bone metabolism. In a major study, Forteo reduced the risk of any vertebral fracture (which you are at highest risk for) from 14 percent to 5 percent. I think that a medication like Forteo, in combination with a good diet with plenty of calcium, supplemental vitamin D and exercise, is your best option.

Dear Dr. Roach: My adult daughter contracted ringworm or some other fungus from her beautiful Border Collie. She has been using over-the-counter meds on the two of them for over 10 months! The dog is doing better than my daughter. Any solutions to get rid of this once and for all?

E.B.

Dear E.B.: Ten months is too long to treat something empirically. It’s time to find out what this fungus might be, and that means a visit to a dermatologist, who can do a culture of the infection to find out what it is. There are some unusual fungi that can be passed from animals (dogs, cats, pigs, horses, cattle) to humans and cause skin infection. Rarely is systemic treatment necessary.

Email questions to ToYourGoodHealth@med.cornell.edu.