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Dear Dr. Roach: I recently had a bone density test and was advised that I have osteoporosis in the wrist and hip. I am now 77 years young. My doctor has advised me to begin taking 70 mg alendronate every seven days. I am not happy about this, as the side effects I have read about are many. Is there something else that you are aware of that can be beneficial?

J.T.

Dear J.T.: There are many treatments for osteoporosis. Before starting treatment, however, your doctor probably checked your vitamin D level and PTH level, as too little vitamin D and too much PTH can cause osteoporosis, and these should be treated directly. Celiac disease should be considered in people with osteoporosis, as it can affect bone strength in absence of GI symptoms.

Alendronate (Fosamax) is in the class of medicines called “bisphosphonates,” and they work by preventing the osteoclasts from overdoing their job, which is breaking down bone. This allows the osteoblasts, which build up bone, to bring bone density back up. Of all the medicines that treat osteoporosis, the strongest evidence for preventing fractures is with alendronate and medicines like it. They do have side effects, including damage to the esophagus, if they are not taken with great care, and bone pain, especially if there isn’t enough dietary calcium.

There are nonmedication options as well, which can be used alone if the disease is mild or in combination with medication. Weight-bearing exercise, smoking cessation and adequate dietary calcium are very important and often overlooked.

Dear Dr. Roach: Some years ago, my psychiatrist, a psychiatry resident and I went into a small room. The psychiatrist asked me why I was speaking so fast, and I replied that I wasn’t. I asked the resident if he heard me speaking quickly, and he said yes. Why couldn’t I hear myself speaking fast?

P.R.V.

Dear P.R.V.: We use the term “pressured speech” to describe the rapid talking people with some psychiatric disorders, especially those who are bipolar, have during the manic phase of their illness. At these times, the brain works extraordinarily quickly, so your speech comes out sounding normal to you, but it can be hard for others to catch up to how fast your thoughts are communicated.

In mild forms of bipolar disorder, people can become what we term “hypomanic,” capable of enormous amounts of productive work in a short period of time. In fully developed mania, the thoughts move so quickly that people are rarely capable of actually getting things done; I have seen people with five different pens in their hands but unable to write anything down.

Email questions to ToYourGoodHealth@med.cornell.edu.

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