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Dear Dr. Roach: I took Fosamax for years, but stopped five years ago. My bone density score is now -2.5. Should I restart Fosamax? If it creates more mass of brittle bone, then it does not seem advisable.

K.B.

Dear K.B.: Fosamax (alendronate) works by preventing absorption of bone by osteoclasts (bone-absorbing cells). When used for three to five years, it improves bone density and reduces the risk of fracture. However, when used for longer periods, it can cause brittle bone, as you have said, and can put people at risk for “atypical” fractures of bone, especially the femur.

You are in a situation that has no definitive answer. Your bone density is at a level where it might be appropriate to re-treat. However, there is more to fracture risk than just the bone density score, so I would recommend a FRAX test (available at sheffield.ac.uk/FRAX/tool.aspx?country=9). If your FRAX score indicates a 10-year risk of a hip fracture of 3 percent or greater, or if your 10-year risk of combined major osteoporotic fracture is at least 20 percent, treatment would be recommended.

Some experts would use a bisphosphonate like Fosamax again, because after five years off treatment, an atypical fracture is not likely. However, others would use a different type of treatment, such as teriparatide, which works by stimulating new bone growth. There are no studies to guide treatment in your situation, so the clinical experience of your treating provider is key. Since you are concerned about brittle bone, I might prefer teriparatide for a person in your situation.

Dear Abby: “Addicted in Kansas City” (Aug.) asked you for secular alternatives to Alcoholics Anonymous. There are parts of your response that I feel need clarification.

First of all, AA doesn’t require lifetime attendance at meetings. AA doesn’t “require” anything. (The third tradition states the only requirement for membership is a desire to stop drinking.) Regular attendance at meetings is encouraged, but certainly not a requirement. Many people continue to go to meetings one or more times a week, while others stop or go only occasionally after a period of time.

The other point is tougher — and perhaps more subtle. AA encourages individuals trying to get sober to find a “God of their own understanding,” a Higher Power, SOMETHING bigger than themselves. Many agnostics and atheists get and stay sober in AA.

AA is a spiritual program, not a religious one. This can be a difficult concept for people just coming in (and a great reason not to stay). That’s one of the reasons AA encourages anyone new to attend different meetings, if possible, and check out other groups. In many cities there are meetings expressly for atheists and other nonbelievers.

Sober And Happy in Atlanta

Dear Sober: Thank you for writing to clarify this. However, there are different programs (different strokes ... ), which is why I also encourage anyone trying to achieve sobriety to research and explore the alternatives.

Email questions to ToYourGoodHealth@med.cornell.edu.

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