Dr. Roach: Does osteoporosis medicine perform differently for men?
Dear Dr. Roach: I am 65 and get very little exercise due to a below-the-knee amputation I had 27 years ago. Although I have a prosthesis, I experience open sores. I have been diagnosed with severe arthritis and severe osteoporosis. My doctor has me taking alendronate, calcium and vitamin B. A recent column of yours and the info in the box of alendronate refer primarily to how it works in women. What about men?
Dear G.K.: Although women get osteoporosis earlier than men do, older men, particularly older white and Asian men, are also prone to developing osteoporosis. Eight million men in the U.S. have low bone mass or osteoporosis, and they are less likely to be either diagnosed or treated than women are.
The first step in treatment is related to lifestyle: diet, exercise, reduction of alcohol if indicated (to no more than moderate) and tobacco cessation. Unfortunately, because of your leg amputation and sores, exercise is going to be difficult for you, but you should still do what you can. Calcium (1,200 mg daily) and vitamin D (800 IU daily) are recommended, either through diet or supplements.
All men with osteoporosis should be evaluated for low testosterone, and treated if levels are low. Low testosterone is the most common identifiable cause for osteoporosis in men. Other conditions that should be at least considered include celiac disease, Crohn’s disease and use of glucocorticoids.
If medication treatment is needed, a bisphosphonate, such as the alendronate (Fosamax) you are taking, is considered first-line treatment for men. It works the same way in men as it does in women, slowing down reabsorption of bone. As in women, treatment should be re-evaluated after five years. Pausing or stopping medication is often appropriate at that time.
The recent column I think you are referring to was on raloxifene, an estrogenlike drug that is not appropriate in men. Denosumab or teriparatide are alternatives to bisphosphonates for use in men with osteoporosis.
Dear Dr. Roach: Our tap water at home has high sodium levels. A letter from the city says it contains sodium at concentrations of 85.8 mg/l. While we do not drink the water often, we do use ice made from this water. My cardiologist has asked that I lower sodium in any way I can. I have mitral and aortic stenosis. I had chemotherapy and radiation in 1985-86 for Hodgkin’s disease.
My research has not shown a way to treat the water to reduce the sodium, and buying water is expensive as well as cumbersome to have to store.
Dear T.F.: Reduction of sodium is an appropriate goal for most North Americans. However, drinking water is not usually a significant source of sodium. It seldom accounts for more than 5% of a person’s sodium intake. In some parts of the country, water naturally has more sodium or it can be introduced into the water supply (such as by salting roads). Or it can be added through water softeners. Even if you don’t drink much, you are probably cooking with it as well. There are few times when the amount of sodium in drinking water makes a significant difference in a person’s medical condition. This may be one of those cases.
If you don’t want to use bottled water, the best solution is probably a reverse osmosis system, which can be installed under your sink. It can remove more than 90% of sodium, and is cheaper in the long run over bottles. I’d recommend finding a plumber experienced in installing these.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.