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Osteoporosis, Metabolic Bone & Mineral Disorders Archive Questions

Below are Dr. Streeten’s answers to Osteoporosis, Metabolic Bone & Mineral Disorders questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 54.

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Q : 1

I have been diagnosed with osteoporosis and was taking Fosamax for about three years but have been off it for about four years with my doctor's consent. I am 64. In June after my yearly DEXA my doctor recommended going back on Fosamax due to a decrease in bone markers. I am reluctant to do this based on reports of jaw problems among other things and was curious as to whether exercising with a weighted vest and using a trampoline would be helpful. I have never had a fracture and have been fairly physically active all my life. I happen to be short and thin. I currently take about 3500 mg of Vitamin D, Vit K and 1200 mg Calcium Ditrate daily as well as consuming lots of almonds, sardines, calcium enriched soy milk and other supposedly bone healthy foods. What do you recommend?

In general, for people at high risk for fracture, the possible benefits of treatment with Fosamax far outweigh the rare risks. Unfortunately, I can't give you personal recommendations without seeing you as a patient, to review your entire history, labs and all DXA images. If you would like to see me, you can schedule by calling my secretary, Angela, at 410-328-6219.

Q : 2

I am a 44-year-old female with a family history of osteoporosis. How soon should I have a bone density study?

Generally, the best time to do the first DXA is at menopause, assuming that you haven't had a fracture following mild trauma.

Q : 3

Do you follow the new standards of TSH where results above 3.0 is abnormal instead of the 2002 standard up to almost 5.0?

It depends on what the results are being used for and the age of the person. For an older person (e.g. >65), a TSH up to 5.0 is normal, whereas most younger people have a lower TSH.

Q : 4

My wife is a vegan and takes calcium supplements that include vitamin D. In conjunction with her multivitamin, she takes up to 1,300 IU of vitamin D daily (325% of RDA). Is that too much vitamin D? Should she continue to take calcium supplements that contain substantial vitamin D?

The only way to determine if a specific dose of vitamin D is right for a specific person is to do a blood test for 25-hydroxyvitamin D. There is a lot of individual variation in how much different people need. Her primary doctor could order the test.

Q : 5

Can resistance training promote bone regrowth or strengthening in a patient with degenerative disc disease? I have seven broken vertebrae and my last bone mineral density scan showed a reduction of 9.5 percent.

Resistive training can be helpful but has to be done carefully to prevent further vertebral fractures. In this situation it is important to evaluate for secondary causes of fracture (e.g. malignancy, hyperparathyroidism) and treat aggressively with medications (eg. bisphosphonate or denosumab or teriparatide). Medical treatment will be much more effective than exercise although exercise is an important component.

Q : 6

Can an osteoporotic patient have a total knee replacement?

Osteoporosis does not affect healing after joint replacement. However, vitamin D deficiency and excess parathyroid hormone (hyperparathyroidism) can impair bone healing so testing a 25(OH)D and PTH level before surgery is a good idea.

Q : 7

Can osteoporosis cause weight loss?

No, osteoporosis does not cause weight loss.

Q : 8

Are there bone pathologies other than osteopenia/osteoporosis associated with primary hyperparathyroidism? Do these pathologies cause bone pain?

Yes, these can cause pain but generally don't. There are no other bone pathologies associated with primary hyperparathyroidism.

Q : 9

My doctor has recommended Prolia for me since biphosphanates are not working and my Dexa Scan is getting worse. I am concerned about the potential "severe reactions" such as pancreatitis, endocarditis. Do you have any patients on Prolia? How are they responding?

The actual studies on Prolia show no serious side effects, so don't believe everything you read. There is a lot of incorrect info out there. I use Prolia routinely in my patients.

Q : 10

Could you give me some information on sugar consumption and osteoporosis?

I am not aware of any studies on sugar consumption and osteoporosis. The only somewhat related issue is that we know people with diabetes have a higher incidence of osteoporosis.

Q : 11

Are there any specific symptoms that can be caused by OI? Are there certain places in the world where OI is more common than others? Are there certain races prone to OI?

Osteogenesis Imperfecta can occur in any race and in any area of the world. It is associated with fractures, usually in childhood (but not always) and sometimes is associated with blue sclerae (the white part of the eye). In some cases, it is also associated with dental problems.

Q : 12

I am experiencing a lot of pain in my hips and from the middle of my back down to my right foot. I am limping and have trouble standing or sitting for extended periods. I was just diagnosed with osteoporosis, are these normal symptoms?

Osteoporosis doesn't cause pain unless there is a bone broken, so your pain may have nothing to do with osteoporosis. Osteomalacia (due to severe vitamin D deficiency) can cause bone pain. Given that your pain radiates down your foot, it is possible that both your hip and back pain are coming from a back problem (eg. spinal stenosis). If you haven't had x-rays or an MRI of your spine, you should see an orthopedic doctor.

Q : 13

Could breaking teeth be a symptom of osteoporosis?

Generally not. Breaking teeth is generally related to a cavity or breakdown in a previous filling.

Q : 14

I have possible stress fractures in my feet, nothing showed on regular x-ray, so I have been recommended for a bone scan. Would an MRI be less invasive and just as accurate? I'm not excited about having a radioactive substance injected into me even with the low the dose of the bone scan.

Both bone scans and MRIs are accurate for diagnosing fractures in the feet. The amount of radiation given for the bone scan has not been associated with any danger.

Q : 15

My mother is suffering from post menopausal osteoporosis. The consulting physician has asked us to go for PTH injections. Are there any big side effects associated with PTH?

PTH is very safe and effective. There can be mild lightheadedness after an injection for a couple of weeks and for this reason, it is generally injected at bedtime. The PTH injections are given by the patient, or her family, at home.

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