Dear Dr. Roach: I am a 63-year-old woman with osteoporosis. A few years ago, I had osteopenia, and my doctor put me on an oral medication that I was unable to tolerate. Since then I have tried to eat many calcium-rich foods, do weight-bearing exercises and walk. But now she wants me to try Reclast or Boniva. I went online to find reviews about their effectiveness, and for every positive review, there were 10 or more bad reviews. My concern is that once it's in my system, there is no going back if I have a bad reaction. With the horrific side effects some of these women reported, there was no way of turning it around. I trust that my doctor only wants what is best for me and that she is concerned that I will start to have issues with breaks and fractures.
When I spoke with my GP, she didn't seem very concerned about the side effects, and said that she didn't have anyone tell her of any issues with the treatment.
I'm hoping you can give me an educated and unbiased opinion as to the effectiveness of these treatments. I am sure a lot of women are going through the same process, and could use the same advice. — C.T.
Dear C.T.: Osteoporosis is a net loss of bone minerals that leads to an increase in fracture risk. It is very common, especially in Asian and white women. However, it can happen to anyone — in black women and white men it happens, but at an older average age.
There are two main measures of osteoporosis: the T-score and the Z-score. The T-score is more commonly used, and it compares the person's bone density at a particular site (usually the hip or spine) with what it would be in a young, healthy person. A T-score of 0 means the person's bone density is the same as a young, healthy person. A negative score means the bone density is lower. A T-score between -1 and -2.5 is called low bone mass, or osteopenia. This is not a diagnosis; rather, it indicates risk of developing osteoporosis in the future, and at this time, advice on diet and exercise is appropriate. A T-score of -2.5 or lower is osteoporosis; however, osteoporosis may be diagnosed at a more normal T-score in someone with a fracture due to fragile bones.
The Z-score compares a person with someone of the same age and sex. It's useful to identify people with a cause other than age for osteoporosis. These include use of prednisone or similar steroids, low body weight, smoking and excess drinking, kidney or liver disease, celiac disease, early menopause, hyperthyroidism and numerous other rarer causes. Identifying a secondary cause, if present, is important.
The lower the T-score, the more important treatment becomes. Treatment is appropriate for people with a low T-score who have not responded to diet and exercise.
The problem with websites that solicit information about side effects is that people with side effects are a lot more likely to respond to them. The overall effect looks horrible. The data from placebo-controlled trials shows that the side effects for Boniva (a pill taken usually once a month) are barely higher than placebo. Only stomach upset and limb pain are significantly higher, and only in about 2 percent of people. Reclast (an IV infusion, usually given once yearly) can cause a flulike syndrome for a few days after infusion.
These medicines will leave the body after stopping them, but slowly. Don't take them for more than three years without a thorough re-evaluation.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.