Dear Dr Roach: I am an 80 year old woman in good health except for a diagnosis of osteopenia. My doctor prescribed me medication for my osteopenia. I have periodontal disease and my periodontal specialist advised me not to take osteopenia medication due to the deterioration of the jaw. I think I’m in a lose-lose situation. I spoke to my internal medicine doctor and he told me he was worried about a hip fracture if I didn’t take the osteopenia medication. I don’t want to take the risk of the jaw deteriorating. Please give me your opinion on the best course of action.
Dear GM: Osteopenia, also called low bone density, is a risk factor for osteoporosis. The risk of developing a fracture depends on a person’s age and sex, height and weight, the results of their bone density test, and the presence of certain other medical risk factors, including a fracture. previous use of glucocorticoid drugs like prednisone, smoking and rheumatoid arthritis. The risk of fracture is generally estimated by the FRAX tool (www.sheffield.ac.uk/FRAX/). If the estimated risk of hip fracture is 3% or the combined risk of fracture is 20%, drug therapy is usually recommended. Getting your FRAX result is a critical number to have to help make an informed decision. You will need the exact results for your bone density.
If your risk is not that high that medication is recommended, there are several things you can do to improve your bone density. These include getting adequate dietary calcium, supplementing with vitamin D, regular exercise, especially weight-bearing and strengthening exercises, and avoiding smoking and excess alcohol. A home assessment to reduce the risk of falling may be of benefit.
If your risk of fracture is already above the above threshold, medications will normally be prescribed in addition to lifestyle-related treatments. Antiresorptive treatments, such as alendronate (Fosamax) or other bisphosphonate drugs, increase the risk of jaw damage, and given what your periodontist recommended, I would not only avoid these drugs, but also denosumab (Prolia), which works in the same way by decreasing bone resorption. Although I am not an expert, I would consider treatment with a drug like teriparatide, which has been used as a treatment for people with osteonecrosis of the jaw. This drug works by stimulating bone growth and has a good safety record.
An expert in the treatment and prevention of osteoporosis would be a helpful colleague to whom your internal medicine doctor could refer. Most often, these are endocrinologists, some of whom specialize in bone metabolism.
Dear Dr Roach: The nurses at the blood bank have trouble finding a vein in either arm almost every time I go to donate platelets. I drink lots of water the night before and 16 ounces the same day, but no luck. Is there anything I can do to make my veins easier to find? Does the weight have something to do with it?
Dear NK: In addition to fluid intake, keeping the arm warm makes the veins more prominent. Keeping your arm down (under your heart) for a long time can also help.
People who are overweight sometimes have veins that are harder to find, but this is not always the case.
Readers can email their questions to ToYourGoodHealth@med.cornell.edu.