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Caring for ‘pre-osteoporosis’

By Richard Harkness
Knight Ridder Newspapers

Q. I’m trying to decide the best approach to prevent osteoporosis and would appreciate your advice. My last bone scan showed osteopenia in the right hip.

I took Prempro (estrogen-progestin) for 15 years, then stopped when the news came out that it increased heart attack risk. My gynecologist thought the risks were minimal, but prescribed Fosamax in place of the hormones for osteoporosis prevention. When I began to have difficulty swallowing, he switched me to Actonel, which I recently stopped taking because of heartburn.

Currently, I take 1,000 mg of Viactiv daily plus a multivitamin with 200 mg of calcium. I also exercise, drink milk and eat yogurt and lots of vegetables.

My question is, now what?

A. You can bet a legion of other women share your place. The osteopenia in your hip (indicating loss of bone mass) might be thought of as “pre-osteoporosis.”

Fosamax and Actonel, called bisphosphonates, gradually increase bone mass and reduce fracture risk.

The downside is that these drugs can damage the food tube (esophagus) unless they’re taken exactly as directed. They are poorly tolerated in people with GERD (gastroesophageal reflux disease), which causes acidic stomach contents to back up into the food tube.

You might be more likely to tolerate the once-weekly version of Fosamax or Actonel.

Or, if you’d rather try estrogen again, you could ask your doctor about low-dose hormones or bioidentical hormones, which may be less heart risky.

Another option to ask about is Evista, a “designer” estrogen that doesn’t seem to carry estrogen’s risk for cancer. However, it can increase hot flashes, and, like estrogen, blood-clotting risks.

Miacalcin (calcitonin) in nasal spray or injectable form might also be an option.

Along with any of the above treatments, you need adequate calcium and vitamin D (required for calcium absorption), as well as exercise (weight-bearing), all of which you seem to be getting.