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ALTERNATIVE THERAPIES FOR BONE DENSITY: LILLIAN’S STORY
March 14, 2011
One of my colleagues told me about one patient taking only Fosamax. A small woman in her early 70s, Lillian eats a fairly average American diet, has difficulty walking (and in fact uses a walker), and so gets little exercise and refuses to take calcium or any other supplements. Despite being about 30 percent low in bone density in her hip and spine, Lillian generally feels fine and is always happy and peppy when she comes into the doctor’s office. But the scan results did convince her she needed something to protect her bones if she didn’t want to fracture her hip or suffer from compression fractures in the spine, so she decided on Fosamax. In two years, she’s had over 6 percent gains in her back and almost 11 percent in her hip, impressive results given the fact that the medicine wasn’t getting support from the recommended lifestyle changes. In Lillian’s case, a positive attitude seemed to be the best medicine.
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DRUG THERAPIES FOR HEALTHY BONES: FLUORIDE
December 20, 2010
I used to prescribe sodium fluoride because it stimulates bone formation. But the bone formed turned out not to be of high quality—and sometimes even abnormal—resulting in dense, but fragile, bones and increases in the rate of fractures. Side effects include gastrointestinal problems and joint and/or bone pain, and it is potentially toxic in high doses. With newer, far better options, the benefits no longer outweigh the drawbacks, so my advice is to avoid it.
However, studies are under way on lower doses in special slow-release formulations that may build bone and decrease fractures, as well as reduce or eliminate side effects. Low doses (45 to 75 mg daily) are already used in Europe, with apparently satisfactory results, but haven’t been approved by the FDA here as of yet. More study is needed, but perhaps lower doses that keep fluoride safe and effective will bring this drug back into favor. It should be a relatively inexpensive option if it does prove useful in the future. If it does make a comeback, you may want to take it along with calcium and vitamin D supplements, and possibly another medicine that blocks bone breakdown.
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