You have many good questions which need to be brought up with the physicians who are caring for her. Poor blood supply can be for many reasons, including damage to nearby blood vessels from the fracture itself. It sounds to me that a consultation with a physician in your area who has a special interest in osteoporosis would be a good idea. I am sure her primary care physician or orthopedist knows someone like that.View Thread
There are numerous causes for a nonunion or delayed union fracture, including poor nutrition, infection, metabolic bone disease, poor blood supply to the fracture site, and the nature of the fracture itself. Fosamax is not known to cause this problem. Evaluation and treatment should be a team effort with a good orthopedic surgeon, primary care physician, and perhaps a specialist in osteoporosis.View Thread
From what you tell me, it appears that the lumbar spine bone mineral density (BMD) decreased from 1.065 g/cm2 to 0.994 g/cm2. This is a loss of 0.071 g/cm2 or 7%. The 7% value is calculated by subtracting 0.994 g/cm2 from 1.065 g/cm2 and then dividing the difference (0.071 g/cm2) by the original value of 1.065 g/cm2. In order to know whether this is a statistically significant change the DXA facility must do what is called "precision assessment" and calculate the "least significant change" (LSC). Typically the LSC is expressed as an absolute value, such as 0.030 g/cm2, rather than a percentage. If the change in BMD is at least as much as the LSC, then it is considered to be a statistically significant change. This assumes that the measurements were done on the same machine, with identical positioning each time, and analyzed the same way. "Precision" is not the same as the LSC, as the LSC is usually calculated by multiplying the precision error by a factor of 2.77. The is probably more information than you wanted, but to assure that you are getting the best quality tests, ask about the credentials of the DXA staff. Certification by the International Society for Clinical Densitometry (ISCD) for the technologist doing the DXA and the clinician interpreting it is one way to assure that they have achieved a basic level of skills in bone densitometry.View Thread
Reclast (zoledronic acid), administered as an intravenous infusion over no less than 15 minutes, is approved for the treatment of osteoporosis in men. It is often used when there are gastrointestinal side effects, as you have experienced, with oral medication. Reclast should not be given if the serum calcium level is low or if there is severe kidney disease, defined as a creatinine clearance less than 35 ml/min. The creatinine clearance can be measured with a 24-hour urine collection or estimated by calculating a glomerular filtration rate (GFR) based the serum creatinine level. Often the estimated GFR is automatically printed out on the same lab report as the serum creatinine. Your concern about the safety of treatment with Reclast is reasonable and it is appropriate that you discuss this with your physician before starting treatment. Ask about your estimated GFR or creatinine clearance so that you have a good understanding of your kidney function. The best treatment decisions are made collaboratively when you are well informed about the benefit and potential risks of therapy and your physician fully understands your concerns.View Thread
I cannot tell you whether you should take the Boniva or not, but I can give you some general information that may be helpful.
First, a diagnosis of osteoporosis can be made in a postmenopausal woman if the T-score is -2.5 or less in a particular portion of the forearm (called the distal 1/3 radius or distal 33% radius), or at the lumbar spine, total hip, or femoral neck. I cannot be sure from the information that you provided whether you have osteoporosis or not, since you did not mention which part of the forearm was measured. I am assuming that you are postmenopausal, since the Arimidex will make that happen even if it did not already occur naturally.
Second, Boniva and other drugs have been shown to reduce the risk of fractures in postmenopausal women with osteoporosis, with a generally good safety profile. In other words, side effects, when they occur, are generally mild and reversible when stopping the medication. Side effects are always possible, of course, as with any medication. Your individual risk of side effects should be discussed with your physician.
Third, while Arimidex is a very effective drug for the management of breast cancer, it can cause bone loss and increase the risk of fractures. Bisphosphonates, such as Boniva and other similar drugs, may reduce that risk. Most clinical practice guidelines suggest that in women with osteoporosis who are taking Arimidex, the benefit of treatment with bisphosphonates (reduction of fracture risk) outweighs the potential risks (possible side effects). The bottom line is that osteoporosis is cause for concern due to the increased risk of fractures, and that medications are available that can reduce the risk of fractures. I suggest that you strongly consider treatment to protect your bones. However, you should discuss your concerns about possible side effects with your physician, and only take the medicine if you feel comfortable with those risks.View Thread
There are many possible causes for the type of jaw pain you describe, including "TMJ Syndrome"- an inflammation of the jaw joint. I suggest you see your dentist or healthcare provider for evaluation.View Thread
If you have osteoporosis and are trying to make a decision about treatment, you should compare the risk of having a fracture (broken bone) if you do not take medication with the expected benefit of treatment (reduction of fracture risk) and the potential risks of treatment (side effects). When the benefit of treatment outweighs the risk, then you should consider taking the medication. Other factors to think about are your past experience with osteoporosis medication, other medical problems, the cost of treatment, and your personal level of concern about breaking bones or having side effects of treatment.
What is your risk of breaking a bone?
A bone density test is often the first step in evaluating fracture risk. When the T-score is -2.5 or below in a postmenopausal woman or man age 50 or older, then a diagnosis of osteoporosis is made. Your healthcare provider can help explain to you what your T-score means. Additional information about fracture is provided by "clinical risk factors" for fracture, such as age, previous fracture, cigarette smoking, and family history of osteoporosis. Even with the same T-score, an older person has a higher risk of fracture than a younger person, and someone with a previous fracture as an adult has a higher risk of fracture than someone who has never had a fracture. If you have never taken an osteoporosis medication, a computer program called FRAX® can estimate your chance of breaking a bone in the next 10 years.
What are the benefits of taking a medication?
Learn about all of the treatment options available to you. All approved osteoporosis medications have been proven in research studies to reduce fracture risk. It is not known with certainty whether any medication reduces fracture risk more than another, since these medications have not been testing in that way side-by-side. There may be differences in insurance coverage and out-of-pocket expenses. Your healthcare provider can help you to decide which choices are best for you based on your medical history and other factors unique to you.
What are the possible risks of taking a medication?
When making a decision about treatment, you should learn about the possible side effects of each medication. When something is listed as a side effect, it does not necessarily mean it will happen to you. For example, a rash may be listed as a side effect of a drug with a risk of 1%. That means that 1 out of 100 patients have had a rash while taking the drug and the other 99 did not have a rash. It does not mean that you will get a rash 1 of 100 times that you take the drug. Your risk of having certain side effects may depend on other health problems you already have. Talk to your healthcare provider or pharmacist about your potential risk of side effects.
Making to decision to treat and how to treat
The best decisions are made as a team, with your healthcare provider giving you all the necessary information you need to understand benefits and risks, and you telling the healthcare provider about your concerns. Once treatment is started, tell your healthcare provider if you are having problems or you are worried about having problems with the medicine. Don't allow your medical care to be directed by what you hear in the news or read in magazines and newspapers. These sources often do not provide accurate information. Talk to your healthcare provider before stopping your medicine or making any changes in treatment. Good teamwork is the best way to stay healthy.View Thread
You raise a number of issues that may be of general interest as well. While I cannot give you individual medical advice, I would like to rephrase your questions and answer them in a way that I hope you and others will find helpful.
1. Which patients with osteopenia should be treated with drugs to reduce the risk of fractures? The National Osteoporosis Foundation recommends that untreated postmenopausal women and men age 50 and older who have osteopenia (T-score at the lumbar spine or femoral neck between -1.0 and -2.5) and no history of hip or spine fracture should be considered for starting drug therapy when the FRAX estimation of the 10-year probability of hip fracture is 3% or more or the 10-year probability of major osteoporotic fracture is 20% or more. You or your physician can find the FRAX website online and do these calculations on information that was available several years ago, before treatment was started. More information about FRAX is also available at www.nof.org .
2. What is the risk of osteonecrosis of the jaw (ONJ) with osteoporosis medication? ONJ is defined as an area of exposed bone in the mouth that has persisted more than 8 weeks after identification by a healthcare professional, in a patient who has taken a bisphosphonate (such as alendronate [Fosamax>) and not had radiation therapy to the jaw. About 95% of cases have been in cancer patients receiving very high doses of these medications. The risk of having this from treatment of osteoporosis with a bisphosphonate is very low- about 1 in 100,00 patient-treatment years. By comparison, this is much lower than the risk of being killed in a car accident or being murdered. ONJ has nothing to do with TMJ syndrome. It is not known whether stopping the drug before a tooth extraction changes the risk of getting ONJ.
3. What is the role of raloxifene (Evista) in treating osteoporosis? This drug acts the same as estrogen is some parts of the body and the opposite in others. It reduces the risk of fractures and reduces the risk of invasive breast cancer. It also increase the risk of blood clots and in women at high risk for cardiovascular disease it increases the risk of dying after a stroke, although it does not increase the risk of having a stroke in the first place. This drug should not be taken by women who have had blood clots in the past or those who are at high risk for cardiovascular disease.View Thread
You can find out if you have osteoporosis by getting a bone density test. This test lets helps to estimate the strength of your bones and the chances of breaking a bone in the future. A bone density test can help you and your healthcare provider:
• Learn if you have weak bones or osteoporosis before you break a bone • Predict your chance of breaking a bone in the future • Let you know if you have osteoporosis after you break a bone • See if your bone density is improving, getting worse or remaining the same over time • Decide if you need a medicine to help prevent broken bones • Find out how well an osteoporosis medicine is working
The National Osteoporosis Foundation recommends a bone density test for: • Women age 65 or older • Postmenopausal women under age 65 with risk factors for osteoporosis • Men age 70 or older • Men age 50-69 with risk factors for osteoporosis • Women going through menopause with certain risk factors • Adults who break a bone after age 50 • Adults with certain medical conditions • Adults taking certain medicines • Postmenopausal women who have stopped taking estrogen therapy or hormone therapy
Bone density testing in younger people. The National Osteoporosis Foundation does not recommend routine bone density testing for children, premenopausal women or men under age 50. Bone density tests are usually only done for people in these age groups if they break several bones easily or break bones that are unusual for their age. For example, breaking a hip or a bone in the spine as a young person is unusual. Healthcare providers may recommend a bone density test for young adults who need to take a steroid medicine for three or more months.View Thread
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