Weighing osteopenia treatment against periodontal disease
DEAR DR. ROACH: I am an 80-year-old female in good health except for a diagnosis of osteopenia. My primary care doctor has prescribed medication for my osteopenia. I have periodontal disease and have been advised by my periodontal specialist not to take medication for osteopenia due to deterioration of the jawbone. I think I am in a lose-lose situation. I spoke to my internal medicine doctor, and he said he was concerned about a hip fracture if I don't take the osteopenia medication. I don't want to take a chance on the jaw deteriorating. Please give me your opinion on the best course of action. -- G.M.
ANSWER: 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, results of their bone density test and presence of certain other medical risk factors, including previous fracture, use of glucocorticoid drugs like prednisone, smoking and rheumatoid arthritis. Fracture risk is commonly estimated by the FRAX tool (www.sheffield.ac.uk/FRAX/). If the estimated hip fracture risk is 3%, or combined risk of any fracture is 20%, then medication treatment 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 of your bone density.
If your risk is not so high that medication is recommended, there are many things you can do to help your bone density. These include adequate dietary calcium, supplemental vitamin D, regular exercise, especially weight-bearing and strengthening exercises, and avoiding smoking and excess alcohol. A home evaluation to reduce fall risk may be of benefit.
If your fracture risk is already higher than the above threshold, medication would normally be prescribed in addition to lifestyle treatments. Antiresorptive treatments, such as alendronate (Fosamax) or other bisphosphonate drugs, do increase the risk for jawbone damage, and given what your periodontist has recommended, I would avoid not only these drugs but also denosumab (Prolia), which works similarly by decreasing bone resorption. Although I am not an expert, I would consider treatment with a medicine like teriparatide, which has been used as a treatment for people with jaw osteonecrosis. This medicine works by stimulating bone growth and has a good safety record.
An expert on osteoporosis treatment and prevention would be a useful colleague for your internal medicine doctor to refer to. Most commonly, these are endocrinologists, some of whom specialize in bone metabolism.
DEAR DR. ROACH: The blood bank nurses have a hard time finding a vein in either arm almost every time I go to donate platelets. I drink a lot of water the day before and 16 ounces the day of, but no luck. Is there anything I can do to make my veins easier to find? Does weight have anything to do with it? -- N.K.
ANSWER: In addition to the fluid intake, keeping the arm warm makes the veins more prominent. Keeping the arm down (below your heart) for a good while may also help.
People who are overweight sometimes have veins that are harder to find, but that's not always the case.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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