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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr.Gagliardi for taking part in the program.

January : Osteoporosis

Question 1
Dear Dr. I had a bone density test last December 04. The results were diagnostic of osteoporosis. They read as follows:

PA Spine t-score -2.973,%young 68%, z-score -1.350.. total l hip t-score -1.746, %young 77%, z-score -0.6333, l femoral neck t-score -1.729, %young 76%, z-score -0.412. I went to my doctor( g.p.) He only advised I take fosomx. I asked how severe the readings were but he did not give me a clear answer. I took the fosomax 6x (it was a weekly pill, but it gave me very bad indigestion, so I discontinued it and started taking calcium 3x a day 600 mgs with vitamin D. My question to you is, how severe is my osteoporosis based on the above readings and is there anything else I can do to help build new bone other than taking fosomax. thank you.

Your T-score is the most important value, on which a diagnosis of osteoporosis is based. It is derived from a bone mineral density (BMD) test. A BMD test is quick, accurate, painless, and safe. It is commonly used to measure the density of various bones throughout the body, typically the spine and hip. A BMD test can detect low bone density before a fracture occurs, confirm osteoporosis after a fracture occurs, predict the risk of a future fracture, or determine the response to treatment.

The T-score compares you to a young adult's bone density. That comparison may seem unfair, but is done as a young adult has peak bone density, and is at lowest risk for a fracture. A negative T-score osteoporosis number means there is bone loss, and The World Health Organization considers the following scores as the standard:

A T-score above -1 is considered normal bone mass.
A T-score between -2.5 and -1 is called osteopenia, a word used to describe low bone mass.
A T-score below -2.5 is considered osteoporosis.

The World Health Organization does not classify the severity of osteoporosis. All cases of osteoporosis are serious. In general, for each standard deviation of a -1 score, that indicates a bone loss of about 10-15%. And, with each 10-15% of bone loss, the risk of fracture increases by 150 to 300%! You're at an increased risk for fracture based on your scores, and calcium supplements will not be enough at this point. If Fosamax didn't agree with you, another medicine may be a consideration. Actonel and Boniva are other options, but may have the same side effects as they work similarly to Fosamax. Boniva, however, only is taken once a month. Some patients use Miacalcin, a nasal spray. Others may consider Evista, a selective estrogen. Another option is Forteo, discussed below. There are pros and cons to all of these, and not all are appropriate for everyone. A thorough discussion of the risks and benefits of each choice with your doctor will help you decide what's best for you.

Question 2
Does one need to take a Calcium supplement separate from dairy food sources, since the body typically only absorbs approximately 500 mgs of Calcium @ a time? If so, by how much time should the sources be separated? We are developing protocols @ our long-term care institution whereby several clients are on anticonvulsants, and other bone-depleting meds. for several years. Thank you in advance for your help!
(PS- I happened on this site because my grandmother was recently an inpatient @ SOCH--- I am a native New Jersey person and most of my family resides in south Jersey). Thanks!

You're right. Calcium, whether from the diet or supplements, is absorbed best by the body when it is taken several times a day in amounts of 500 mg or less. Most brand name calcium products are absorbed easily in the body. Chewable and liquid calcium supplements dissolve well because they are broken down before they enter the stomach. Calcium carbonate is absorbed best when taken with food, while calcium citrate can be taken any time. That may make calcium citrate, taken between meals, your best option, since ideally, at least an hour or two should pass between doses. For the average person, whose medication taking isn't as regimented, taking it all at once is better than not taking it at all!

Question 3
I would appreciate any information on the new drug Forteo for osteoporosis. Possible side effects & how safe this drug is.

Forteo is a natural bone-building hormone, based on parathyroid hormone. Bone is dynamic, with cells actively building and breaking down bone (called remodeling) throughout our lives. Other osteoporosis drugs known as antiresorptives treated osteoporosis by slowing or stopping bone loss by blocking the action of osteoclasts (the type of cell that removes cells from the bone). Forteo stimulates the formation of new bone by increasing the number and action of osteoblasts, the bone-forming cells.

Forteo provides continual improvement in bone strength over a treatment period of 18 to 24 months. Forteo has not been studied beyond 2 years and is therefore not recommended for use beyond that period of time. Forteo is given by daily injection. It can't be in pill form because our digestive system would destroy it before it could reach the bloodstream. A pill form is probably at least a few years away. It's natural to be nervous about injecting Forteo, but the needle is very small.

Most side effects from Forteo are mild and include dizziness and leg cramps. Allergic reactions are rare. As a part of drug testing, Forteo was given to rats, and some of these rats developed osteosarcoma, a bone cancer. Osteosarcoma in humans is a serious but very rare cancer. It is not known if humans treated with Forteo also have a higher chance of getting osteosarcoma; no cases attributed to Forteo have been reported in humans thusfar. It is relatively expensive, running approximately $500.00 to $600.00 per month.

Question 4
Dear Dr. Gagliardi, I have cyst on my ovaries,and sometimes when I ovualte,I notice I spot blood when I urinate, can that mean there’s a problem?and If they grew more.? There is also pain involved too.

Ovarian cysts are generally benign, and many come and go as a natural part of ovulation. Some grow larger, however, and don't resolve on their own; some of these may be painful. Others may bleed into themselves and cause pain. There are characteristics of cysts on ultrasound that may be reassuring or concerning. Your doctor should advise you on how to manage these cysts based on those findings. Some are followed with further testing, some are surgically removed, and others (such as follicular cysts) can be safely ignored.

Ovulation occurs as a result of a surge in a hormone called FSH, which occurs when estrogen levels drop temporarily. Because the body interprets drops in hormone as a signal to start to menstruate, some mid-cycle spotting can occur, but is usually brief and resolves because hormone levels go up quickly after ovulation. There are other reasons to have mid-cycle spotting that may not be normal; a thorough evaluation would be necessary to rule these out.

Question 5
I am 62 years old and am preosteo. There are many forms of calcium supplements on the market,which type will be absorbed better. Coral Calcium, chelated, citrate, carbonate or gluconate. Should the supplement contain magnesium, Vitamin D, Zinc or others minerials. Is 1500mg daily sufficient for me.

The National Osteoporosis Foundation recommends daily calcium intakes of 1000-1200 mg/day for adult men and women. According to experts, food is the best source of calcium; however, most Americans do not have enough calcium in their diets. Calcium supplements can fill the gap, ensuring that the daily calcium requirement is met. The amount needed from a supplement depends on how much calcium you get from food sources.

Calcium exists in nature only in combination with other substances, including calcium carbonate, calcium phosphate and calcium citrate. These compounds contain different amounts of elemental calcium, which is the actual amount of calcium in the supplement. It is important to read the label to determine how much elemental calcium is in the supplement and how many doses or pills to take.

Calcium supplements are available in many combinations with vitamins and other minerals. While vitamin D is necessary for the absorption of calcium, it is not necessary that it be in the calcium supplement. Minerals such as magnesium and phosphorus also are important, but usually are obtained through food; most experts recommend that nutrients come from a balanced diet. Please also refer to question 2 for more details on calcium's absorption.

Dr. Gagliardi's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.