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Should bone loss always be treated?

Osteoporosis is a serious disease, but the milder osteopenia may just be a sign of normal aging.

June 13, 2005|Judy Foreman | Special to The Times

So, when should a woman be screened for potential bone loss? And how safe are the drugs for long-term use? In 2002, the U.S. Preventive Services Task Force, a panel of independent experts convened by the government's Agency for Healthcare Research and Quality, concluded that women 65 and older should be screened routinely for osteoporosis. Screening should begin at 60 for women at increased risk, which includes a family history of hip fractures, current smoking, thinness and use of steroids such as prednisone.

As for drug safety, a study published in March 2004 in the New England Journal of Medicine showed that Fosamax (alendronate) appears to be safe for as long as 10 years. But a 1998 study showed that although Fosamax helps prevent fractures in women with osteoporosis, it does not do so in women with osteopenia and no previous fractures.

Fosamax and Actonel can cause small ulcers in the esophagus, or food tube; Evista can cause hot flashes, and in rare cases, blood clots.

There is no evidence that the widespread use of Fosamax and Actonel is causing any problems, said Col of Rhode Island Hospital. But the drugs do get incorporated into bone. "If 10 years down the line, it turns out that something is dangerous, it will be sitting in a lot of people's bones. The benefits of treatment need to outweigh the risks."

That applies to another drug too: Forteo, the only medication that actually increases bone growth. However, Forteo carries a special warning because, in rodents, it can trigger bone cancer.

Bottom line? Try to prevent thinning bones in the first place. Do weight-bearing exercise several times a week and walk briskly for 30 minutes a day or more. Get enough calcium -- 1,200 to 1,500 milligrams (but not more) a day, plus 800 international units of vitamin D, from food and, if necessary, supplements. Minimize use of Valium-type drugs. If problems such as an overactive bladder or poor eyesight are raising your risk of falls, get those treated.

And if one doctor recommends drugs on the basis of mild bone loss, consider getting a second opinion. Obviously, no one wants a broken hip. But no one should take any drug for decades without careful thought, either.

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