DEAR DR. ROACH: I am a 68-year-old woman diagnosed with osteopenia. My hip T-score is -2.3, and lumbar spine T-score is -1.6. My doctor suggested medication, but I am concerned about side effects. Is this really necessary? Can I safely wait? I am very active, eat a well-balanced diet and take calcium and vitamin D supplements. Three years ago, my scores were -1.3 and -0.1, so this seems a significant change. Also, what medication is best to try? -- N.M.
ANSWER: You are right; you have osteopenia, which is defined as a bone density of between -1 and -2.5. Although a fracture can happen with any bone density, the rate of fracture goes up faster at a bone density less than -2.5. But many other factors also affect fracture risk. You can get a better understanding of your fracture risk at www.shef.ac.uk/FRAX/tool.jsp.
Because your bone density has dropped significantly in three years, I think it isn’t unreasonable to start medication now, or you could get your bone density rechecked soon (e.g., 12 months). Before thinking about medication, I would make sure you are getting enough vitamin D. I see many people still taking the previously recommended 400 units, whereas most authorities now recommend at least 800, and I find that 1,000 or 2,000 is necessary in some people. I obtain vitamin D blood levels for men and women with osteoporosis. Calcium is best obtained through diet, but supplements generally are recommended in those with osteoporosis or at risk for it.
You mention that you are active, but higher-intensity activities are best for promoting bone strength and preventing fractures.
As far as which medication is best, the best evidence for fracture prevention is seen in bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva), but these medications should be re-evaluated after three to five years to see if they are still necessary. Teriparatide (Forteo) and denosumab (Prolia) are used mostly in severe osteoporosis, and raloxifene (Evista) is most commonly used in women who also have increased risk of breast cancer.
The osteoporosis pamphlet furnishes details on how to prevent this universal condition. Readers can obtain a copy by writing: Dr. Roach Book No. 1104, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name address. Please allow four weeks for delivery.
DEAR DR. ROACH: I live in Florida. It rains a lot here, and the rain pools in the grassy areas. We live in a natural preserve, where we have lots of wild animals. The swale area water is a runoff from the preserve, where these animals defecate and urinate in the woods. The grass areas are sprayed with chemicals, fertilizer, weed killers, etc.
I noticed three little children playing in the stagnant water. What are the dangers of diseases the children could contract? -- B.G.
ANSWER: There are many conditions I would be concerned about, the most pressing probably being the wild animals themselves, which in Florida are an immediate life-threatening danger. The chemicals also might cause problems, but let me answer your question about diseases.
Stagnant water is a breeding ground for mosquitos, and that means West Nile virus, Eastern equine encephalitis and St. Louis encephalitis (which is indeed found in Florida). There even have been occasional cases of malaria and dengue fever transmitted in Florida.
Wild animals mean ticks, and that means a risk for both Lyme disease and Rocky Mountain spotted fever, which, despite its name, is commonly found in North Carolina; can be found in Florida; and is life-threatening.
Animal waste can lead to disease, including leptospirosis, but also rat bite fever (Streptobacillus) and others.
Finally, stagnant ponds in Florida can contain the amoeba Naegleria, which can cause a fatal type of brain infection.
Obviously, these children shouldn’t be in this area at all, and I would tell the children, their parents and the authorities if necessary.