When should I go back on a bisphosphonate drug?

DEAR DOCTOR K: I am currently on a bisphosphonate "drug holiday." How will I know if, or when, I should go back on the drug?

DEAR READER: After menopause, loss of bone (osteoporosis) can lead to crippling bone fractures. Drugs called bisphosphonates slow bone loss. Below, I've put a table with detailed information about these drugs. But bisphosphonates can cause troubling side effects. The pills can cause burning in the esophagus. And a small number of users have developed bone loss in the jaw and in the large bone in the upper legs (the femur), causing the femur to break.

My DEXA scan showed my T-score is minus 2.7– what does this mean?

DEAR DOCTOR K: I'm a 63-year-old woman, and recently I had a screening test for osteoporosis. My "T-score" was minus 2.7. What does this mean?

DEAR READER: In the past, osteoporosis -- a thinning of the bones -- was frequently diagnosed only after a bone fracture. Today, osteoporosis can be detected earlier with a bone mineral density test. Several tests can assess bone density. The most common, considered the gold standard for osteoporosis screening, is known as "dual energy X-ray absorptiometry" (DEXA). For this test, a machine sends X-rays through your bones in order to calculate bone density.

Do “hip protectors” really reduce the risk of hip fractures for people with osteoporosis?

DEAR DOCTOR K: I have osteoporosis. I've heard about "hip protectors" that reduce the risk of hip fracture if you fall. Are they worthwhile?

DEAR READER: Osteoporosis contributes to about 300,000 hip fractures in the United States each year. The hip is not the most common site of an osteoporosis-related fracture (it follows behind the spine and wrist). But a hip fracture can have particularly devastating consequences. Hip fractures can impair your ability to walk or perform everyday activities, such as dressing yourself or rising from a chair.

Is there anyway to reduce the side effects of my osteoporosis drug?

DEAR DOCTOR K: My doctor wants me to take Fosamax for osteoporosis, but the drug gives me heartburn and makes me nauseated. Is there anything I can do to reduce these side effects?

DEAR READER: Fosamax (alendronate) is part of a group of drugs called biphosphonates. Actonel (risedronate) and Boniva (ibandronate) are also in this group. Doctors prescribe biphosphonates to prevent and treat osteoporosis.

Why do people lose height and develop a stooped posture as they get older?

DEAR DOCTOR K: Why do so many people lose height and develop a stooped posture as they get older?

DEAR READER: You may be surprised by the answer. In many older people, loss of height and stooped posture results from fractures of the spine. When you think of a bone fracture, you probably picture a long bone being snapped like a twig, as with a broken arm or leg.

How can I reduce my risk of osteoporosis?

DEAR DOCTOR K: I'm a woman in my 40s. Both my mother and grandmother had osteoporosis. What can I do now and in the coming decades to reduce my risk?

DEAR READER: All people lose bone as they age. For women, that process starts to accelerate when they enter menopause. One important reason for that is the lower level of estrogen in a woman's body after menopause begins, as estrogen helps to build bone. Osteoporosis is not inevitable, and there's much you can do to shield your bones from this disease.

Can vibration therapy prevent osteoporosis?

DEAR DOCTOR K: I've heard that vibration therapy can help to improve bone density. Can you tell me more about it?

DEAR READER: Our bones are in constant flux, as old bone is broken down and new bone is created. If old bone is broken down faster than new bone is created, low bone density and eventually osteoporosis develops. After menopause, women are more prone than men to develop osteoporosis. One reason is that their natural estrogen levels drop, and estrogen helps preserve bones. Women are advised to stimulate their bones through physical activity, particularly weight-bearing and resistance exercise. That's because stress placed on the bones through activities such as running and weightlifting makes bones denser and stronger. Many drugs are also used to prevent and treat osteoporosis.

Can exercise help prevent osteoporosis?

DEAR DOCTOR K: I've read that certain types of exercise help prevent osteoporosis. What types are best? How do they prevent bone loss?

DEAR READER: Osteoporosis is a disease that weakens bones and makes them more susceptible to breaks. Bones are very dynamic. Inside every bone, some cells are laying down new bone and other cells are chewing up old bone. You want these bone-building and bone-destroying forces to always remain about equal, and for most of our young and early adult lives they are.

Can osteoporosis drugs cause fractures?

DEAR DOCTOR K: I recently read that some osteoporosis drugs can cause fractures. Should I stop taking my osteoporosis medication?

DEAR READER: Osteoporosis is a disease that weakens bones and makes them more susceptible to breaks. It is slowly progressive unless it is halted by treatment. Fortunately, a group of drugs called bisphosphonates have become available to treat osteoporosis.