- Question from Linda: I don't like to take pill supplements or medications, so what "natural" alternatives are there? I've recently been diagnosed with osteoporosis.
- Answers —Charles Shapiro, M.D.: This is an excellent time to bring up exercise. Weight-bearing exercise, like walking and jogging, when your bones are bearing the weight of your body, has a positive effect in decreasing bone loss. Resistance exercise, or light weight training, which means lifting light weights, also helps to build bones.
- Marisa Weiss, M.D., president and founder: Avoidance of smoking and drinking is an important way to prevent bone loss. Natural sources of calcium and Vitamin D will also prove useful. If after you have taken all of these measures the osteoporosis persists, you may still need to consider taking a medication that could help build your bone strength up in addition. For women who already have osteoporosis, all of the exercise and dietary factors can help to some extent, but they may not help enough. You need to speak with your doctor about the nature of your osteoporosis and whether or not you already have fractures to get a sense of what your risk is of developing fractures in the future. The good news is that there is a whole choice of medications now available to help women build back bone strength that they may have lost.
- Charles Shapiro, M.D.: If despite the lifestyle changes your bone density is such that your doctor has recommended treatment for osteoporosis, there are several options. There are two pills, Fosamax and Actonel, which are both oral medications. Fosamax is in a weekly dose. It used to come in a daily dose, but now it's a weekly dose. Actonel is also taken once a week. These medicines are highly effective, but some people experience upset stomachs when they take them. There's also a new medicine called Zometa that's intravenously administered. It's not widespread in use and not approved for use for postmenopausal osteoporosis, but in a recent study, with one intravenous dose of Zometa per year, women experienced less bone loss. That was in a paper published recently in the New England Journal of Medicine.
- Marisa Weiss, M.D., president and founder: One dose per year?
- Charles Shapiro, M.D.: Both one and two doses per year were found to be effective. So stay tuned. You may be hearing more about this drug.
- Marisa Weiss, M.D., president and founder: Many women do find taking Fosamax, for example, a little bit difficult. You have to take it on an empty stomach, first thing in the morning, and you're not supposed to eat anything for half an hour afterwards and you also have to stay upright (don't lie down) for half an hour or so after taking it. It's also important not to take calcium for the first half of the day after your weekly dose of Fosamax.
- Charles Shapiro, M.D.: Another option is Miacalcin, a hormone therapy medicine made up of calcitonin, a natural hormone that drives calcium into bone. Miacalcin is intranasal - you spray it in your nose, like allergy medicines—and has a positive effect on osteoporosis and bone loss.
- Marisa Weiss, M.D., president and founder: There are various options that you can consider with your doctor. You may tolerate one better than another. Sometimes women start with one medication; if it works well and you tolerate it well, then you stick with it. Other women who may have some difficulty with one medication may switch over to another. Your doctor will assess your response to any medication that you take, along with the lifestyle changes over time. A DEXA scan is usually repeated about once a year in women who are beyond menopause after breast cancer treatment.
On Wednesday, August 21, 2002, our Ask-the-Expert Online Conference was called Keeping Your Bones Strong. Charles L. Shapiro, M.D. and Marisa Weiss, M.D. answered your questions about how to measure the strength of your bones, how to find out your risk for osteoporosis, and what you can do to lower that risk.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
