Dr. Gott: Addressing non-traumatic bone fractures

DEAR DR. GOTT: I have been taking Boniva for almost five years. Could I or should I stop now? I’ve heard there is some discussion about this. I’m 74. Your opinion, please.

DEAR READER: Boniva is prescribed to slow bone loss, increase bone mass, and treat or prevent osteoporosis in women, a condition in which bones become thin, weaken, and are subject to easy fracture.

The Food and Drug Administration issued a warning to physicians and their patients on Oct. 14, 2010, regarding an increased risk of bone fractures of the thigh with bone-strengthening bisphosphonates such as Boniva, Fosamax and Actonel. The report went on to indicate it remains unclear whether drugs in the category trigger thigh fractures, but because of the potential connection, labeling now warns of the possibility. It is understood an individual who falls or is in an automobile accident might experience a fracture, but these findings suggest breaks without any degree of trauma involved. Rarely, osteonecrosis (destruction and death of bone tissue) of the jaw has been linked to bisphosphonate use.

At this stage, there are no guidelines as to how long a patient should remain on the drugs, but the FDA stated the fractures “may be related to the use of bisphosphonates for longer than five years, but patients should continue treatment unless directed otherwise by their physician.”

My guess is that you have undergone testing such as a DEXA (dual energy X-ray absorptiometry) that measures the density of bones in areas most commonly affected by osteoporosis. Other tests less commonly used include computerized tomography (CT) or ultrasound sonography, which utilize high-frequency sound waves to view internal structures. If it is time for another X-ray, your physician can determine whether the Boniva is working for you. If both of you feel it’s time for a change, ask whether 1,500 milligrams of calcium combined with 600 IU of vitamin D might be an appropriate substitute. This is a tough call only you and your prescribing physician can agree upon.

To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR DR. GOTT: I am 89 and in good health, but I no longer have a sense of smell. Can it be restored?

DEAR READER: The answer depends on the cause. Some causes result in temporary loss, while others, unfortunately, result in permanent loss. If you have had a recent cold, sinus infection or hay fever, the condition will likely clear on its own within a reasonable period of time. If you suffer from nasal polyps, a tumor or nasal deformity, surgical correction may be necessary to remove the lesions or correct the abnormality and may restore your sense of smell. Medical conditions such as diabetes, Huntington’s disease or hormonal disturbances should be ruled out.

Speak with your primary-care physician for his or her opinion. If you don’t meet with success, request a referral to an otolaryngologist (ear-nose-and-throat specialist), who can help you sort through this annoying problem. Good luck.