DEAR DR. ROACH: I’m 48 and had a lumpectomy, chemo, and radiation for stage I breast cancer. Thankfully, I’m doing well, but I began having osteopenia in my mid-50s, possibly due to the chemo and estrogen-blocking meds. My mom also had osteoporosis.
I’ve taken alendronate for five years for osteoporosis in my hip, but it didn’t stop the bone loss. Now I’m on Prolia, which has been helpful. I’m active and walk 3-5 miles almost every day. How long can I take Prolia with breaks? Are there other options? I worry about running out of strong treatments for my osteoporosis. — A.M.L.
ANSWER: You’re right to be concerned. The estrogen-blocking drugs can speed up bone loss, especially with your family history. Staying active is fantastic for your bones and overall well-being, plus it may reduce cancer risks.
Prolia works by slowing down bone breakdown. Unlike alendronate, when you stop Prolia, its effects fade quickly. About 8% to 10% of those who stop Prolia experience fractures in the following year unless they switch to another treatment.
Since alendronate didn’t work for you, it’s worth considering how you’re taking it. It shouldn’t be taken with food or mineral water, as this might affect absorption. Also, ensure you get enough calcium and vitamin D for any osteoporosis medication to work well.
If bisphosphonates aren’t suitable for you, anabolic agents like teriparatide build new bone. Romosozumab is another option that helps build bone while reducing breakdown. Raloxifene might be particularly beneficial as it supports bone health and can lower breast cancer risks. Discuss these alternatives with your doctor.
DEAR DR. ROACH: I eat a high-fiber diet and am adding psyllium husks daily. With my oats, grains, and beans, will this help reduce my LDL cholesterol? How much psyllium should I take? — R.P.
ANSWER: Psyllium is a great fiber supplement. A fiber-rich diet has many advantages, including a reduced risk of heart disease. Research shows that taking about 10 grams of psyllium a day can lower LDL cholesterol by 6% to 15% on average. This decrease is significant and can mimic the effects of doubling statin doses for those who take them.
I advise starting with a smaller dose and gradually increasing it to avoid gastrointestinal discomfort, which is common when starting high-fiber supplements.
It’s crucial to consult a healthcare provider before making any changes in medication or diet, especially when addressing specific health concerns.
This information incorporates insights from reliable health resources and studies to enhance understanding of osteoporosis and cholesterol management.
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