George Kannankeril (NorthShore)
Thank you for the question, Robert. Being on prednisone or other steroids for a prolonged period of time is a risk factor for osteoporosis. There are a few things you can do to help reduce your risk for osteoporosis or fractures. To build strong bones, your body needs calcium and vitamin D, and many people do not get enough of these in their daily diet. You should intake 1200mg of calcium and 800 units of Vitamin D on a daily basis. If you are not getting this much in your diet, you may need to take a supplement. Additionally, getting into a regular exercise program is important. Weightbearing exercises put stress on your bones, and the bones respond to stress by fortifying themselves and becoming denser. If ok with your doctor, the recommendation for exercise is 150min of moderate aerobic activity per week, or 30min 5 days of the week.

George Kannankeril (NorthShore)
Barbara, once osteoporosis has been diagnosed, the first step is to make sure Calcium and Vitamin D levels are adequate, and to supplement if appropriate. If these levels are normal, then the first line treatment for osteoporosis are medications called oral bisphosphonates. These medications help reduce bone resorption (breakdown). The most common side-effect of these medications involve throat or stomach problems such as acid reflux or ulcers. Thus, if any pre-existing esophageal or stomach conditions exist, these medications may need to be avoided. The reason these medications are used as first line is that we have the most experience using them and they are found to be effective for most people. They are also easy to administer, as other medications may require infusions.

George Kannankeril (NorthShore)
Thanks, Janice. For Boniva and other bisphosphonates, one year may not be enough time to consider it a failure of treatment. If no improvement in your bone density has occurred in one year, it is reasonable to wait another 1-2 years and recheck bone density for any improvement. If it is still not improving, then switching to an IV bisphosphonate such as Reclast may be the appropriate next step. Usually the IV formulations have a more favorable response.

George Kannankeril (NorthShore)
Michele, thank you for your interesting question. Palindromic rheumatism is a type of inflammatory arthritis that comes and goes in episodes. Other types of inflammatory arthritis include Rheumatoid Arthritis, Psoriatic Arthritis, and others. There is an association between Rheumatoid Arthritis and osteoporosis, and so I would consider increased surveillance for osteoporosis in someone that has Palindromic rheumatism. However, I am not sure that there is a definite link between the two.

George Kannankeril (NorthShore)
Thank you, Carolyn. Osteoporosis is not an indication for hip replacement, although after certain osteoporotic hip fractures treatment may involve a total hip replacement rather than fracture repair. The biggest consideration is in patients who are being evaluated for hip replacement to manage their arthritis. Patients with osteoporosis may be at increased risk for post-surgical fracture or loosening of the implanted prosthesis. Because of this risk, some effort should be made to address the osteoporosis with appropriate medical management prior to undergoing surgery. However, at this time, untreated osteoporosis is not a contraindication to having a joint replacement. That being said, your surgeon may discuss with you his/her concern about complications and may determine that the risk of undergoing joint replacement is too high depending on how severe the osteoporosis is.

George Kannankeril (NorthShore)
Janice, I believe there are some cases of patients with Hereditary Multiple Exostoses that have been reported to have lower than normal bone densities compared to the general population. I would recommend following the guidelines I listed earlier regarding calcium/vitamin D intake and exercise. Your doctor can help you determine if you should be screened earlier than the general population for low bone density, but there would be no need for osteoporosis treatment unless you are found to have a low bone density, just as anyone else.

George Kannankeril (NorthShore)
Joanne, Forteo is a different from bisphosphonates, such as Fosamax, and it is used in patients that either have severe osteoporosis or have failed to respond to traditional bisphosphonates. It tends to be better at improving bone density, so I am hopeful that your upcoming scan will show an improvement! In general, if you are not making improvements on Forteo, it is not recommended that you need to combine it with another osteoporosis medication. However, if another treatment is warranted, there is another medication called denusumab, which is an immunotherapy agent, and can be used for patients that don't respond to Forteo. It may be something to discuss with your osteoporosis doctor after your bone scan.

George Kannankeril (NorthShore)
Eileen, thank you for resubmitting your question. At best, I would say that it is debatable that dairy can worsen osteoporosis. There are some studies to show that diets that include dairy as well as calcium, vitamin D, and protein have a positive effect on bone density rather than a negative effect. So overall, I would not recommend avoiding dairy as a way to manage osteoporosis.

George Kannankeril (NorthShore)
Nicole, thank you for the question. There is some hereditary component to osteoporosis, but it is not as simple as "if your parents have it, you will too." The environment and your dietary intake can play a major role. If your parents had an osteoporotic hip fracture, that is a definite risk factor for you to develop osteoporosis, though, so you may require earlier screening of your bone density, as well as earlier treatment with medications if you do have low bone density.