Questions on Osteoporosis & Constipation

Dear Dr. Spence,
You hear about osteoporosis in women all the time in the news. What about osteoporosis in men? Is this something to be concerned about?
Signed,
Week Femur

Dear Week,
Valid point. Though much of the literature and lay press focuses on osteoporosis in women, there is no doubt that men are affected as well. In fact, men with osteoporosis are twice as likely to die within one year of fracturing a hip, therefore, prevention is key. Unfortunately, men are generally unaware of potential risk and physicians tend not to screen as often as they might screen their female counterparts. The American College of Physicians has released a set of guidelines to help identify those patients who may be at greater risk of developing osteoporosis and should be screened with bone mineral densitometry. - age older than 70 - physical inactivity - low body weight (body mass index less than 25) - prior light trauma fracture (breaking bones doing something non-strenuous) - use of certain medications i.e. steroids, anticonvulsants, diuretics. Males with osteoporosis should be evaluated for secondary causes of decreased bone mineral density. Vitamin D screening is critical given its high prevalence.

Dear Dr. Spence,
What can I do about my constipation? I don’t feel like anything helps and it has lasted for years.
Signed,
Ima Fuller

Dear Fuller,
Chronic constipation typically lasts for several months or more and is defined by frequency and consistency of bowel movements. Normal for one individual may not be normal for another. If you begin to have less frequent bowel movements or if stools become harder or more difficult to pass, you are probably constipated. Your doctor will ask about medical history and associated symptoms accompanying the constipation. Constipation coupled with abdominal pain, bloating or fullness may be irritable bowel syndrome. It is also critical to investigate medications as a potential cause. Many common agents for hypertension, depression or heart disease are notorious for causing constipation and may need to be replaced. A patient’s diet may be low in fiber or fluids. Simple adjustments in intake may help, as may an increase in exercise. Physicians may suggest a variety of tests to ensure your issues are not related to anything more ominous. If you are over the age of 50, colonoscopy is almost always indicated to rule out colon cancer. Women who have given birth vaginally may have problems with the pelvic floor muscles that are involved in having a bowel movement. Some women in these situations may benefit from biofeedback that retrains the pelvic floor musculature. Finally, I generally treat with over the counter medications initially. Milk of magnesia once or twice daily is well-tolerated and safe even at higher doses. One or two ounces a day are usually sufficient. Patients may also use senna or polyethylene glycol (miralax) as over the counter alternatives. I discourage the use of frequent stimulant laxatives as some studies suggest the bowel may develop "dependence" on these agents to function properly. There are several prescription medications that can be used as well. A newer agent, lubiprostone (amitiza) allows more fluid to enter the colon and theoretically allows stool to pass more easily.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.