Question on Osteoporosis

Dear Dr. Spence,
I have been informed of a new medication for osteoporosis that is given only once per year. Is it effective and can I get it?
Signed,
Curious George

Dear George,
Zoledronic acid, or reclast, is a novel infusible agent used to treat osteoporosis. It is given as an intravenous infusion once yearly and generally takes approximately fifteen minutes to administer. Ten million people in the United States have osteoporosis and there are 300,000 hip fractures each year. When one considers that women with hip fractures are three times more likely to die within the next six months, we realize just how important prevention is. Previous therapies revolved around the oral osteoporosis drugs called bisphosphonates (actonel, fosamax, boniva). One study in greater than 35,000 women over age 45 showed a 45% risk reduction in fracture over two years. The number needed to treat to prevent one fracture was 125. Unfortunately, compliance with these medications was a major obstacle. Only 20% of the women enrolled in the aforementioned trial completed the study at one year. These drugs can cause significant gastrointestinal side effects including nausea, stomach upset and severe reflux. They need to be taken with an 8-ounce glass of water prior to eating or drinking and the patient must remain upright for at least 30-60 minutes. Reclast, on the other hand, appears to be a viable alternative with fewer complications. Studies have shown a reduction in vertebral fractures by 70% and hip fractures by 41%. Even more amazingly, there was a 3.7% absolute risk in death. Only twenty-seven patients need to be treated for two years to prevent one death, or nineteen to prevent one clinical fracture. One caveat – at $1200 per dose it can be an expensive option. Fortunately, it looks like medicare will reimburse for reclast infusions, thus making it an even cheaper option for treatment of osteoporosis. At this juncture, few physicians provide the infusion. Our office has been sending patients to other clinics that do carry the medication. Dear Dr. Spence, How do I know if I have irritable bowel syndrome? Signed, Crampy Dear Crampy, Irritable bowel syndrome (IBS) is an extremely common condition. It is generally a clinical diagnosis based on patients presenting complaints and is the gastrointestinal specialists most common diagnosis after referral. There are no clinical tests that help make a concrete diagnosis, but they are often used to rule out other pathologies. Patients are usually classified as being constipation predominant, diarrhea predominant or mixed. If you want to get technical, there are specific ROME criteria to assist in establishing a diagnosis of IBS. Patients may present with bloating, constipation, gassiness, or abdominal pain and cramping often relieved by bowel movements. Treatment remains challenging - zelnorm was a great agent until its removal from the market. Now we try antidepressants, antispasmodics and a host of medications geared towards treating constipation (i.e. amitiza.)

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.