Ask the Doctors December 2005 Issue

Ask the Doctors: 12/05

I’m a 58-year-old woman and concerned about osteoporosis. It runs in my family, and I’d like to take steps to prevent it. What can you tell me about Actonel and Fosamax? Are they effective, and is one better than the other?

We’re glad that you’re concerned about osteoporosis. It is a common disease affecting well over 10 million women with another 34 million at risk. A woman’s lifetime risk for fracture is more than 40 percent.

The decision to take a medication for osteoporosis is usually based on a bone-density test (DXA) and a clinical evaluation. The clinical evaluation is important since more than 50 percent of all fractures occur in women with osteopenia, or low bone mass (defined as a T-score on the DXA test of -1.- to -2.5 with osteoporosis defined as a T-score of less than -2.5). The National Osteoporosis Foundation recommends treatment in women with a T-score of -1.5 to -2.0 if you have such risk factors as a family history of osteoporosis, smoking, body weight of less than 127 pounds, or previous fracture, and in all women with a T-score of less than -2.0.

Actonel and Fosamax (taken once per week) and Boniva (taken once per month) are all in a class of drugs called bisphosphonates, and all are effective for the prevention and treatment of low bone mass. Other drugs include Evista, Calcitonin, and Forteo. Forteo, in a unique class of drugs called anabolics, is reserved for higher-risk patients and is given as a daily injection.

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My doctor has discovered bone spurs on the spine in my neck. He calls the condition cervical spondylosis and says that most people my age—over 70—have it. How serious is it, and is there anything I can do about it?

Your doctor is correct. Cervical spondylosis is a common condition in people your age: about 70 percent of people have contracted the condition by the age of 60 to 70 years. 

Cervical spondylosis is another name for degenerative osteoarthritis that affects the vertebrae in the upper spine. It causes narrowing of the space between the vertebrae and development of benign bony growths, called osteophytes, on the vertebrae. Pressure on nerves by these osteophytes can cause shooting pains from the shoulders to the hands and numbness, tingling, and weakness in the arms and hands.

The gradual progression of cervical spondylosis cannot be stopped; however, it doesn’t always produce symptoms. For individuals who do experience problems, conservative treatment usually is effective in managing the condition. This may include rest, use of a soft cervical collar, medication, and physical therapy. Surgery may be necessary if you have severe pain that does not improve with other treatments or if you have progressive neurological symptoms.

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I’m told I have an arthritic cyst in my shoulder joint. What is it, and how can I treat it?

An arthritic cyst is a benign, fluid-filled sac in the bone underlying the cartilage of a joint that has been damaged by arthritis. The cyst is an indication of the severity of the arthritis involving the shoulder. If there are no symptoms, no specific treatment of the cyst is needed. Usually pain in the shoulder joint is caused by the arthritis and not the cyst, and treatment of the arthritis is therefore recommended.