Dear Dr. Roach: I have read in your previous columns that you have expressed caution about taking medications like Fosamax. I hope you can help me with my situation. I am 76 years old. I took Fosamax for 13 years, stopping in 2010. My last scan showed a T-score of -2.4 in the spine and -2.1 in the hip, which was a little worse than last time.
Does Fosamax stay in the system and continue to work? If so, for how long? What are some alternatives?
E.M.
Thirteen years is a long time to continue taking a bisphosphonate drug, such as alendronate (Fosamax) or risedronate (Actonel). There are not good studies to show effectiveness beyond 10 years. There does seem to be some residual effect on bone density after stopping: Bone density remained higher and fracture risk lower, corresponding with data showing that the medication remains in the bone for years (and possibly decades) after stopping it.
If your bone density is getting worse, it is reasonable to consider restarting treatment. I don鈥檛 have enough information to make a recommendation to you; other items that should be considered include your risk for fracture (the FRAX score is commonly used), the rate of decline (if any) of the bone density and evaluation of other risk factors, especially vitamin D, diet and exercise.
Some authorities recommend restarting bisphosphonates such as Fosamax if the bone density goes down and fracture risk is high after stopping it; however, I certainly would consider other options, including the parathyroidlike hormone teriparatide, or raloxifene (an estrogenlike drug).
Dear Dr. Roach: Our son, who is in his 40s, had always been a happy person until he was diagnosed with clinical depression. He has been to psychiatrists and psychologists, and has been prescribed medications. He said the side-effects of the medication were worse than what he was going through, so he and his wife agreed that he鈥檇 stop taking them. It has been a year since we have seen him, as it is too emotional for him to meet with us. We miss our son, and any help would be appreciated.
C.P.
Major depression is a serious illness, with morbidity (ill health) and mortality associated with it, but for which there are treatments. Effective treatment improves health and reduces mortality. It is certainly true that medication treatment for depression might have side- effects, and it also is true that there are people for whom finding an effective medication treatment is difficult.
However, there are many different kinds of treatment: several classes of pharmacological therapy (some, such as gabapentin, not normally used for depression), but also nondrug treatments. I would encourage your son to seek another opinion, one from a person willing to look beyond standard therapy.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
