Dear Dr. Roach: I’m a 68-year-old female with osteopenia. My doctor wants me to take a bone medication such as Boniva or Fosamax. I’ve read that folks with esophageal issues may be harmed by taking these. Can you explain why?
C.M.C.
First off, we don’t usually treat isolated low bone mass (osteopenia) with powerful medicines like the ones you mention, which are both bisphosphonates. These medicines have the potential for harm and should only be used when the benefits clearly outweigh the risks.
A person with low bone mass and a history of a fragility fracture has osteoporosis, regardless of their bone density. Some people with low bone density may be at such a high risk for fracture (based on their FRAX score) that treatment is indicated. Many authorities recommend a 10-year risk of a fracture to be 20% or higher (or a risk of a hip fracture to be 3% or higher) before treating someone with medication. You should find out your FRAX score.
The issue with the esophagus is that if pills get stuck in the esophagus, they can cause severe damage to it. So, people with esophageal disorders — such as achalasia, esophageal stricture or varices, or Barrett’s esophagus — should not take these types of medicines by mouth. People with reflux without these complications can take oral bisphosphonates as long as they can comply with staying upright for 30 minutes after taking them.
Dear Dr. Roach: My boyfriend got cancer from HPV. He was successfully treated. Is he capable of transmitting it to me?
S.
HPV causes different types of problems. Warts are all caused by HPV, but only a few strains of HPV can predispose people to cancer.
The most common HPV-related cancer in men is head and neck cancer. HPV is now the leading cause of head and neck cancer. Most of these cases in men occur from sexually acquired HPV infection. Men are at a higher risk for HPV-related head and neck cancer than women, even though women are at a much higher risk for the overall HPV-related cancers, since cervical cancer unfortunately remains common.
Once a person has had HPV, they can potentially spread the virus, even without any visible signs of infection. Condoms reduce but do not eliminate the risk of transmission. Close skin-to-skin contact is necessary for transmission, and although sexual contact is a common way of transmitting HPV, it is not necessary. Most people cure themselves of the virus within a few years.
By far, the best way to prevent HPV transmission (apart from never having close contact with anyone) is vaccination. The HPV vaccine is highly effective at preventing infection if it is given before the onset of sexual activity, but it may still be fully or partially effective after the onset of sexual infection.
The HPV vaccine prevents infection but it is not recommended for treatment. The recommendation from the Advisory Committee on Immunization Practices (ACIP) is to vaccinate at the age of 11 or 12, up to the age of 26. But it is approved up to the age of 45. I have rarely given individual patients the HPV vaccine even after that age, based on their particular circumstances.
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]
