Dearest:  My guest tonight, Felicia Cosman, M.D., is an osteoporosis specialist, 
the Clinical Director of the National Osteoporosis Foundation, Medical Director
of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y., 
and associate professor of clinical medicine at Columbia University.

Dr. Cosman is the author of "What Your Doctor May Not Tell You About Osteoporosis: 
Help Prevent--and Even Reverse--the Disease That Burdens Millions of Women."
Dr. Felicia Cosman brings an important new perspective on osteoporosis and offers 
a balanced program for preventing and slowing bone loss. 

Dearest:  Welcome to Power Surge, Dr. Cosman. 


Felicia Cosman M.D.:  Hi, it's great to be here :) 


Dearest:  Dr. Cosman, women go for annual pap smears, mammograms, but I'd venture 
a guess that about 50% of women don't even have one bone density test during their 
lifetime. Do you agree? 


Felicia Cosman M.D.:  Yes.  We know that use of bone density testing has picked
up in certain populations but the majority of people haven't been tested.

The NORA Study (National Osteoporosis Risk Assessment) has looked at 250,000 women 
who were at the doctors offices for an unrelated problem.  None of these women had 
been previously tested for bone mineral density (BMD).  When they were tested
as part of the NORA Study, many were found to have osteoporosis problems.


SPC:  Is there any form of calcium supplement that doesn't cause constipation? 


Felicia Cosman M.D.:  The form that has the best reputation for avoiding constipation 
is Citracal.  Calcium carbonate is a very good form of calcium, but if you have
a problem with that, try the calcium citrate (Citracal).


Dearest:  I thought calcium citrate was the best form of calcium to take for bone 
health. 


Felicia Cosman M.D.:  Well, the difference between calcium citrate and other forms 
is very minimal.  There are many types, pills, fruit chews, chocolate, many types.  
It's nice to have the choice.  Most have a USP designation which helps to insure 
that they are pure and have the strength. 

If you have questions, try to dissolve it in a glass of water. It should dissolve 
in 45 minutes. You should take your calcium with food, if possible. 


CindyTree:  I am 46. What is your best advice for me to start doing now - what can 
I wake up tomorrow and begin doing to help prevent or reverse osteoporosis at 46? 


Felicia Cosman M.D.:  First thing. Are you premenopausal? Are you still having 
periods? 


CindyTree:  Yes. They are becoming a little more irregular, but yes. I do take 
Citracal.


Felicia Cosman M.D.:  First, you should begin making sure that your calcium intake 
is good. Get calcium fortified foods and milk each day.  If you have 2 dairy 
products a day, you should supplement with calcium, 300 mg.  If you get none, you 
need 900 mg.  With the Citracal, you need the multivitamin for the Vitamin D.

You need exercise with weight bearing aerobic exercise on your feet for 30 
minutes, 3 times a week.  Muscle-strengthening exercises, too, to strengthen
the frame.  If you smoke, quit. 

Review your risk factors for osteoporosis, your family history, your weight,
if you've ever smoked.  Use these risk factors to talk to your doctor, but
don't get the bone density test yet, if you're still menstruating. 


Dearest: It has always been Power Surge's recommendation that perimenopausal
women take 1200 mg. of calcium supplementation and postmenopausal women, 1500 mg. plus,
of course, vitamin D for the body's proper absorption of the calcium. 

At what age should a woman with no symptoms of bone problems have a bone density test 
and what does such a test involve?


Felicia Cosman M.D.:  All woman by the age of 55 should be tested.  If you are
a postmenopausal woman before 55, look at the risk factors. If you have personal 
or family history, smoking, or you are very thin, then be test.  The test is 
minimal, takes about 5 minutes and you can remain fully clothed. The DEXA Scan 
gives a spine and hip reading. If the numbers are low, you may have osteoporosis 
and should take medication. 


Dearest:  Does having arthritis have anything to do with osteoporosis and,
if so, should a woman with arthritis have a bone density test at an earlier age? 


Felicia Cosman M.D.:  Good question! This is an area of confusion for many women 
and many doctors.  The diseases are completely different.  Osteoporosis has no 
pain involved until the thinned bones start breaking.  Osteoarthritis can produce 
pain and swelling, often in the hips, knees and other joints.  Both appear with 
higher frequency as we age, but we don't consider a woman with osteoarthritis to 
be at a higher risk for osteoporosis.


Kataneena:  I had TAH-BSO at age 45, seven years ago and have been on natural HRT 
ever since. I was diagnosed with osteoporosis that same year, so it was well 
underway at the time of my hysterectomy. I run 15 miles a week, plus weight train 
and have for over 20 years. I followed all of Dr. Lee's recommendations, but am 
still peeing out my bones. My BMD showed -3.4 in my spine and -1.9 in my hip. 
Please help.


Felicia Cosman M.D.:  The issue here is has there actually been bone loss despite 
being on the natural hormones?  Are the hormones really working in your body?  
Natural hormones can range between Premarin (horse urine) to progesterone cream.  
If there has been active bone loss while you were taking this, you should talk to 
your doctor about changing medications.  You could try Evista, the designer 
estrogen.  Evista reduces, rather than increases, breast cancer risk.  Actonel and 
Fosamax are very effective in increasing bone mass and reducing fractures. Forteo 
is new and very effective and potent. It would be a good consideration for you.  
You need to make sure you have a high calcium and vitamin D intake.  See a 
specialist to see that there are no underlying diseases contributing to the loss 
of bone mass. It's very low, but if your numbers are stable, then you can stay on 
the hormones. 


Loon:  What is the difference between osteopenia and osteoporosis? 


Felicia Cosman M.D.:  Osteopenia is a precursor to osteoporosis.  It's another 
name for low bone mass. As we age, having a bone mass in the osteopenia range
is fairly normal.  If the osteopenia is severe, medicine should be considered.
If it's mild, then you may want to just watch it. Osteopenia is not a disease
and doesn't always need to be treated, but rather watched, depending on your 
personal history. 


PatC:  I have some risk factors for osteoporosis. In January had a bone density 
scan that gave me T scores of -1.63 on my spine and -2.81 on my left hip. I am 
planning to go back next Jan and see if it has improved, with exercise and
Revival Soy. Does this sound reasonable? 


Felicia Cosman M.D.:  It's reasonable to wait a year. However, I think a 
postmenopausal woman in this category should use medications.  I don't think
that the soy would improve the bone mass with the score of -2.81. 


SherryC:  If you are going to take Calcium, do you need to take magnesium?
If so, do you take them at the same time or separately? Also, can you tell me
if H blockers affect absorption of Calcium? 


Felicia Cosman M.D.:  First part. Most healthy individuals do not need to take 
magnesium with calcium.  It is difficult for a healthy person to become magnesium 
deficient.  People who are on chemotherapy or have bowel problems might need 
magnesium.  It doesn't need to be at the same time as the calcium, though.  It
can be used to reduce constipation.  If you take calcium with food, you may not 
need the magnesium. 

For the H2 blockers you you need calcium citrate.


Dearest:  What are H2 blockers? 


Felicia Cosman M.D.:  H2 blockers are for acid reflux.  They are prescription 
medications like Nexium, or OTC medications like Pepcid AC and Tagamet.


Loon9950:  My T score in the hips is -2.0, and -0.2 in the spine. Is that bad?
Do I need more than a bone density like an MRI or CT scan? I had my ovaries 
removed last year and I don't take hormones because ovarian cancer in our
family and breast cancer. I am taking Fosamax. 


Felicia Cosman M.D.:  Yes, this is a concern and something that you need to
think about.   Since you just had your ovaries out, you should have your bone 
density done every year. 


Loon9950:  Is Fosamax bad for you? 


Felicia Cosman M.D.:  No, Fosamax is a good choice.  Beyond that, be sure you're 
getting enough calcium and exercising regularly. 


Deboc98:  What do you think of Coral Calcium with Magnesium and vitamin D that
is so talked about now. Do you think it will be effective against osteoporosis?
I have taken it and seen a difference in constipation and overall healthier 
feelings. 


Felicia Cosman M.D.:  There's no evidence that Coral Calcium is any better than 
any other forms of calcium. 


Slim:  If you have osteoporosis, are there natural medications you can take?


Felicia Cosman M.D.:  If you truly have osteoporosis, I don't think you should 
rely on natural things except estrogen.  Estrogen should not be taken for more 
than 5 years, and many women aren't candidates for estrogen.  If you actually
have osteoporosis, I wouldn't count on naturals to help with it. 


Trish:  I am 50 and just found out I have osteopenia. Can this be reversed and
how much mg of calcium should I be taking? 


Felicia Cosman M.D.:  Osteopenia is just slightly reduced bone mass. You need
at least 1200 mg of calcium a day. Osteopenia doesn't need to be reversed, but 
maintained.  Take your vitamins and exercise and repeat the bone density until 
you're stable. 


Dearest:  You say it's better to space the calcium over the course of a day, 
rather than take it in one dose. Why is that? 


Felicia Cosman M.D.:  Because the ability of your body to absorb is lessened
if you take more than 500 mg at a time.  If you take 1,500 all at once, your
body can't use it as well as if it's spaced out through the day. 


Dearest:  I take 400 IU's of vitamin D with only my morning dose of calcium 
because my understanding is that vitamin D helps the body absorb calcium more 
effectively. You say it's not essential that all of us take vitamin D -- that
most of us make Vitamin D through our skin upon minimal exposure to sunlight.
Can you elaborate? 


Felicia Cosman M.D.:  For younger individuals, we don't recommend additional 
Vitamin D. When women get to menopause, a multi-vitamin is good for many reasons.  
For some people with some diseases and the elderly, it might be necessary to take 
more Vitamin D.  People on steroids need more vitamin D. 

It's true that when the skin is exposed to sunlight it can make Vitamin D from a 
precursor. With sunscreen, and hats and clothing, our ability to make Vitamin D
is reduced. This makes it more important to take a good multi-vitamin. 


CindyTree:  I also have three daughters, ages 21, 17 and 14. Should they be
taking any calcium supplements? At what age should they start being concerned?


Felicia Cosman M.D.:  At this age, they're hopefully healthy young women.
They should only be concerned with getting in exercise and getting enough
calcium. I prefer that they get calcium through the diet.  If they can't get
at least 3 servings, they can take a supplement. Find one that they can take 
easily, that doesn't need water or food. A chewable calcium is good, because 
they're most likely on the move. Exercise at least 3 times a week and do not 
smoke.  Much later, they should get their bone density done 


SBHamee:  What do you think of Evista for bone loss and Activella for hot flashes? 
Are they safe to take? 


Felicia Cosman M.D.:  Yes, I think Evista is a good drug for bone loss for women 
in their 50's.  These women are at risk for spine fractures.  For women who have 
hot flashes, Evista can make them worse.  Activella is not known to be safer than 
PremPro. PremPro is the HRT which has been recently found to cause a lot of 
problems. 


Egy:  I have also lost bone every year since my hysterectomy 7 years ago, despite 
estrogen supplementation. I am now at -1.32 in spine and -2.97 in hip. I also have 
had an ileostomy for 29 years. I walk 1/2 to 1 mile each day, take calcium and 
vitamin D, thyroid fine. My doctor has now added progesterone cream and 
testosterone cream to my regimen, along with Miacalcin. I can't take Fosamax
due to stomach problems.  I thought Forteo was only approved for women who
had had a fracture? 


Felicia Cosman M.D.:  Very good question.  Forteo is approved for women at high 
risk for fracture.  You are a possible candidate for Forteo.  You should ask about 
an IV version of the drug Aredia.  There is also an injectable Forteo. These drugs 
are not FDA approved yet, for osteoporosis, but for other reasons so we can use 
them in special cases like yours.  

For a woman who has had an ileostomy for a long time, you may need a higher
amount of  vitamin D. That would require further testing. Vitamin D dosage is 
determined by your blood levels. You might need a high dose, up to 50,000
once a month. I would only prescribe that after testing.


Egy:  Is there a certain type of specialist that I should see? 


Felicia Cosman M.D.:  You should see an endocrinologist. 


Baker:  What other diseases can contribute to loss of bone mass?


Felicia Cosman M.D.:  A variety of hormone problems such as thyroid disease, 
parathyroid disease and Cushing's Disease, as well as rheumatoid arthritis, 
autominume diseases, Crohn's, seizure disorders and some bowel diseases. 


Kataneena:  Is there a difference between bone density and bone architecture,
and can one have low density and never get a fracture?


Felicia Cosman M.D.:  Yes.  Another very good question.  There is definitely
a difference.  Bone density is the amount of bone.  Bone architecture cannot
be measured without a bone biopsy, which is only scientific at this time.
It is definitely possible to maintain a better bone architecture, if you
haven't suffered from a lot of bone loss.  Many people have low bone density
and never have fractures because the bone architecture is so good. 


Dearest:  Dr. Cosman, thank you for a very informative chat about osteoporosis
and the various methods of treatment available to protect our bones and, 
hopefully, prevent this disease. I strongly recommend Dr. Felicia Cosman's
book, "What Your Doctor May Not Tell You About Osteoporosis."
 


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