Bone density loss under treatment may signal hidden cause

AskBro IKdttDn ModsksOü MUD) Dr. Keith Roach M.D

Bone density loss under treatment may signal hidden cause

DEAR DR. ROACH: In 2012, I was diagnosed with osteoporosis in my hip and osteopenia in my spine. My doctor put me on alendronate. I was on that for two years, but did not like the way it made me feel (very achy and stiff). So I quit taking it. My chiropractor suggested strontium to be taken with vitamin D-3, vitamin K-2, magnesium and fish oil. I have been doing that for almost two years. I just had another bone density scan done, and it showed that I went from a moderate risk (2.2) to high risk (-2.6).

I eat a variety of fruits and vegetables and exercise regularly, but no matter what I do, my bones do not absorb the nutrients they need to stay strong. I am only 59 and weigh 112. I know that is a factor. I know that when I see my doctor at the end of the month, she will suggest that I go back on alendronate. I really do not want to do that. Are there any alternatives? I am not taking any other prescription medication, but I wonder if there is something else I am doing (or not doing) that could be causing this. I am at a loss. Anything you can suggest will be appreciated. — M.S.

ANSWER: There are many options for treatment of osteoporosis, but I am concerned that your bone density went down during treatment, which suggests that you may have a separate problem. Before trying another medication, I would want to see that your calcium intake was adequate, that your vitamin D level is where it should be and that you do not have a high level of parathyroid hormone, which can weaken bones. I also would be concerned that you have a problem absorbing nutrients, especially due to celiac disease, but there are other, rarer conditions as well.

Strontium increases bone density even if it doesn't improve the strength of the bone, because strontium absorbs X-rays better than calcium. An increase in bone density on strontium does not always mean stronger bones. A decrease in bone density while taking strontium is concerning because there may be a larger decrease in bone strength than expected.

Although there are other options, such as denosumab and teriparatide, you first need to evaluate why the current treatments have not seemed to work.

DEAR DR. ROACH: If a woman were to be injected with a man's semen, would her body create antibodies against sperm cells which would thus prevent her from becoming pregnant? Likewise, if a man were to be injected with his own semen, would he create antibodies against his own sperm cells and cause himself to become sterile? — M.H.

ANSWER: Both men and women can develop antibodies to sperm. It is an uncommon cause of infertility; however, it sounds like you are considering its use as a contraceptive. Several scientists have looked at this possibility as a contraceptive vaccine. (Research has focused on which chemical components of sperm would make a vaccine after purification.) In animal studies, the approach was found to be successful in both males and females. The animals' fertility returned once the vaccinations were stopped, which probably is good news for its use as a contraceptive choice in humans, as there are effective forms of permanent sterility in both men and women who are sure they no longer wish to have children.

Unfortunately, we are a long way from proving it reliable for pregnancy prevention in humans. Finally, contraception is different from protection from sexually transmitted disease.