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DEAR DR. ROACH: I am a 69-year-old male who has been very active throughout my life. Two years ago, through a fall which resulted in a compression fracture of the T12 vertebra, I was diagnosed with osteoporosis. I had a bone density test with a T-score of -4.2. My doctor said that’s the worst he’s seen. I was then prescribed alendronate and calcium supplements daily for two years. Last month, I had my checkup and bone density test, but the test results showed no change. I am scheduled to see an endocrinologist next month. In the meantime, I’m still on alendronate and calcium supplements. My doctor was talking about a more aggressive approach and put me on Forteo. He is also testing my testosterone levels, too. My question is, how can, or will, the long-term usage of these drugs affect me and my bone quality? I fear it might affect my active lifestyle. — B. ANSWER: Osteoporosis is a condition where the loss of bone minerals and bone strength occurs, predisposing someone to fractures. It is found in both men and women. A T-score of -4.2 is very, very severe osteoporosis, putting you at high risk of a fracture. When I see osteoporosis in men, I think first of low testosterone, so I am glad that is getting checked. The fact that the alendronate isn’t working also makes me suspect low testosterone. Treatment of low testosterone will help your bones get better faster. A hip fracture is a serious event, usually requiring urgent surgery. It would dramatically affect your active lifestyle. That’s what you really need to be most concerned about. Teriparatide (Forteo) and abaloparatide (Tymlos) work in a different way from alendronate (Fosamax), and many experts choose this as initial therapy in the severe osteoporosis you have. Teriparatide has been used for decades, and the long-term safety record is excellent. Short-term side effects include nausea, headache and muscle cramps. These don’t last long in most people, and your risk of fracture without effective therapy is very high. You need to consider not just the risk of these medicines, but the risk of not doing anything. In my opinion, with a T-score of -4.2, the risk of doing nothing is much, much higher. Alendronate (Fosamax) needs to be taken very precisely to be absorbed: It must be taken first thing in the morning on an empty stomach, and you will have to wait at least 30 minutes before eating. It can be taken only with tap water: Some bottled waters have enough minerals to decrease absorption. DEAR DR. ROACH: My husband and I recently contracted COVID and are currently recovering well, following treatment with Paxlovid. We are both over 60 years of age with no other major risk factors. I know that we both need to wait at least three months before we can get the new COVID booster shot. How long should we wait before we get our annual flu shot? — K.P. ANSWER: You may get the flu vaccine as soon as you are feeling better from your COVID infection. You should no longer have a high temperature. For most people, that’s somewhere around a week or two after the start of the infection, but can be shorter or longer depending on who you are. For people who haven’t gotten COVID: If you haven’t gotten your flu shot by now, it’s time to do so.

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] or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2022 North America Syndicate Inc. All Rights Reserved

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