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Below you will find a list we’ve compiled of frequently asked questions about osteoporosis and provided answers by experts in the healthcare field. If you don’t see your question on the list below, please feel free to contact us with your question and we will do our best to answer it.

Q: What time of day and how often should I take calcium supplements?

A:Calcium supplements should not be taken all at once because the body cannot utilize more than about 500mg of calcium at one time. If you are instructed to take 1500mg per day, consider using 500mg tablets and dividing into 3 doses. Calcium carbonate, the most common form of calcium, is best taken with meals to enhance the absorption of calcium. Calcium citrate, on the other hand, can be taken anytime during the day, without regard to meals. Calcium from dolomite or bone meal should NOT be taken. Calcium products should not be taken simultaneously with iron supplements, or medicine such as tetracycline, or ciprofloxacin, levofloxacin, or other quinolone antibiotics.

Q: What calcium supplement do I take and how do I take it if take a Proton Pump Inhibitor (PPI) like Omeprazole (Prilosec), Pantoprazole (Protonix), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant), Esomeprazole (Nexium), and Rapeprazole (Aciphex)?

A:   It you take a PPI and take a calcium supplement on a regular basis, the best option for a calcium supplement is calcium citrate. Calcium citrate is the better option in this case because it does not require stomach acid in order to dissolve. 

Q: Is there truth to placing a calcium tablet in vinegar to see if it dissolves, thereby proving it will dissolve and be absorbed in your stomach?

A:  If you are unable to obtain calcium with healthy eating and choose to take a supplement , the best way to know whether your calcium supplement will dissolve in your stomach is to look for the “USP” emblem next to the word “calcium” on the ingredient list. This emblem means that the supplement is free of lead and other metals, and that it has also been thoroughly tested to make sure it will dissolve in your stomach. There is some correlation between placing a calcium tablet in clear vinegar, stirring occasionally, for up to 30 minutes to see if it dissolves and the solubility of the tablet in the stomach, however the digestive tract is far more complicated than a glass of vinegar.  Furthermore, there are no set standards for what the temperature of vinegar should be or as to the length of time that I should take to dissolve. A USP rating means that the supplement has passed a variety of dissolving tests which better mimic the digestive system hondrocream.

Q: Can you help me weigh the risks and benefits of taking a bisphosphonate? A doctor took me off my bisphosphonate when I was diagnosed with TMJ.

A:   TMJ (temporomandibular joint disorder) is not correlated with osteonecrosis of the jaw (ONJ) which is a serious bur extremely rare side effect associated with bisphosphonates. To better understand the benefit of taking a bisphosphonate compared to its risk, consider this: nearly ½ of all women and ¼ of all men in the United States over the age of 50 will break a bone due to osteoporosis. Greater than 20% of people over the age of 50 who fracture a hip will die within 1 year of the time of that fracture. Bisphosphonates have been shown to decrease the chance of hip fractures by 40-50% when taken for at least at least 3 years, with most benefit seen in women with prior fractures and low bone mass. The incidence of ONJ for patients on bisphosphonates is less than 1 in 100,000 person-years of exposure. The majority of bisphosphonate-related ONJ is seen in patients who underwent chemotherapy receiving high doses of bisphosphonates over prolonged periods of time and/or those with poor dental hygiene or pre-existing periodontal disease (disease of the gums).  The benefit of taking a bisphosphonate for someone 50 years of age and old with osteoporosis greatly outweighs the risk of potential side effects.

Q: I have osteoporosis and was told to avoid exercises such as toe touches and exercises that involve the twisting of my back. Can you clarify if I can or cannot do such exercises?

A: Exercise, particularly weight-bearing exercise is recommended to prevent osteoporosis and to prevent progression of osteoporosis for those with early evidence of it, i.e. osteopenia. Activities that ensure that gravity works against the weight of the body are considered ‘weight-bearing’ exercises. Examples include: walking, jogging, Tai-chi, dancing, tennis, and stair-climbing. Activities that strengthen muscles such as weight-training and resistant exercises are other examples of weight-bearing exercises. However, bending forward, especially in combination with twisting of the torso is best avoided by those with pre-existing osteoporosis (to lessen the risk of vertebral fracture).

Q:  I was told that men do not have to worry about osteoporosis. Is that true?

A:  There are two types of osteoporosis. Primary osteoporosis is the common form and due to the age-related changes in bone mass, and may be sub-classified as Type 1 or Type 2. Secondary or Type 3 osteoporosis is associated with the presence of other medical conditions that are linked to greater loss of bone mass. Type 1 osteoporosis is commonly referred to as postmenopausal osteoporosis and occurs in women within 15-20 years after the onset of menopause. Type 2 or senile osteoporosis occurs in individuals over the age of 70 and occurs in both women and men. One in 5 men will experience an osteoporotic fracture due to osteoporosis. Some of the causes of Type 3 osteoporosis which occurs in both men and women include some endocrine disorders (imbalances of natural hormones such as thyroid), gastrointestinal conditions (after procedures such as gastric bypass), auto-immune disorders (such as rheumatoid arthritis or ‘lupus’), and eating disorders such as anorexia nervosa. Some groups of medications are also associated with osteoporosis. Examples include some medications used to treat seizures, such as phenytoin and phenobarbital, chemotherapy agents to treat cancer, and heparin and corticosteroids such as prednisone, if given long-term. 

In summary, 1 in 5 men will experience an osteoporotic fracture due to osteoporosis and need to consider and minimize the risks listed above in an effort to prevent osteoporosis.

Q:  Prolia™ is administered twice a year while Reclast™ is administered only once (or less). Why is it administered twice?

A:  The amount of time that a drug you take is working effectively in your body differs because of the specific structure and formulation of the drug. Prolia™ strengthens your bones effectively for 6 months while Reclast™ has been shown to strengthen bones for a longer period of time. Both drugs work to strengthen your bones with the only difference being how long each specific drug does so.

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