Dear Dr Roach: I have been taking calcium supplements for many years to help strengthen my bones. I am 74 years old, weigh less than 95 pounds, and stand 5 feet tall. I am on the verge of osteoporosis and have been receiving Evenity injections for almost a year. Now I hear that calcium supplements may be of no value. What is the truth ?

– H.

Dear H .: Before answering your calcium question, I want to ask you why you are on medication without being diagnosed with osteoporosis. All osteoporosis medications – all medications, for that matter – can have side effects. They should only be used when they clearly have more potential for benefits than potential risks. Too many people experience serious side effects from osteoporosis drugs when it was not clear that the drug should have been prescribed in the first place.

In your case, although your osteoporosis may not be confirmed by a bone mineral density test, you still have a high risk of fracture due to other medical conditions. Being 95 pounds can be a risk factor in itself.

I have never discussed romosozumab (Evenity), which was approved in 2019 by the Food and Drug Administration after trials showed it reduced fractures compared to placebo or alendronate (Fosamax). It works by increasing bone formation, but it also reduces bone resorption, which greatly increases bone density. It is given as a monthly injection or every three months. In one trial, women receiving romosozumab had an increased risk of heart attack and stroke, and until this possible risk was further assessed, many doctors reserved this treatment for women who did not. well done or are not good candidates for other treatments.

While many small trials have shown that calcium supplements alone increase bone density, there has been only inconsistent evidence that calcium supplementation, by itself, reduces fractures. The less calcium a person normally absorbs, the more important it is to increase their intake. In general, I recommend dietary calcium over supplements because of the risk of kidney stones from supplements (dietary calcium actually lowers the risk of kidney stones) and because there is controversy due to conflicting studies regarding whether calcium supplements increase the risk of heart disease. However, a theoretical risk of heart disease won’t stop me recommending calcium supplements for someone who just can’t get enough from their diet.

In the case of men and women taking medications, such as Fosamax or Evenity, for osteoporosis, adequate calcium intake is recommended, as the bone needs extra calcium to get stronger. All the tests that have shown the effectiveness of the drug have been carried out ensuring an adequate intake of calcium and vitamin D.

Dear Dr Roach: Sixty-seven years ago, I developed extreme back pain after giving birth to my second child. The x-ray technician said I was born with an extra joint at the end of my spine. Now I feel like he just escaped again, and I don’t think the doctors believe me. What type of doctor would be aware of this condition?

– JEL

Dear JEL: My best guess is that you are in the roughly 10% of people born with a sixth lumbar vertebra. In most cases, a person is never aware of this and it does not cause any problem, but can become a problem in some cases of spinal cord injury.

An orthopedic surgeon, rheumatologist, or physiatrist will be aware of this condition and can assess you, possibly with an x-ray. Some people will benefit from an injection into the joint between the vertebrae, but no one can say for sure if it would help without a full evaluation.

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