#Middlebury #ToYourGoodHealth #Osteoporosis
By Keith Roach, M.D.
DEAR DR. ROACH: I have mild osteoporosis in one area. I was on Fosamax for seven years. I have been off for two years. My doctor is suggesting I go back on Fosamax. Your thoughts on treatment in my case? – A.B.
DEAR DR. ROACH: I have been advised that Medicare will cover the bone density test only every two years. If that’s true, why? – A.L.
ANSWER: Osteoporosis is loss of bone minerals and strength. There are at least two ways to measure changes in bones, whether as an age-related drop in bone density and strength or as an increase in response to treatment. One way is to measure the bone density via an X-ray (DEXA). The other is a urine test, N-telopeptide of collagen (abbreviated NTX), which looks at net bone loss.
DEXA correlates well to fracture risk, but it changes very slowly. In fact, it changes so slowly that a repeat test within two years usually reflects variability in the test itself rather than an actual change in the bone, which is why most insurance companies – and, yes, Medicare – will cover the test only every two years.
Some experts believe that measuring NTX is a useful way of measuring the effectiveness of treatment, such as with a medication like Fosamax. Further, although the optimum duration of treatment for osteoporosis isn’t clear, five years is commonly used (as it sounds like is the case for A.B.).
NTX can guide whether restarting treatment is necessary. There just isn’t enough information to make this a general recommendation, although the theory makes sense to me. If I were treating someone in A.B.’s situation, I would restart treatment if the NTX level showed high bone resorption.
READERS: Nearly every woman, if she lives long enough, must come to grips with osteoporosis. To order the booklet about this debilitating disease, write to Dr. Roach – No. 1104W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow up to four weeks for delivery.
DEAR DR. ROACH: What are your thoughts about the MiraDRY procedure to get rid of underarm sweat? Is it safe not to have sweat under the arms? – S.J.
ANSWER: MiraDRY is the brand name of a microwave device designed to treat hyperhidrosis (excessive sweating). This is a condition of abnormal, drenching sweat that greatly interferes with social activities, not normal underarm sweating. It is currently used only for underarms – not hands, feet or face, the other most common places for localized hyperhidrosis. According to several published papers, the microwaves heat up the water in the sweat glands, destroying them, while the skin itself is cooled. The published success rates (at reducing sweating to “never noticeable” or “tolerable”) are very high, as are patient satisfaction results. Side effects included swelling, redness and temporary numbness.
This is a new procedure, but it appears to have promise in the treatment of excess sweating. I also found a very helpful website at www.sweathelp.org.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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