Dr.  Keith Roach

Dear Doctor. Roach: I’ve been taking calcium supplements to strengthen my bones for many years. I’m 74, I weigh less than 95 pounds and I am six feet tall. I’m about to have osteoporosis and have had evenity injections for almost a year. Now I hear that calcium supplements may have no value. What is the truth?

– H.

Dear H.: Before I answer your question about calcium, I would like to ask why you are on drug therapy without a diagnosis of osteoporosis. All osteoporosis drugs – all drugs, by the way – have the potential for side effects. They should only be used if they clearly have more benefit than harm potential. Too many people experience serious side effects from osteoporosis medication unless it was clear that the medication should have been prescribed in the first place.

In your case, despite osteoporosis not confirmed by a bone density test, you may have had a high risk of fractures due to other diseases. Being 95 pounds can be a risk factor in itself.

I’ve never talked about romosozumab (Evenity), which was approved by the Food and Drug Administration in 2019 after studies showed it reduced fractures when compared to placebo or alendronate (Fosamax). It works by increasing bone formation, but it also reduces bone resorption so it greatly increases bone density. It is given as an injection monthly or every three months. In one study, women who received romosozumab were at increased risk of heart attacks and stroke, and until that potential risk is further investigated, many doctors reserve this treatment for women who have not had good results or are not good candidates for other treatments.

Although many small studies have shown that calcium supplements alone increase bone density, there is only conflicting evidence that calcium supplements, by themselves, reduce fractures. The less calcium a person normally consumes, the more important it is to increase its consumption. In general, I recommend dietary calcium instead of supplements because of the risk of kidney stones from supplements (the dietary calcium actually reduces the risk of kidney stones) and because there is controversy based on conflicting studies about whether calcium supplements increase the risk of heart disease. However, a theoretical risk for heart disease isn’t going to stop me from recommending calcium supplements from a person who just can’t get enough of the diet.

Adequate calcium intake is recommended for men and women taking medications such as Fosamax or Evenity for osteoporosis, as the bones need extra calcium to become stronger. All of the studies that showed the drug’s effectiveness were done to ensure adequate calcium and vitamin D intake.

Dear Doctor. Roach: 67 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 it feels like it just slipped back out, and I think the doctors don’t believe me. What kind of doctor would be aware of this condition?

– JEL

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

An orthopedist, rheumatologist, or physical therapist knows this condition and could probably examine you with an X-ray. Some people will benefit from an injection into the vertebral joint, but no one can say for sure if it would help you without a full evaluation.

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