Fosamax Can Help Prevent Bone Loss--but It May Cause Ulcers

Question: I am concerned about my sister, who has been taking Fosamax to treat osteoporosis for nearly two years. A month ago, she suddenly developed swallowing problems and could not eat or even sip water. The doctor recommended she stop Fosamax immediately because it had given her an ulcer at the end of her esophagus.

Now she is on applesauce, Ensure and milkshakes, and I am wondering about this medication. Is there any other way to treat osteoporosis?

Answer: Fosamax is quite effective for preventing bone loss and fractures due to osteoporosis. It is not for everyone, however. This drug can be extremely irritating to the throat and esophagus if a pill gets stuck. In some cases, people have been hospitalized because of the kind of severe ulceration your sister experienced.

The manufacturer of Fosamax recommends that this pill be swallowed with a full glass of plain tap water on an empty stomach at least half an hour before breakfast. The person must remain sitting or standing during that time to help the pill make it into the stomach. This might not work for everyone, though, since some people have a hard time getting pills down and might not even realize if Fosamax lodges in the esophagus.

There are other ways to treat osteoporosis. Evista (raloxifene) and Miacalcin (calcitonin) are used to strengthen bones. Estrogen is also effective.

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Q: I sometimes have to get up in the middle of the night to urinate and then have a hard time falling asleep again. What is the new drug you mentioned that might work in this situation?

A: Ask your doctor about the prescription sleeping pill Sonata. It goes to work fast and wears off quickly, so it is unlikely to cause a morning hangover.

Alternatives

Q: My husband takes a baby aspirin every day on the advice of his doctor. He wants me to do the same, but I am afraid to. Years ago, before I met him, I had a frightening allergic reaction to aspirin. Is there any other way to get the heart protection that aspirin gives him? I’d prefer a natural product if possible.

A: People allergic to aspirin risk a life-threatening reaction if they are exposed to this drug. Others find that even small doses can be irritating to the digestive tract.

Aspirin is acetylsalicylic acid. There are certain foods that contain salicylates, related compounds that might have some of aspirin’s benefits without the complications. Including foods such as apples, cherries, grapes, prunes, tomatoes and strawberries in your diet might provide a beneficial dose of salicylate.

Wine and tea also contain antioxidant compounds, called flavonoids, that might provide cardiovascular protection. Surprisingly, so do cocoa and chocolate. Researchers report in this month’s American Journal of Clinical Nutrition that the antioxidants in cocoa might reduce the risk of a blood clot.

The scientists used Cocoapro, made by the Mars candy company, which paid for the research. It is richer in flavonoids than ordinary cocoa. After drinking this special cocoa beverage, the subjects’ blood was slower to clot, much as if they had taken a low dose of aspirin.

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Q: I have adopted a vegetarian diet, but now I am experiencing a burning sensation or numbness on the right side of my tongue. This happened once before, many years ago, when I was single and did not eat well. Have you ever heard of such a symptom?

A: A burning tongue might signal a vitamin B12 deficiency. Since this crucial vitamin is not found in plant sources, strict vegetarians might be susceptible to a shortage. A lack of vitamin B12 can affect the nerves and will eventually show up on a blood test.

Please ask your doctor to check for this because the deficiency can be serious. Luckily, taking a B12 supplement might be enough to correct the problem, if this is indeed the explanation for your burning tongue.

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Q: I am taking St. John’s wort extract, standardized potency, for depression. I’ve taken one capsule three times daily for more than a year.

I have been extra-sensitive to the sun, but now I seem to have problems urinating. Could this be a side effect of the herb? If so, should I stop taking St. John’s wort completely?

Please send me information about this herb so I can decide what I need to do.

A: St. John’s wort extract (hypericum) seems to be as effective as some antidepressant medications for treating mild to moderate depression. One side effect of the herb is its ability to cause an exaggerated burn or rash on skin exposed to the sun. Urinary retention is not well-known, but we have heard of other cases of difficult urination linked to St. John’s wort.

This complication can be serious, so we suggest you discontinue the herb for now and consult your doctor.

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Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their column runs every Monday. Send questions to People’s Pharmacy, King Features Syndicate, 235 E. 45th St., New York, NY 10017, or e-mail them at pharmacy@mindspring.com.