DRUG THERAPIES FOR HEALTHY BONES: MAYA’S STORY
One patient I recommended calcitonin to was a Middle Eastern woman just reaching menopause. A DEXA scan showed Maya’s bone density to already be 15 percent below ideal levels in her spine and 12 percent lower than I would have liked to see at the hip. Her NTX level was still in the normal range, but at the high end of it (41), indicating a risk of fracture mildly higher than her bone density alone would predict. She was an avid exerciser, and was glad to learn how much that contributed to protecting bones. She was determined to go through menopause as “naturally” as possible, and didn’t want HRT for this reason. But she was concerned enough about her bones to consider other prescription treatments if she could avoid side effects and not raise her risk of any other condition. Calcitonin appealed to her since it is “natural” in the sense that the pills are made from salmon; the substance is also produced in the human body and has no known side effects other than nasal irritation in one in ten people who use it (it comes in a nasal spray).To aid and abet calcitonin to the best of her ability, Maya adopted a diet rich in plant estrogens, upping the amount of tofu and other soy products she ate. She started taking the recommended doses of calcium and vitamin D supplements, along with a multivitamin and other supplements similar to those described in Chapter 6. She kept up her regular exercise program, with a renewed focus on strength training.One year later, her bone scan showed her vertebrae to now be 13 percent above expected, though her hip was still 4 percent below ideal levels. She was among the fortunate 90 percent of patients who experience no side effects from calcitonin, so she continues to take it every day. I expect that when she comes back for her next scan in about two years, she’ll have rebuilt all her bones to the level of a healthy 30-year-old woman—or even better*155\228\2*
