More tests needed to diagnose bone disorder

Dear Dr. Gott: I am a 54-year-old female. One year ago, I had a DEXA scan, which showed severe osteopenia. I have GERD and a hiatal hernia and cannot take biphosphonate pills, so my doctor put me on Boniva IV.

My question, however, doesn’t have to do with the medication. Just before having the DEXA scan, I noticed several enlarged bones in my right foot and ankle. I was tested for Paget’s disease, but the results were negative. At my last physical exam, my doctor noticed that my left shoulder blade had enlarged. I have seen several doctors, and none can tell me what is causing my bones to enlarge. Do you have any ideas?

Dear Reader: Because you do not say what type of testing you have had and what types of doctors you have seen, I can give you only general suggestions. If these are repeats of what has been done or said, I apologize.

I hope you were told to increase your calcium and vitamin D intake in addition to taking Boniva. Boniva and other osteoporosis medications were not designed to treat osteopenia but have been increasingly given to people with this preosteoporotic condition. If you are not already, I urge you to take 1,000 to 1,500 milligrams calcium and 600 to 800 milligrams of vitamin D daily. This can be achieved with supplements or by increasing your intake of fortified milk, cheese, yogurt and dark, leafy greens. Tofu is also often fortified with calcium and vitamin D to round out vegan diets.

Second, I suggest your seek another opinion from an orthopedic specialist, who can order testing to determine whether you do indeed have Paget’s disease. The process of bone breakdown and regrowth is sped up and often causes bone enlargement. Despite the enlarged bones, they often are weak and brittle, which is why Paget’s is often known as “soft-bone disease.”

Testing can include X-rays to pinpoint bone enlargement, and show reabsorption and other abnormalities. Another valuable test is a bone scan, in which a material is injected to show the bone better. In Paget’s disease, the affected areas show up darker than healthy, normal bone. A final step is a blood test to determine the level of alkaline phosphatase. In most people with this condition, the levels are elevated. Because I don’t know what testing you have had, I cannot determine whether you have had all or some of these.

Treatment for Paget’s disease is similar to that of osteoporosis. It includes biphosphonates such as Fosamax, Boniva and others, and calcitonin. Therapy is aimed at improving bone strength and mineral content.

Therefore, even if you have Paget’s disease, you are already receiving proper care; however, you need to have a diagnosis. If you don’t have Paget’s disease after having thorough testing, you need to know why you are having spontaneous bone enlargement. Ask your primary-care physician for a referral to an orthopedic specialist and go from there.

To give you related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.