ANDREW WEIL: Make sure you're taking 1,000 IU a day of vitamin D3.

What factors define the subgroup of patients most at risk for necrosis of the jawbone?
Elaine Pecci
Cameron Park, CA

ANDREW WEIL: We don't know.

Dear Dr. Weil, I have been taking Fosamax for about a year and recently a dental problem occurred where my dentist wanted to consider an implant. The Oral surgeon (knowing I took Fosamax) would not extract the tooth. What is the danger?
Marcia Berkowitz
Dumont, New Jersey

ANDREW WEIL: Weakness of the jaw bone caused by the drug, which increases chance of complications of the implant.

I'm 55 and have been on Fosamax for 18 months. How often do I need to get the bone density scan to see if it's working? Should my primary care physician handle the care for osteoporosis or a specialist?
Michele Stiefel
Lancaster, PA

ANDREW WEIL: At least once a year, and, yes, your primary physician should be able to do it.

Is it dangerous to take so much vitamin D? I know it is a fat soluble vitamin which means that the levels stored in the body might reach harmful levels. What is the usual RDA recommendation and why is it safe to take so much more?
June Miller Sanders
Westford, MA

ANDREW WEIL: No, there is no toxicity in the 1,000 to 2,000 IU a day range. Usual recommendation is 200 to 400 IU — much to low to for disease prevention.

Dr. Weil: What do you know about OsteoValin? I saw this supplement advertised on TV. They claim that it is not a calcium supplement, that it helps build bone mass. It's not a prescription drug. I would appreciate your advice. Thanks again!!
Nora Carnahan
Ocala, FL

ANDREW WEIL: Sorry, I don't know it but will try to find out.

In the 3/20/06 issue of TIME where you write about a subgroup of patients having trouble with their jawbone, was this a very extensive study that determined that bisphosphonate drugs caused the necrosis? Those drugs are intended to help the bone so it seems strange that the Jawbone would be affected adversely. I've been on Fosamax for about 5 years and so far my jaw has not been affected.
Carol Kilduff
Woodridge, Illinois

ANDREW WEIL: These reports are just coming in. We don't know the percent risk. Pay attention to information as it develops. The point is these drugs are not benign and benefits must be weighed against risks.

Aside from supplements and fortified foods are there any foods that are naturally rich in Vitamin D?
Liberty Pattillo
Santa Barbara, CA

ANDREW WEIL: Oily fish, fish livers, other animal foods, but it's hard to get what you need from diet. Moderate sun exposure and supplements are better.

When using 70mg of Fosomax I had servere muscle and bone pain. Now using 35mg of fosomax I still have a lot of muscle pain. Is this something I should be concerned about.Can this effect my heart since the heart is a muscle? Is there something else on the market you would advise to use that would cut back on the bone pain? Thank you,
Suzanne Chisler
Pittsburgh,PA

ANDREW WEIL: Yes, I'd be concerned. You should ask about other medication regimens.

I immediately turn to any new information about osteoporosis, but am often frustrated because the information is so heavily toward prevention. I am 77 and have severe osteoporosis and I cannot rewind my life. Actually I have eaten nutritionally all of my life. I cannot tolerate the bisphosphonate drugs and currently I have been prescribed IV infusions of Aredia every three months. I requested this treatment, my doctor concurred, and Medicare will covers it. However as I talk with others also on this treatment I am concerned that the strength of the treatment I am being given is not optimal. My doctor will not increase it. What information can you give me about Aredia and about the recommended strength. My bone density has not been positively impacted to a significant degree since I have been receiving the treatments. When I asked my physician if there is something more I can do to prevent fractures the answer was, "Try not to fall".
Jeanne Davis
Augusta, Maine

ANDREW WEIL: Ask about using new forms of partathyroid hormone for bone building.

Why do men still in their early 60's get osteoporeosis. I'm 64, was diagnosed with osteopenia about 4 years ago and osteoporeosis about 2 years ago. I have cardiomyopathy and chronic heart failure, get easily tired and have dyspnea. So my exercise is rather limited. I'm taking 1500 mg of calcium with vit. D and Fosamax. My testesterone level is normal.
Frank Villaroman
Manila, Philippines

ANDREW WEIL: Could be due to low testesterone levels or side effects of medications such as steroids. Consult your physician.

Dear Dr. Weil: I am a 50 year old postmenopausal woman with every risk factor for osteoporosis except smoking. I have family history (maternal grandmother with severe osteoporosis). I am small boned, 118 lb, fair skinned,Caucasian, and of northern European descent. I am also on a cancer-suppressing dose of Unithroid, a thyroid drug which is believed to cause bone loss. (I had a thyroidectomy two yrs ago.) I have had a bone density test every two years for the last six years and my most recent one put me just into the range of osteopenia (T score is -1.0 at the spine). I have been exercising regularly for years and take 600 mg. Calcium + D twice a day. I do not want to go on Fosomax, Evista, etc. but am wondering whether my family history and lifelong sentence of Unithroid means it is the only way to go. Any thoughts on the risk of these drugs versus the risk of ending up like my grandmother, bent over like a pretzel? Thanks,
Margaret Young
East Greenwich, RI

ANDREW WEIL: Increase vitamin D to 1,000 IU a day and eat calcium rich foods. Do weight bearing exercise. Monitor bone density regularly, and investigate all the options for medication so that you know both risks and benefits.

What do you recommend for a woman who has been labeled a "non-responder" to Fosamax. I am 57 and have gone from a T-score of -1.8 to -2.3 in 2 years. I am currently taking Fosamax, calcium with Vitamin D, and Multi-Vitamins. Thank you.
Saundra Olvey
Bloomington, Indiana

ANDREW WEIL: Ask your physician about using new forms of parathyroid hormone for bone building as well as the selective estrogen receptor modifying drugs

Dr. Weil, thank you for the great article in TIME this week. My question concerns eating fish to help strengthen our bones against osteoporosis. Please advise about mercury in fish that we hear so much about. Thanks,
Jeannie Betts
Chipley, Florida

ANDREW WEIL: Learn which fish pose the greatest risk. A good choice is canned sockeye salmon (all wild, low in contaminants), mashed up with the bones for calcium. Make it into salmon salad or cakes.

I went to one of those mobile testing units advertised by Peggy Fleming where they test for four things, one of which is osteoporosis. I went because I was concerned about possible blockage in my neck arteries but the only test that came back was a recommendation that I see my doctor about osteoporosis. I'm a 45 yr old male, about 5'7 and 185 pounds, and I feel fairly healthy although I do feel achy at times in my bones and joints. I just assume this is getting older however. Is this something I should worry about?
Ken Rosadiuk
Torrance, CA

ANDREW WEIL: Yes, because men don't usually develop bone density problems at your age. Get a proper bone density test done along with a general medical examination.

I am currently taking Fosamax once a week. What are the benefits (if any?) to switching to once a month Boniva? Is one better than the other in treating osteoporosis? Thank you.
Gisela Hunermund
Cold Spring Harbor, NY

ANDREW WEIL: Boniva may not protect all bones as well as Fosamax — ask your physician to explains the pros and cons of both medications.

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