Osteoporosis Archive

On call

Q. After I have a bowel movement I sometimes get quite weak and have to lie down until the feeling passes. Why does this happen and is it cause for concern?

A. The sensation you are describing is most likely due to a reflex called a "vasovagal reaction." Here's what I mean.

A drug holiday is one recommendation to reduce the risk of a rare bone condition that affects the jaw.

A dentist refers a woman to an oral surgeon because she needs a tooth pulled. But upon reviewing her chart, the oral surgeon turns her away.

The reason? She's taking a common medication to treat her osteoporosis, a condition that causes bones to become thin, brittle, and prone to fracture.

Peripheral artery disease is serious but preventable.

As people get older, they sometimes shrug off painful cramping in their calves when they walk as a sign of age or overexertion. But it can be a symptom of a more serious condition known as peripheral artery disease, or PAD.

PAD is a condition in which fatty deposits collect in arteries outside the heart — most commonly in the legs — and reduce blood flow in that part of the body. Doctors used to think PAD mostly affected men, but when researchers began to include more women in their studies, they learned that the condition is just as common in women, affecting one in every 10 women over age 50 and one in every five over age 60, says Dr. Aruna Pradhan, a cardiologist and assistant professor of medicine at Harvard Medical School.

Q. I have rheumatoid arthritis, and my doctor wants me to take prednisone for it. Will prednisone be bad for my blood pressure, which is already high?

A. Prednisone raises blood pressure in many people who take it. One reason is that prednisone and other corticosteroids cause the body to retain fluid. Extra fluid in the circulation can cause an increase in blood pressure.

Q. I have read that people who have had their gallbladders removed should take bile salts. My gallbladder was removed many years ago, and no doctor has said I should take bile salts. Should I?

A. Bile salts are produced in the liver, secreted into the bile ducts and gallbladder, and sent from there to the small intestine by way of the common bile duct. In the intestine, bile salts make it easier for your body to absorb and digest the fats and fat-soluble vitamins that you've eaten. Remember, not all fats are bad: there are "good" fats, and they are crucial to our health.

Q. For years, I have had recurrent cold sores and took antiviral drugs to treat the outbreaks. A friend suggested that I take daily lysine.  What's the evidence that it works?

A. Cold sores (sometimes called fever blisters) are painful fluid-filled lesions on or near the lips that are caused by the herpes simplex virus (HSV). There are two kinds of HSV: HSV-1, which causes most cold sores, and HSV-2, which is mostly responsible for genital herpes. HSV-1 infection is very common and easily transmitted by kissing or other contact with saliva. Once you're infected, the virus lays dormant in the nerve cells that supply sensation to the skin. When the virus becomes active, it travels to the skin surface and multiplies, causing an outbreak.

Q. You wrote about weak, brittle fingernails with longitudinal ridges. I have strong nails with horizontal ridges. What causes this, and what can I do about it?

A. You may be referring to Beau's lines, which are grooves that run horizontally across the nail plate. They usually develop when nail plate growth, which begins in the nail matrix (located under the cuticle), is temporarily disrupted. This can occur with direct injury to the nail matrix; an inflammatory condition such as psoriasis; infection around the nail plate; repetitive picking at the nails or cuticles; or even a manicure. Systemic causes include a common side effect of chemotherapy, nutritional deficiencies, illnesses accompanied by high fever, metabolic conditions, and diminished blood flow to the fingers (from Raynaud's phenomenon, for example).

Ask the doctor

Q. A friend says that the worst disease of all is ALS. What is it?

A. What makes a disease the "worst?" For many, it would be a disease that robs them of their mind. For others, it would be a disease that creates constant pain. For still others, it would be a disease that makes them unable to care for themselves or to control their bodily functions — in full view of their family and closest friends.

It might be orthostatic hypotension, a condition that can be challenging to catch and treat.

You stand up and suddenly feel unsteady on your feet. It's easy to brush off this experience as a fluke or a bug, but don't. You may have a condition called orthostatic hypotension, a temporary drop in blood pressure when you stand. It's tricky to catch.

"Blood pressure is highly variable, and depends on position, timing, the method of measurement, and circumstances associated with its measurement," says Dr. Lewis Lipsitz, chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center and director of the Marcus Institute for Aging Research at Hebrew SeniorLife. "It may take multiple blood pressure measurements at different times of day, lying and standing, in order to detect orthostatic hypotension," Dr. Lipsitz says.

Sales of cannabidiol-infused products are expected to top $2 billion by 2021. But is CBD right for you?

Cannabidiol (CBD) is touted as a natural wonder that can help treat symptoms of everything from anxiety to arthritis pain. The plant extract comes from two varieties of cannabis — hemp and marijuana — and is available in creams, tinctures, oils, patches, gummy bears, capsules, and more. You can even add CBD to a latte if you walk into a coffee shop in some cities.

But is CBD safe for older adults? There haven't been a lot of large studies of CBD's safety, but more traditional medicines for pain and anxiety are not free of adverse effects, either. "I think CBD is likely safer than many other treatments people use for pain, insomnia, or anxiety," says Dr. Peter Grinspoon, a primary care physician with Harvard-affiliated Massachusetts General Hospital. Other physicians don't think we know enough about the safety profile of CBD to be sure.