I recently had a bone density scan and the doctor told me that there was no improvement. I don't get it. I take my medication regularly, what am I doing wrong? Should I take a different medication?

This is a common concern that I am consulted on. There are many issues that need to be addressed. This includes taking the medication properly, the right supplements, work up for additional causes of disease and careful evaluation of the bone density.

Medications

It is important to evaluate the proper technique that one employs when taking their osteoporosis medications. Bisphosphonates, such as Actonel, Fosamax and Boniva must be taken first thing in the morning on an empty stomach, without any other medications or food and one has to wait for the proper allotted time. The Forteo pen must be refrigerated and given daily. Miacalcin nasal spray must be primed and sprayed fully into the nose. Careful attention should be placed on using all medications properly to attain the desired results.

Supplementation

Calcium and Vitamin D are essential for building and maintaining a healthy skeleton. According to the National Osteoporosis Foundation recommendations, adults under age 50 need 1,000 mg of calcium daily, and adults age 50 and over need 1,200 mg of calcium daily. Adults under age 50 need 400-800 IU of vitamin D3 daily, and adults age 50 and older need 800 - 1,000 IU of vitamin D3 daily. Supplements must be chosen from brand names with proven reliability to ensure purity and absorbability.

• A USP (United States Pharmacopeia) symbol means that the supplement is free from lead and other metals.
• One can test absorbability by placing it into a small amount of water or vinegar for 30 minutes to see if it will dissolve. If it doesn't, it probably won't dissolve in your stomach either.

Secondary Causes

There are many treatable causes of osteoporosis that must be addressed. A full workup should be performed on anyone who does not respond well to medications. This includes a full discussion of the patient's history, physical as well as laboratory workup. This is important as many of these conditions may be treatable.

Bone Density Evaluation

Finally, it is of utmost importance for someone knowledgeable to directly observe the bone density study. This involves looking at the pictures of the scan and not by just reading the report. Unfortunately, there are many physicians reading these scans who are not properly trained or certified. To ensure that the reading is done properly, the physician must have ample experience and be aware of the published guidelines. Often when the change on the scan is not expected, it may be due to technical discrepancies that make it impossible to accurately compare the scans. These can include different locations of equipment, different brand or model of machinery, technical and physical machine upgrades, new scanning techniques or guidelines, a shift in the patient's scanned position and a different radiology technician. Any of these variations, may alter results enough that the studies cannot be directly compared and would make it impossible to judge whether a medication is affecting the bone density.