Getting ready for a doctor's visit

There comes a time when aches and pains drive us to the doctor to find relief and reasons. Such a visit is not always easy. Then there are the follow-up visits to keep track of your progress or to get help for yet another health problem. Here are some tips to help you make the most of your visit with the doctor.

Going to your doctor's appointment prepared with questions to ask, will improve your chances of gaining the knowledge you need to look after yourself or your family. Sometimes the pressure and stress of illness, combined with our limited understanding of medicine, means we don't make the most of a visit to the doctor. Take someone with you for support, or go armed with questions and information. Consider writing down the answers so you don't forget them.

Recognising osteoporosis

So you have heard something about osteoporosis but you don't really know much about it. "Osteo" means bone and "porosis" means porous, or something with holes in it like a sponge. Osteoporosis is a progressive decrease in the density of bones - that is, their natural lace-like structure becomes thinner. This weakens bones and makes them more likely to break.

It is also referred to as the "silent disease" because it can creep up on you without producing symptoms, until you find yourself breaking a bone all too easily.

Healthcare is your responsibility. Don't be embarrassed or afraid to ask your healthcare provider (doctor or nurse) about osteoporosis. Open communication with him or her will ensure that you get the best treatment. And read information given to you by any of those people.

Self assessment

Most people don't know when they have osteoporosis. A broken bone may be the first sign. Your doctor can detect osteoporosis by a special test known as a bone density scan. If you think you are at risk or actually have osteoporosis, ask your doctor to arrange this test for you.

Check if the following risk factors apply to you:

• previous history of fracture
• female (or male, but less likely)
• family history of osteoporosis
• age 50 years or older
• past menopause
• ovaries removed, or menopause before age 45
• low level of calcium in diet - less than four servings of dairy products a day
• less than 30 minutes outdoors in sunlight each day
• less than 30 minutes of physical activity each day
• thin, 'small-boned'
• white, Caucasian or Asian ancestry
• smoker
• alcohol drinker (more than four standard drinks a day)
• long-term use of certain medications, including steroids (eg, cortisone and prednisone), and anticonvulsants.

The more risk factors you have, the greater your risk of developing osteoporosis. If several risk factors apply to you, consider having a bone density scan. Discuss this with your doctor.

Preparing to visit your doctor

Here are some questions you could ask to help you find out if you have osteoporosis, or to understand it better. You could write down other ideas before your visit to the doctor.

Common questions are:

• What is osteoporosis?
• Who gets osteoporosis?
• Can younger people get osteoporosis?
• How do I know if I have osteoporosis?
• How can osteoporosis affect me?
• Who has the greater risk of getting osteoporosis?
• How do I reduce my risk?
• What is the difference between osteoporosis and osteoarthritis?
• How can hormone therapy help?
• I do not want to take hormone replacement therapy. How do I avoid this?
• What other treatments are available?
• How do I prepare for my visit to the doctor when I want to discuss osteoporosis?

More common questions are below - some with general answers. But note that this is not a substitute for medical advice about your personal circumstances. Discuss your condition with your doctor.

1. What are normal values in the bone density test?

Answer:

• Normal value (T-score -1.0)
• Osteopenia, or low bone mass (T-score -1.0 to -2.5)
• Osteoporosis (T-score -2.5 or below)

2. Should everyone have bone measurement testing?

Answer: No, these are not screening tests. You should discuss your risk factors, such as age, medications, medical history, and family history with your doctor. Together, you can decide on the usefulness of this test for you.

3. I had bone testing done and the results were normal. Am I safe?

Answer: No. The ability of bone strength testing to predict fractures is limited. The fact that one site has a normal result does not guarantee that bone density is normal in other sites. Also, loss of bone density continues with age. Therefore, steps to decrease the loss of bone strength are important regardless of the results of this test.

4. The testing that I had done showed that I have osteoporosis, and now my family thinks that I will break a bone if I do anything active. Is this fear real?

Answer: No. Osteoporosis is an important indicator of the risk of fracture, but it is only one factor. Lifestyle and environmental factors are also important. A diagnosis of osteoporosis should indicate the need to take steps to minimise the risk of a fracture. For example, check the home for health hazards such as trailing electric cords or loose rugs. Eliminating these risks will help minimise the chance of a fall.

Additionally, you should increase your calcium intake and discuss with your doctor an appropriate exercise programme and the use of medication to improve your bone density.

5. How often should I have bone measurement testing?

Answer: Repeating the test at intervals of less than two years usually will not lead to useful results.

6. Why is it so important to recognise and treat osteoporosis?

Answer: Osteoporosis can threaten your independence because it leads to fractures of the spine, wrists, hips and other bones. Fractures increase a person's disability and dependence. Also, once bone has become weak as in osteoporosis disease this leads to small breaks in the spine, caused by something as minor as coughing or lifting a bag of groceries. You may not even notice these small fractures but they accumulate and make you shorter.

Or a wrist can break by just bumping into a table, leading to difficulties dressing, housekeeping, gardening, etc until you are healed. More than half of women with osteoporosis who survive a broken hip need long term care or rely on others to get around.

Going back for more: surgery, drug monitoring, information

Some treatments for osteoporosis can only be prescribed by a specialist. Other medicines such as calcium supplements might be prescribed by a general practitioner or a specialist to help increase your bone density.

Pain and swelling associated with arthritis and other bone diseases are not usually symptoms of osteoporosis, so you are not likely to be taking painkillers or anti-inflammatory drugs for osteoporosis - except perhaps if you are recovering from surgery for a fracture of osteoporotic bone.

When it comes to discussing drugs with your doctor, consider asking questions such as the following:

• What is the difference between the types of treatment such as bisphosphonates, calcium supplements, hormone replacement therapy and a selective oestrogen receptor modulators (SERMs)? What is best for me?
• Should I be taking hormone replacement therapy (HRT) regardless of the bone measurement test result? If so, what are my risk factors for other problems such as heart disease?
• How will you (my doctor) know a bone "rebuilding" drug is working?

For a specific medicine, ask:

• What is it?
• Who is it for?
• Who should not take it?
• What should I tell you (my doctor) before and during treatment with this medicine? For example, it might be important your doctor knows: you are pregnant or plan to become pregnant. Many drugs should not be used in late pregnancy because they may harm the foetus.
  - you are breast-feeding or plan to breast-feed. For many drugs, it is not known whether they are passed through to human breast milk and what their effects could be on a nursing child.
  - you have a condition such as kidney disease, liver disease, heart failure, high blood pressure
  - you had an allergic reaction to a drug
  - you had a serious stomach problem in the past
  - you are unable to sit upright or stand for 30 minutes
  - any other medical problems or allergies you have now or have had in the past
  - all medicines that you are taking or plan to take, even those you can get without a prescription, eg, calcium supplements
  tell your doctor if you develop problems such as stomach pain, dyspepsia (heartburn), oesophageal problems, abdominal distension, diarrhoea, flatulence, constipation, vomiting, musculoskeletal pain or headache
• How should I take the drug, eg, with or without food, and why?
• How long should I take it for?
• Can I take it with other medicines?
• Tell your doctor about all of the other medicines you are taking or plan to take while you are on this new drug, even other medicines that you can get without a prescription. Your doctor may want to check that your medicines are working properly together if you are taking other medicines
• What are the possible side effects of the drug?
• What else can I do to help manage my osteoporosis, eg, exercise, control my weight, measures to prevent falls and fractures?
• What else should I know about the drug?
• What does it cost?

Job descriptions of specialists focusing on osteoporosis

Orthopaedic surgeon
An orthopaedic surgeon is a medical specialist trained to diagnose and treat, usually with surgery, disorders of the musculoskeletal (muscle/bone) and related systems.

Endocrinologist
A medically qualified specialist in internal medicine who has subspecialised in the diseases of endocrine glands (eg, ovary, testis and pancreas) and the substances they secrete (hormones).

Some endocrinologists deal with osteoporosis, for example, because the disease is commonly associated with reduced production of the hormones oestrogen and testosterone, and with changes in the action of vitamin D.

Source: Health website www.merck.com, produced by Merck-Medco company, a USA provider of prescription drug care, health organisation management and educational programmes.

Original material supplied by LivingWith, edited by everybody.