"Break a Leg"- No, Please do NOT!

At the risk of sounding like an alarmist, today's post, like yesterday, carries a warning from the FDA. Today's concern regards the medications we prescribe to help INCREASE your bone strength- the bisphosphonates- commonly known as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and Reclast. The FDA Drug Safety Communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures was issued today regarding unusual leg fractures that see to be occurring in women who have been on these drugs for five years or more.

Do the medications CAUSE the fractures? How common is this? Well, we're not really sure yet. What we do know is that the fractures are located either just below the hip joint or in the long bone of the thigh, and these types of fractures represent less than 1% of leg and hip fractures. However, 94% of the people with these fractures had been taking the bisphosphonate medications. Of course, there are huge numbers of people taking these drugs, and the study found only 310 cases of these fractures, so each person's individual risk of getting a fracture is quite low.

What should you do if you take a bisphosphonate? Number one- don't worry! There is a much greater chance that your medication is PREVENTING you from getting a fracture than potentially causing one. Have a discussion with your physician about your risks and benefits, and make a decision together at your next exam.

Remember the things YOU can do to strengthen your bones: get enough calcium in your diet (especially when you are young, so help your daughters!), enjoy weight-bearing exercise like walking and jogging, limit your caffeine, get your sunshine vitamin (D) and make sure your thyroid medication is not over-replaced!

BOTTOM LINE: Be aware that medications taken for thin bones may carry some extra risk, and as always, focus on what you can do to improve your bone strength!

Doctor Preferred Medicine #3- Ibuprofen

Okay, back to what drugs doctors keep in their home medicine cabinets... The first drug I mentioned was aspirin, then diphenhydramine (benadryl), and today-ibuprofen. I have to confess that this is without a doubt the most used medication in our house. Now, I do not believe in medicating every ache or even temperature, but when one of us is in pain or has a high fever, ibuprofen is our drug of choice.
When the kids were little, we kept liquid ibuprofen around (for fevers and teething primarily) but now happily, everyone in our family can swallow pills, so we have a bottle of caplets.

Ibuprofen has many trade names- Advil and Motrin being the most popular, I believe. They offer capsules, gel caps, tablets and liquids. Generic ibuprofen typically works just as well, though some people prefer name brands for taste or texture. (We buy generic.) Ibuprofen is a Non-Steroid Anti-Inflammatory Drug, NSAID for short. This class of drug works well for muscle aches, joint pains, tooth pain, post-operative pain, menstrual cramps, headaches and fevers. For chronic problems such as arthritis, longer acting preparations may be more appropriate.

Many people pop NSAIDs like candy- not a good idea! Yes, we often prescribe ibuprofen at higher doses than the OTC label recommends, but that is for acute, short-lived problems. Taking NSAIDS at high doses can be a danger to your kidneys, and do NOT use these daily for extended periods without consulting your physician. Also, be aware that NSAIDS can cause fluid retention, which may raise your blood pressure, and they can irritate the stomach lining (leading to ulcers.) Wow- that sounds like a commercial, but those are real precautions.

BOTTOM LINE: Keep a bottle of ibuprofen in your medicine cabinet for muscle aches, joint pains, fevers, headaches, etc.- this is a "go-to" drug for many minor maladies, but must be used with caution.

Leg Cramps Killing You?

Okay, on a more serious note today, there is a way leg cramps could kill you. Unfortunately, the prescription drug, quinine sulfate, that has been used off-label for decades as an effective cure for nighttime leg cramps is once again having continued reports of serious side effects- from bleeding to kidney damage to death.

If you are taking this medication and you notice bleeding gums, easy bruising,or blood in your urine- go immediately to your doctor and she will need to check your blood count, with special attention to your platelets (the team members that cause your blood to clot.)

So, what are you to do if you swear by this drug? First of all, please discuss it with your doctor. Make sure you have been recently checked for low iron stores (a ferritin level) to be sure that isn't the real cause of your leg pain. Your physician will examine you and possibly check a few blood tests.

If all is normal, here is one alternative medicine thing to try. Don't laugh (although I did chuckle when my dear patient first told me about this!). Try sleeping with a bar of soap. Yes. What brand? Whichever one you prefer. There are actually a few scientific studies that have shown promise with this, though I'll be the first to say I wont expect this to help everyone. On the plus side, though, there are no serious negative side effects from sleeping with a bar of soap under your pillow or covers!

BOTTOM LINE: If you take quinine for leg cramps, it's time for another discussion with your doctor!