DEAR DR. ROACH: I am a 74-year-old man. I have a DEXA score of -3.3. I take 1,200 mg of calcium with vitamin D daily. I lift weights and swim two to three times a week. My doctor put me on Prolia, and I had six months of infections. He switched me to Fosamax, and my blood pressure was 201/121 mmHg.
I found a Phase 4 clinical trial showing that Fosamax can cause high blood pressure, but my doctor says that Fosamax “doesn’t cause high blood pressure.” I’m reluctant to try the other bisphosphonates for fear that they will do the same as Fosamax. Do I try the other drugs one at a time, or do you have a recommendation? — D.S.
ANSWER: Your doctor should have said that people taking alendronate (Fosamax) have the same rate of developing high blood pressure as people who are put on a placebo pill, which would have been a more accurate statement.
In the 12 months when subjects in a trial took alendronate, 1.9% developed high blood pressure — about the same rate seen in a placebo group over the same time period. It’s unlikely that Fosamax caused your high blood pressure levels, but it is certainly possible that you are having a rare reaction, which happens to few enough people that it hasn’t yet been recognized. I hope your physician reported this as a possible adverse event.
A T-score of -3.3 by a DEXA represents quite severe osteoporosis. When I see levels this low, I tend not to use denosumab (Prolia) or bisphosphonates, both of which work by preventing the osteoclast cells from reabsorbing bone.
Prolia also has a theoretical risk of increased infections, and it seems that this might have been the case with you. Instead, I would consider a medicine that promotes bone growth, such as teriparatide.
Finally, I test all men with osteoporosis for low testosterone since it is a major risk factor.
DEAR DR. ROACH: I currently take several medications and supplements daily that are encapsulated in “dissolvable” plastic capsules. How much concern should I have regarding a large or dangerous buildup of microplastic particles in my body? — G.H.
ANSWER: Microplastics are tiny amounts of polymers that have been detected in human blood and organs. The primary source is in contaminated food and water, but microplastics can be inhaled as well. Bottled water is probably the single largest source of microplastics, with levels 20 times higher than tap water. Beer is the second most-common source, while air is third.
The material that drug capsules are made from is most often gelatin, a plant protein. Starch, methylcellulose and polysaccharides may also be used. Plastic is almost never used, although I do know of a very few exceptions — such as Procardia, where the shell of a capsule isn’t intended to be absorbed and is excreted intact.
You should not worry about your medications as a significant source of microplastics. If you drink bottled water, you can dramatically reduce how much you take in by drinking tap water instead of plastic bottled water.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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