An Ounce of Prevention? Maybe

I’ve always figured that the fewer medications I take, the better. If there’s something wrong with me and a drug can help, I might not have much of a choice. But dose myself daily to prevent something that might never go wrong? Every drug has some side effects. For me, it’s a hard decision to make.

I remember hormone replacement therapy (HRT). I took medications for years because they supposedly corrected an estrogen deficiency that developed in all women in midlife. HRT was touted as a way to prevent heart disease, among other things. Ads claimed it also kept a menopausal woman feeling young and happy, and “usually makes her pleasant to live with once again.”

Though some feminists insisted that menopause is a natural part of aging and objected to having it medicalized, Premarin (a form of estrogen used in HRT) was the best-selling drug in the United States for years. Then in 2002, a huge study not only found no evidence that HRT prevented heart disease but reported that it increased the likelihood of blood clots, strokes and breast cancer.

Today, based on further research, experts believe HRT is a safe choice for a few years to treat problems of menopause such as hot flashes, but they don’t recommend it as a long-term preventive for all women.

I blame my reluctance to take drugs partly on my disillusionment with HRT. That reluctance is why, when I have my annual physical exam and my doctor gives me a prescription for a bone density scan, I drop the script in my inbox and forget about it.

I had a scan years ago and my bones were normal then. If a new scan showed they were thinning, I was sure my doctor would prescribe a medication to prevent osteoporosis. I’ve read that the drugs usually recommended—the bisphosphonates, including Fosamax—come with rare but horrifying side effects: your jaw bone can disintegrate or a thigh bone can suddenly snap when you’re doing something ordinary, like crossing a room. And afterward, those broken bones don’t heal easily—sometimes not at all.

I don’t want to chance any of that. And if I’m not willing to take the medication, there’s no point in having a bone scan, right?

That was my reasoning until recently, when a piece in the New York Times reported that those potential side effects are exceedingly rare. Apparently, out of every 100,000 individuals with osteoporosis who take bisphosphonates, somewhere between 10 and 40 break a thigh bone. Even fewer develop the jawbone problem.

At about the same time, a friend pointed out that refusing to have a bone density scan is like refusing to do a breast self-exam because you’re so afraid you’ll find a lump. Well, I’ve avoided that too, at times. And I have to agree that in either case, what you don’t know can hurt you.

I finally did some online research and learned that recommendations for what people should do to try to prevent osteoporosis have changed a lot. For years, many doctors urged virtually all postmenopausal women to take bisphosphonates to keep their bones from deteriorating. Now medical authorities have recognized that the drugs available have more risks than benefits for someone who’s healthy. (That’s not true for those who actually have osteoporosis. It’s a nasty disorder.) What’s more, in 2016 researchers found—to their surprise—that many women lose bone quite slowly after menopause. The bottom line: if your scan looks normal when you’re 65 or older, chances are your bones will stay normal for at least the next 15 years.

For me, the lesson here is that before I make medical decisions—including decisions not to do something—I should check with my doctor or with Dr. Google for up-to-date information.

My 15 years are almost up, and there’s no real reason to hold off on a bone scan. If it shows that my bone density is still normal or only slightly compromised, nobody is going to urge me to take drugs just to head off problems in the future. On the other hand, if I’ve already developed osteoporosis, I’ll definitely have to take medications despite those rare side effects.

Why, then, am I still hesitating to dig out my prescription for a scan? I’m 81 and I cherish my self-image as an active, healthy individual. If the test shows that my bones are in trouble, I’ll be transformed into a patient overnight. I’m concerned about that—and, of course, about what might follow. So I’m still dragging my feet.

But I also see myself as someone who makes rational decisions—that too is part of my self-image. I’ll get around to using that prescription soon.