Dr. Keith Roach
Dear Dr. Roach: I’m an 85-year-old lady in comparatively good well being. I had been taking raloxifene for about 45 years. My physician on the time mentioned that since I had a whole hysterectomy, I needs to be on it for the remainder of my life to assist forestall breast most cancers and osteoporosis. My bone density is regular.
Just a few months in the past, my supplier refused to resume my prescription as a result of she was not conversant in the drugs. I would really like your opinion on this choice.
— H.W.
Dear H.W.: Raloxifene was authorized to be used in 1997 within the United States as prevention for osteoporosis, and in 2007, it was authorized to scale back the chance of breast most cancers. Most specialists who prescribe raloxifene intend that the drugs needs to be taken long-term.
One motive that many individuals are involved about taking osteoporosis medicines is that those that decelerate bone absorption are related to a rise danger of atypical femur fractures in the event that they’re taken for too lengthy. Bisphosphonate medicine, like alendronate and risendronate, are on this class. RANKL activators like denosumab are additionally related to atypical femur fractures, that are devastating. These medicine are usually reevaluated and normally stopped after three to 5 years.
By distinction, raloxifene, which acts like an estrogen to strengthen bones (and an anti-estrogen to forestall breast most cancers), doesn’t appear to have a major danger of creating an atypical femur fracture.
The long-term security research on raloxifene went on for eight years, so you might be properly previous the revealed literature. Still, I don’t suppose that “refusing” to represcribe the drugs was one of the simplest ways of dealing with this. If she was uncomfortable doing so, it may need been prudent to refer you to an knowledgeable in osteoporosis.
Dear Dr. Roach: We’ve lived at 6,000 ft for about 30 years. Over the years, our imply corpuscular quantity (MCV) ranges have slowly elevated to 100 fl (the traditional vary being 79-97 fl). Our main care doctor and different medical doctors have indicated that they’ve seen bigger purple blood cells than what’s regular in different sufferers as properly, attributable to residing at a excessive altitude.
My husband and I are in our 80s and 60s, respectively. We are wholesome and have had principally regular blood take a look at outcomes. If our MCV ranges proceed to rise, will there come a time once we needs to be nervous about them?
— S.Okay.A.
Dear S.Okay.A.: MCV ranges are the commonest method to specific the dimensions of your purple blood cells. There are many frequent causes for purple blood cells to be larger than regular, together with low vitamin B12, low folic acid, low thyroid ranges, alcohol use, a number of medicines, and a lot of blood illnesses.
However, your medical doctors are fairly proper that there’s a small enhance in MCV ranges amongst individuals residing at increased altitude. On common, their ranges are 6 factors increased, so the traditional vary at excessive altitude may be 86-103 fl.
There isn’t a hazard of enormous purple blood cells at this measurement, so it’s a query of whether or not there may be one other trigger moreover the altitude. If it retains going up, your physician would possibly order some lab exams or refer you to a hematologist, who’s an knowledgeable in blood circumstances.
Readers could electronic mail inquiries to ToYourGoodHealth@med.cornell.edu.
