The exchange.(Q A)(Interview)

DEAR AFI: After a recent bone density scan, I just received a diagnosis of osteoporosis. Before being put on medication, my doctor did one further simple blood test for calcium, vitamin D and parathyroid hormone (PTH). It turns out that I have high levels of calcium and PTH in the bloodstream, an indication that there may be a benign tumour (adenoma) on my parathyroid. I go for a sestamibi scan in a few weeks. I may also be looking at surgery to have the adenoma removed. From what I have read, once the adenoma is gone, my bones will return to normal. I was shocked to learn that the only function of the parathyroid is to regulate calcium in the body. When I've asked my friends who are taking medication for their osteoporosis if they've had their calcium levels checked, they have all told me no. I have also read that high calcium levels can cause fatigue, joint pain, heart palpitations (which I have had for several years now), depression, kidney stones and stroke. Why aren't more women being told about the parathyroid?--M.B.

AFI: Fortunately osteoporosis caused by parathyroid abnormalities is rare. It does point to the importance of ensuring that there is no treatable cause for osteoporosis when it is discovered. Your health care practitioner should do a careful history, physical exam and appropriate lab tests to make sure that you do not have any of the symptoms that may suggest that another illness is contributing to your osteoporosis. Interestingly, if you are not getting enough Vitamin D, parathyroid hormone levels can be elevated leading you to think that there is something wrong with the parathyroid when it is a vitamin deficiency that is the problem.

DEAR AFI: My naturopathic doctor has prescribed natural progesterone capsules, natural pregnenalone capsules and a small dose of testosterone cream--all from a compounding pharmacy. Would this be considered HRT? Does this carry the same increased risk of all sorts of problems that HRT carries? The second part of my question is this: Even with these treatments, I continue to have real trouble with headaches, dizziness, sore and tired eyes, lack of energy and huge challenges staying focused. I'm also coping with low thyroid (taking natural thyroid) and adrenal exhaustion (taking supplements). I take great pains to make sure I get enough sleep, take supplements and walk at least a kilometre a day. Do you have any thoughts about the reasons I might be feeling this way?--K.J.

AFI: Taking any hormones could be considered hormone replacement therapy (HRT). The important issue however is not what you call them but what risks and benefits they offer to you. There is lots of debate about the difference between bio-identical (called natural by some) hormones versus hormones that are not identical to the hormones that humans make. The difficulty is that there have not been any large, well-designed studies to prove the effectiveness ...