Dear Doctor: I noticed that Fosamax may lead to high blood pressure, but my doctor disagrees.

Dear Dr. Roach: Concerns About Osteoporosis Treatment

I’m a 74-year-old man with a DEXA score of -3.3. I take 1,200 mg of calcium with vitamin D each day, and I lift weights and swim a couple of times weekly. My doctor initially prescribed Prolia, but after suffering six months of infections, he switched me to Fosamax. However, while on Fosamax, my blood pressure spiked to 201/121 mmHg.

I came across a Phase 4 clinical trial indicating that Fosamax might cause high blood pressure, but my doctor insists it “doesn’t cause high blood pressure.” I’m hesitant to try other bisphosphonates since I’m worried they might lead to a similar problem. Should I experiment with them one at a time, or do you have any better suggestions? — D.S.

Answer

Your doctor might have meant that the occurrence of high blood pressure among those taking alendronate (Fosamax) is similar to that seen in individuals on a placebo, which is a more accurate statement.

In trials over a year, only 1.9% of participants on alendronate developed high blood pressure—comparable to rates in the placebo group. So, while it’s unlikely that Fosamax is the root of your elevated blood pressure, there’s a possibility you’re experiencing a rare reaction. I hope your physician reported this as a potential side effect.

A DEXA score of -3.3 indicates severe osteoporosis. For cases like yours, I usually hesitate to prescribe denosumab (Prolia) or bisphosphonates, which work by inhibiting bone resorption.

Prolia carries a theoretical risk of increasing the likelihood of infections, which seems to have been your experience. It might be better to consider a medication that encourages bone growth, such as teriparatide.

Lastly, I recommend testing all men with osteoporosis for low testosterone, as it plays a significant role in bone health.

Answer

Microplastics, tiny polymer fragments, have been found in human blood and organs. They mostly come from contaminated food and water, though they can also be inhaled. Bottled water is a leading source of microplastics, containing levels 20 times higher than tap water, followed by beer and then air.

Capsules for medications are typically made from gelatin, a plant protein. Some may use starch, methylcellulose, or polysaccharides; plastics are rarely involved, with few exceptions, like Procardia, where the capsule shell is excreted intact.

You shouldn’t worry that your medications are a significant source of microplastics. If you’re drinking bottled water, switching to tap water can greatly reduce your intake of microplastics.