DEAR DR. ROACH: I am a 78-year-old male who is in pretty good health. I keep my blood pressure under control and exercise five days a week at a gym, doing 30 minutes of cardio and lifting light weights. However, I have osteoporosis. As I have declined to take medications such as Fosamax due to their potential side effects, my doctor has suggested that I take 1,400 mg of calcium and 600 mg of vitamin K per day (500 mg of MK-4 and 100 mg of MK-7). I also take 35 mcg of vitamin D3.

While I eat a reasonably good diet, it could be better. Would it be better for me to go on a strict diet of eating foods that contain high levels of calcium, and if so, which foods (and at which quantities) would I have to eat to properly address my osteoporosis? Are there supplements or other ways to address this to reduce or eliminate my osteoporosis? — O.H.

ANSWER: Calcium and vitamin D are standard treatments for osteoporosis. However, they are often inadequate to restore severe bone loss, so I don’t recommend them as the only treatment in people who have severe osteoporosis.

Calcium is more effective and safer when obtained through the diet compared to supplements, so I do recommend a high-calcium diet for those who are open to it. About 1,400 mg of calcium a day is a reasonable dose, and you can reduce your supplements with additional dietary calcium such as dairy and fish with bones (sardines and anchovies). Almonds, beans, and dark, leafy green vegetables are also modest sources of calcium.

It’s almost impossible to get enough vitamin D through the diet, so supplements are the safest way to consume more vitamin D. But sun exposure is an option, especially for lighter-skinned people and those living further south (e.g., below the line of Los Angeles to Atlanta).

Vitamin K2 was found to be a useful treatment in Japan, but no study in the United States found a significant enough benefit for me to recommend its use. However, it is safe. Prunes were found to have a modest improvement in bone density in women who consumed 4 ounces daily.

For men in their 70s with osteoporosis, checking their testosterone blood levels is mandatory as this is a common risk for the development of bone loss.

If your osteoporosis is severe, and you have a high risk of fracture that was calculated by the FRAX score, I recommend considering treatment such as parathyroid hormone analogues.

DEAR DR. ROACH: I have suffered with an idiopathic peripheral neuropathy for over 20 years. I currently take duloxetine and gabapentin for the pain. They are somewhat helpful, but their side effects are problematic even at low doses.

Lately I’ve found articles on the internet recommending vitamin B1 for nerve improvement. Does your practice support its use for neuropathy? Any thoughts are appreciated. — J.A.

ANSWER: “Neuropathy” is a term that relates to any of a large number of conditions that cause damage to the nerves. Peripheral nerves are the nerves outside the brain and spinal cord, and “idiopathic” just means that we don’t know the cause.

I have also found articles recommending thiamine, or a drug that is converted to thiamine in the body (benfotiamine), for a peripheral neuropathy from an unknown cause. I did find a few small trials that showed a benefit with thiamine and benfotiamine in neuropathy due to diabetes or excess alcohol use.

Severe thiamine deficiency can cause a neuropathy that can be specifically treated by thiamine, but thiamine deficiency is a very rare cause of long-lasting peripheral neuropathy. I didn’t find any high-quality evidence that showed a benefit with an idiopathic peripheral neuropathy.

Because thiamine is so safe (and cheap), I have often tried using it for my patients with various forms of neuropathy. My clinical experience is that it is not effective for most.

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. (c) 2025 North America Syndicate Inc. All Rights Reserved