DEAR DR. ROACH: I am a 75-year-old man in excellent overall health. Routine bloodwork recently showed an elevated potassium level of 5.6. For the most part, I follow a vegetarian diet, which includes a number of very healthy foods that also happen to be high in potassium. I exercise regularly. Two years ago, my level was 4.9. My cardiologist stopped my metoprolol, as he said that could have pushed up the potassium, and he felt that based on my routine tests it was safe to stop it. I also stopped the 500-mg turmeric supplement I was taking, as a precaution. I take no other drugs.
I'd hate to have to give up bananas and the other fruits that contain potassium, which I eat in moderation as part of my regular diet. Do you think the 5.6 level is cause for concern, and could you make a recommendation? — V.D.
ANSWER: A potassium level of 5.6 is still in the normal range in my hospital's laboratory. Although metoprolol can raise potassium, it's not one of the medicines that is very likely to do so, such as an ACE inhibitor or spironolactone. Some people just have a high normal potassium. Turmeric, on the other hand, has lots of potassium, so stopping that was reasonable.
I would recommend that you not worry too much about the potassium and keep up your diet, including fruits in moderation. In addition to avoiding turmeric, I would recommend that you avoid salt substitutes, since they have very high amounts of potassium.
DEAR DR. ROACH: I am fortunate enough to be a healthy and well 81-year-old woman. I take vitamin D, and exercise daily with walking and yoga. My recent bone density test showed my T-score for the hip at -2.2 and spine at -3.2. My primary doctor insists that I take Prolia or Boniva. I am reluctant to do this, as I am aware of the side effects and don't trust the ultimate results of the medication. Nutrition centers have recommended calcium supplements. Your help would be greatly appreciated. — L.B.
ANSWER: Anyone can get an estimate of his or her risk for fracture using the FRAX calculation tool at www.sheffield.ac.uk/FRAX. I made a few assumptions with the information you gave me and estimated your risk of a hip fracture in the next 10 years as 6%, and any major osteoporotic fracture as 17%.
A medication like Boniva would be expected to reduce your risk to something like 4% and 14%. Prolia has been shown to reduce risk of vertebral and hip fractures, and the decreased risk of vertebral fracture might be even greater with this drug (perhaps 4% hip and 8% total), although Prolia and Boniva have not been directly compared. Guidelines would clearly recommend medication for you. Calcium alone is unlikely to significantly reduce your risk of fracture.
"Insist" is a strong word, but given the reduction in your relatively high fracture risk, I would suggest that you reconsider. Boniva is given once monthly and Prolia twice yearly. The side effects are mild for most people. Taking the medication for three to five years is very reasonable, after which you'd re-evaluate. I hope this information makes it easier for you to make the right decision for yourself.