ArcaMax

DEAR DR. ROACH: I have low serum cholesterol but a high coronary calcium score, and I was told to take magnesium supplements to bring my calcium score down (in addition to daily aspirin and a statin). What are your thoughts about magnesium to bring down a high calcium score? -- D.B.

ANSWER: A coronary calcium score is a measurement of calcium in the blood vessels of the heart. High coronary calcium scores predict an increased likelihood of blockages in the blood vessels, which can lead to a heart attack.

The literature is mixed about whether a high magnesium intake can reduce the risk of coronary calcium and, in theory, reduce heart disease risk. Most of the evidence suggests that high blood magnesium levels reduce heart disease risk. However, people with higher magnesium levels are more likely to be consuming a healthier diet, which is known to reduce heart disease risk by itself.

To be sure that magnesium helps prevent heart disease, a future large trial could give half the subjects a magnesium supplement and the other half an identical-appearing pill without magnesium, then follow the groups to see which is more likely to get heart disease. These types of trials are difficult, time-consuming and expensive, and they have not yet been done for magnesium.

However, you already have coronary calcium, so you are at a higher risk for a heart attack. Studies that have looked at the use of magnesium supplementation to prevent a heart attack in people with known or suspected blockages haven't consistently found a benefit.

This is in contrast to statin trials, which have universally shown a reduction in heart attack rates in people with coronary blockages or those who are at a very high risk. Statins are effective at reducing risk for people with known blockages in their arteries, even if they have normal cholesterol levels.

Having a low cholesterol level reduces but does not eliminate the risk for blockages. About 30% of people with coronary disease have normal cholesterol. This is why a holistic look at the coronary risk (including traditional and nontraditional risk factors apart from cholesterol) is so important.

DEAR DR. ROACH: I have osteoporosis. I took the generic form of Boniva for two years, and there was some improvement. A local business is offering specialized exercise that they claim will strengthen my bones. Is this possible or unlikely? I take so much medicine now that I hesitate to add more. -- M.L.

ANSWER: For years, the standard teaching has been that higher-impact, weight-bearing exercise was better at protecting the bones from fracture when it comes to a person who is being treated for osteoporosis.

However, more recent studies have suggested that this may not be the case, so I have relied on the advice I give for exercise in general: Do what you like and do something that you will keep doing. For many people, this is walking. If you want to add stretching exercises or weightlifting, this is likely to have an additional benefit.

Several people have asked me about vibration machines, but I'm not yet convinced that the studies have shown a clear benefit. I do not recommend them.

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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.

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