Q. What are the recommendations for a female having high cholesterol and osteoporosis?
Hello doctor,
I got my mom’s routine blood work done recently. Can you please take a look at her report and let me know if you have any comments or recommendations? She is 59 years old and does not have any illness. As per our family doctor’s prescription, she takes the following medications. Take Cholesterol medicines daily, Calcium supplement daily as she has osteoporosis, and Vitamin D and B12 once a week. Please let me know if I can provide any additional details.
Hello,
Welcome to icliniq.com.
Since when is she taking vitamin B12 and vitamin D supplements? What is the dose of cholesterol medicine, vitamin B12, and vitamin D supplements? Her reports (attachment removed to protect the patient's identity) are fine except for mild elevation of LDL (low-density lipids) cholesterol and vitamin B12. Her vitamin D is not tested here. Now LDL cholesterol is slightly elevated (which may be acceptable) and if there is any scope for dietary improvements like reducing fats or oily intake, it should be started. Also, regular physical activities like morning and evening walks should also be started. If the lifestyle can't be improved further then the dose of cholesterol medicine should be increased slightly from the existing dose. Again the vitamin B12 is slightly on the higher side, which is again acceptable (and no harm in continuing the current dosing). However, whenever you visit a physician next time, then discuss reducing the dose of vitamin B12 supplements slightly, however, the same dose may even be continued. But schedule the repeat testing of vitamin D and vitamin B12 after one month just to see the trend. After normalization of the vitamin D level then we have to reduce the dose to the maintenance level (if it was low previously). So in a nutshell, there is nothing alarming in the reports, however slight dose adjustment may be required for vitamin B12, vitamin D, and cholesterol medicine. I hope this helps you. Thank you.
Hello doctor,
She has been taking the cholesterol medicine Rosuvas 20 for the last three years. She has been taking vitamin D3, 60000 IU once a week also for the last three years. She does not take B12 supplements. There was some confusion and I have incorrect information about this in my earlier message. Is her high B12 a cause of concern as she is not taking supplements for the same?
Hello,
Welcome back to icliniq.com.
Alright, she should try to improve her lifestyle further if there is any scope for improvement (including diet and regular physical activities). If LDL cholesterol remains above 100 then you can discuss with the treating doctor changing Rosuvas 20 to Rosuvas F 20 mg, which contains additional content (Fenofibrate). And lipid profile should be tested after fasting for eight to ten hours (not even tea should be consumed). A high vitamin B12 level is not concerning. She should also get tested for vitamin D levels as she is taking quite a high dose for a long period. Usually, 60,000 IU weekly doses are given for a short period of time (for two weeks). Thank you.
Hello doctor,
We will discuss with her doctor regarding the Rosuvas F 20. Regarding your point on vitamin D, the report I shared with you earlier does have a vitamin D test. It is within the normal range. Regarding her naturally high B12, I got some worrisome results when I searched on the internet about it. Thanks for confirming that it is not a problem. Before I got your reply, I took her to get her B12 re-tested from a different lab. This lab reported her B12 as lower than normal. I am attaching the report with this query. What should I do about this discrepancy? One report shows her B12 is very high, and the other shows a little lower than normal. Is either of these scenarios worrisome? Can we get any additional tests done for peace of mind?
Hello,
Welcome back to icliniq.com.
Alright, as vitamin D is in the normal range, then it is fine. However, still I would suggest that the frequency of vitamin D (60,000 units) should be once every four weeks. However, just confirm the doses of the current vitamin D supplements, is it 60,000 units or lesser (like 1000 or 500 units)? If it is lesser then it may be continued as it is going on. Regarding her B12 level, either low or high is not worrisome. However, if it is low then she will require supplements. Both these labs are good however in this scenario either of the two reports is false. The third test will be required to confirm the true value. So, you can discuss both labs and ask them to rerun the test if they have the sample. If they do not have the samples then ask to retest them. As she is not on any B12 supplements, it is probably will be low. If confirmed to be low, then supplements will have to be started. Thank you.
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