Q. For post-menopausal women (I am 67), is it necessary to take either Fosamax or hormones for bone health? What are the side effects?

A. All postmenopausal women should know if they already have a decrease in bone mass known as osteoporosis.

Your doctor should ask questions about your lifestyle, medical history, and family history. Specialized tests called bone density tests, similar to an X-ray, can measure the bone density in various sites of the body, including the hip and spine. This test will detect osteoporosis before a fracture occurs, predict your chances of a fracture in the future, and determine your rate of bone loss.

Since osteoporosis is a leading cause of death and disability in women, prevention is advised. Hormone replacement therapy and Fosamax, a drug that helps prevent and reverse bone loss, are both good options. Calcium (at least 1,500 milligrams per day) also is important, but isn't as useful without adding one of these drugs.

The major side effects from Fosamax are nausea and indigestion. Talk with your doctor about whether this drug is right for you; if you have no family history of osteoporosis, for example, it may not be as important for you to take it.

Other practical steps to prevent and treat osteoporosis include a balanced diet rich in dark green vegetables, vitamin D (400 to 800 mg per day), and plenty of weight-bearing exercise such as walking and light weight-lifting. Since tobacco interferes with estrogen, women who smoke will lose benefits from hormone replacement therapy and become menopausal earlier than nonsmokers.