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Friday Q&a: Aspirin Or No Aspirin; Polypharmacy In Older Adults; Thinning Hair; & Osteoporosis Meds

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The following questions have been lightly edited for length and clarity.

QUESTION #1: ASPIRIN AND CANCER RISK

Hello, I just read that aspirin may help prevent certain cancers and slow their spread. Is this true? I've heard about all kinds of benefits for Aspirin and the conversation keeps changing. Should I be taking Aspirin every day or are there risks I am missing?
- Barbara

Hi Barbara,

The changing narrative around aspirin can be super confusing! Here’s where things stand right now: for people who have already had a heart attack, stroke, or have established cardiovascular disease, daily low-dose aspirin remains appropriate. The evidence for this (what we call “secondary prevention”) is solid.

What has changed significantly is the guidance around primary prevention—that is, taking aspirin to prevent a first-ever cardiac event. A major study published in 2018 found that in healthy older adults, daily aspirin did not reduce the risk of cardiovascular events meaningfully but did increase the risk of serious bleeding. The guidelines were subsequently updated to reflect this: for most people over 60 without existing heart disease, the bleeding risk of aspirin is thought to outweigh the benefits. (Remember that this is a general guideline—i.e., the decision to take aspirin should be individualized.)

On the cancer question: studies suggest that regular aspirin use may reduce the risk of certain cancers, particularly colorectal cancer, and may slow metastasis in some cases. The evidence is strongest for people with Lynch syndrome, a genetic condition that significantly raises colorectal cancer risk. For the general population, the signal is real but more modest, and it doesn’t yet translate into a blanket recommendation because the bleeding risk still has to be factored in.

The honest answer to your question is that aspirin is not a simple yes or no for most people. It depends on your cardiovascular risk, your cancer risk, your bleeding risk, and your age. If you’re not already on it and you’re wondering whether you should be, that’s a conversation worth having with your doctor with your specific history on the table. I hope this clarifies things!

My mother-in-law is 80 yrs old, quite healthy & active for her age, but she recently had a serious fall that broke both wrists. She's been on a statin for four decades. Also Metformin more recently & I've been wondering whether her medications played a role. I've read that statins can affect glucose levels & muscle function in older women. How do you think about medication safety & falls in elderly patients?
- Hannah

Hi Hannah,

Your instinct to consider medications as a contributor to her fall is a good one. “Polypharmacy” is a common issue in elderly patients, which is not to say that medications inevitably cause more harm than good. But it’s true that statins can cause muscle weakness and fatigue, sometime subtle enough to go unnoticed until something like a fall makes it visible. The link between statins and elevated blood glucose in older women is also well established. (My discussion about these issues with cardiologist Dr. Greg Katz here.)

Whether or not these meds played a role in her fall is something she should discuss with her doctor, but as someone who cares for this age group, I can attest that medications prescribed appropriately at 60 don’t automatically remain the right choice at 80, particularly when someone’s health profile has changed substantially. Falls are one of the leading causes of serious injury in this population, and medication review is a standard part of fall prevention.

When you bring this up with her doctor I suggest framing it around fall risk rather than second-guessing the original prescriptions. That might get you more of what you need. Good luck!

Hello Dr. McBride, I am a 62 year old woman who never got on hormone therapy and am losing my hair... it is thinning and I can see my part and it is so distressing. Is this just how it is going to be? Or is there something I can do? Also how much of this is hormone related? Thank you.
-Colleen

Hello Colleen,

Hair thinning can be incredibly distressing, especially when it feels like it’s happening all of a sudden. You are not alone in this, and the good news is that there are things we can do to address it.

First is hormones. Estrogen and progesterone play a protective role in hair growth, helping to keep strands in their growth phase longer. When these hormones decline during and after menopause, hair can become finer, grow more slowly, and shed more easily. Androgenic alopecia (aka “female pattern hair loss”) is often triggered by this hormonal shift. Genetics also play a big role, as does overall health, stress, and nutritional status.

Here are some other things to consider:

Over-the-counter treatments – The most effective topical treatment for female pattern hair loss is minoxidil (Rogaine). It’s available without a prescription and can help stimulate hair growth and slow further loss. It requires consistency, i.e., results can take months. Some people get an itchy scalp from it, but it’s a well-studied, safe option.
Prescription options – Some women benefit from medications that block the effects of androgens on hair follicles, like spironolactone. This is particularly helpful for those who notice hair thinning along with increased facial hair growth. Oral Minoxidil at very low doses can also make a difference. Ask your doctor about these!
Nutritional support – Iron deficiency is a common cause of hair loss. Make sure you have your blood iron, IBC, and ferritin levels checked. In addition, dietary protein, vitamin D, and biotin all play key roles in hair health. If you have any underlying deficiencies, addressing them can make a difference.
Scalp health – Think of your scalp as the soil in which your hair grows. Avoid excessive heat styling, harsh chemical treatments, and tight hairstyles that cause mechanical stress.
Hormone therapy – Especially if you are within 10 years of menopause, menopausal hormone therapy (MHT) could be worth discussing with your doctor. While it’s not a first-line treatment for hair loss, women commonly find that it improves hair quality when started earlier in menopause.
Stress management – Chronic stress and inflammation can accelerate hair thinning. Strategies like mindfulness, exercise, and prioritizing sleep can support hair health in indirect but meaningful ways.

The upshot: I don’t think you have to accept this as the “new normal.” There are real, evidence-based interventions to help slow hair loss and support regrowth. Last, I do suggest a conversation with your PCP or a dermatologist. Hopefully you can get more nuanced advice there :)

I've been managing osteopenia for years, but taking Anastrozole for breast cancer has pushed me into osteoporosis. My doctors are recommending bisphosphonates like Fosamax or Reclast, but I'm wondering whether strength training combined with calcium, magnesium, K2, and prunes might be enough to maintain my bone density for the next 18 to 24 months until I finish the Anastrozole. What's your thinking on bisphosphonates, and is my approach reasonable?
-Ruth

Hi Ruth,

Your situation has a specific wrinkle that makes it different from garden-variety osteoporosis: Anastrozole is an aromatase inhibitor, and its bone loss effect is ongoing and active for as long as you’re taking it. That said, the lifestyle approach you’re describing—strength training, calcium, magnesium, K2, vitamin D—is valuable and should continue regardless of what you decide about meds. The issue is whether it’s sufficient to offset the active bone loss that Anastrozole causes, and for most women on aromatase inhibitors, the data suggests it isn’t, particularly once the threshold into osteoporosis has been crossed (i.e., a T score of -2.5 or less.)

The 18 to 24 month plan you’re describing—hold the line until you finish Anastrozole and hope for a rebound—is not unreasonable, but it carries real risk. Bone loss during that period could be significant, and the “rebound” after stopping Anastrozole is real but modest and unpredictable. Starting from a lower baseline makes recovery harder.

Bisphosphonates do have risks, but the side effects people read about (jaw problems, unusual femur fractures) are rare, and they are substantially more common with long-term use and intravenous administration than with standard oral dosing. For someone in your situation, they can be a great tool.

Upshot: this is a decision worth making with an oncologist and either a primary care doctor or endocrinologist who knows your full picture, including your fracture risk score and the trajectory of your DEXA. The goal isn’t to convince you one way or the other, it’s to make sure the decision is based on your actual, personal numbers and risk.

PS. Weighing risks and benefits and making decisions like this thoughtfully with your providers is a topic I cover in my forthcoming book, Beyond the Prescription!

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind. Are You Okay? subscribers get exclusive bonuses if you preorder from my website—including a virtual “doctor’s lounge” with me, downloadable guides, and discounts on bulk orders. Info here!

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Friday Q&a: Aspirin Or No Aspirin; Polypharmacy In Older Adults; Thinning Hair; & Osteoporosis Meds

QUESTION #1: ASPIRIN AND CANCER RISK

QUESTION #2: MEDICATION AND BALANCE FOR OLDER ADULTS

QUESTION #3: THINNING HAIR

QUESTION #4: OSTEOPOROSIS MEDS

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