I am a 64-year-old woman, and I am taking Fosalan (alendronate) for osteoporosis. I read recently something that scares me that patients taking bisphosphonates may be at risk of experiencing a painful, disfiguring condition known as osteonecrosis of the jaw, a disease that leads to the breakdown of the bone. It made me nervous. The article said that at the same time that bisphosphonates support the buildup of bone in the trunk of the body, some patients taking bisphosphonates may experience the opposite effect in the lower and upper jawbones. Is this relevant to me? V.M., Tel Aviv Prof. Joseph Foldes, director of the Jerusalem Osteoporosis Center of Hadassah-University Medical Center, answers: This complication has been discussed in several papers in the last few years. It appears that the problem affects mainly two malignant conditions that involve the bone multiple myeloma (a primary tumor of the bone marrow) and bone metastases of breast cancer. For these conditions, patients usually receive large doses of intravenous bisphosphonates, such as pamidronate (Aredia) and zoledronate (Zomera), which are approved therapies for these indications. These patients differ from ordinary osteoporotic patients, since their bone is affected by their malignant conditions, chemotherapy and steroids, and, as I mentioned, by receiving much higher doses of the medications. In osteoporotic patients who receive oral Fosalan, the condition is extremely rare, so you need not worry. I am a 34-year-old mother of five who doesnâ€™t bother to get the flu vaccine because itâ€™s mostly for older people (and, I suppose, also out of laziness). Are there any easy ways to reduce the risk of getting influenza? B.T., Kiryat Ono Judy Siegel-Itzkovich comments: The Health Ministry recommends flu shots not only for people over 65 and those who have chronic diseases such as heart problems, diabetes or weak immune systems, but also for babies ages six to 23 months, as well as their parents and siblings. Health care workers and caregivers for children and the elderly should also be vaccinated, the ministry says, as well as anyone not in the previous categories who canâ€™t afford to be away from work. This not only protects the children but also reduces the spread of flu to those in the population who are most likely to die from complications. It doesnâ€™t hurt, itâ€™s cheap or even free for high-risk groups, and in people not allergic to the whites of eggs (albumen), it causes no side effects except for rare skin reactions. So you can go get a shot. But you can also do things to lower your risk of infection. Prof. Pamela Aaltonen, a public health expert and nurse at Purdue University in the US, says that frequent handwashing is an excellent way to cut the risk of flu and other pathogenic infections. She says studies have shown that 40 to 60 percent of people donâ€™t wash their hands after using the bathroom, and those who do wash their hands often donâ€™t know the proper technique. Most people who do wash their hands do so much too quickly, she says. To be effective, hands should be washed with soap for 20 to 25 seconds. â€œThe three keys are soap, friction and water.â€ Hands should also be washed before preparing and eating food, after helping a child use the bathroom, after changing a diaper, after blowing your nose or coughing or sneezing into your hands, after handling animals or animal waste, and before carrying out first-aid for an open cut or wound. Aaltonen says waterless hand sanitizers are an acceptable substitute if traditional handwashing is not an option. One reason those products are effective is that people tend to use a lot of friction when they apply them, and the friction kills more germs. In addition, eating right, getting enough sleep and exercising help bolster the immune system and fight sickness. Doing these things boosts inherent resistance. She says it also is important to stay home from work or school if you do feel under the weather to avoid carrying germs into a larger population, but this is not a common habit among Israelis. Rx For Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx For Readers, the Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and residence.