What should you do if your doctor’s advice for treating your osteoporosis conflicts with treatment for your diabetes, or other medical condition? Johns Hopkins researchers analyze this common problem and offer bottom line advice.

Half of people over age 65 have three or more chronic diseases, and they juggle advice from different doctors about how to deal with them. Researchers who recently set out to look at this problem have demonstrated how challenging it can be to follow guidelines for several chronic diseases at the same time.

Johns Hopkins researchers found that some of these clinical practice guidelines consider a specific pair of diseases. But the guidelines rarely give recommendations for treating people who have three or more chronic diseases at the same time.

For their study, the Johns Hopkins researchers determined the most prevalent diseases in older Americans by reviewing data from the National Health Interview Survey and a sample of national Medicare claims. They then evaluated clinical practice guidelines for nine of the 15 most common chronic diseases: high blood pressure, chronic heart failure, stable angina (chest pain from coronary disease), atrial fibrillation (an arrhythmia with an erratic heartbeat), high cholesterol, diabetes, arthritis, chronic obstructive pulmonary disease (emphysema), and osteoporosis.

As an example, the researchers specifically evaluated what would happen if they used clinical practice guidelines to treat a hypothetical 79-year-old woman who had moderately severe osteoporosis as well as type 2 diabetes, arthritis, high blood pressure, and chronic obstructive pulmonary disease.

Using explicit instructions from the published guidelines for each individual disease, they assembled a comprehensive treatment plan for her. If she were to abide by all of the guidelines’ recommendations, this imaginary woman would be taking 12 medications in 19 doses, five times a day. The medications would cost her more than $400 a month. What’s more, adhering to all five guidelines at once could lead to interactions among medications for different diseases or between her medications and her food. Also, taking so many medications would increase her risk of receiving the wrong medication, of having an adverse drug reaction or of needing to be hospitalized.

Bottom Line Advice: For the best care, you need to discuss all of your medications and treatment requirements with each of your doctors. If advice from different doctors conflicts, talk with them about it. No two people are the same, and your care plan should be as unique as you are. Ideally, you should have one primary doctor who has the responsibility to keep tabs on all of the medications you are taking, including all of your over-the-counter drugs and any nutritional supplements you use.