The stories about subtrochanteric femur fractures are not quite complete.
The information from them is coming from a study by a group in New Zealand who has made it its life work to disparage the osteo drugs.
The study was not a controlled study. The results are not reliable.
What is not being said is that these fractures happen just as often (which is not often) to people who have never been on the bisphosphonate drugs.
I'm so sorry you've had this fracture. It may very well be that your bones were already at high risk for fracture. With RA, I'm sure you were taking medications that interfere with bone health.
The osteo drugs do not carry a no fracture guarantee. They only reduce your risk for fractures. Also remember too that if you do not consume 1200 mg of calcium, the drugs are not as effective. It's like hiring a bricklayer and not giving him any bricks.
I understand about the fear of falling and the balance issues. It's ironic that a fear of falling actually increases your chances of falling. I would suggest that you look on the National Osteoporosis Foundation website (www.nof.org) and look at the balance exercises they have. Do them. Taking a yoga or T'ai Chi class would also help with balance and strength building.
Another suggestion is to wear a backpack instead of carrying a purse. It leaves your hands free in case you stumble and it also aligns your spine naturally.
You're too young to live like this. There are options for you. For sure you need to be on another medication to improve the health of your bones. You don't want another fracture. For what it's worth, I totally do not believe the Boniva caused your fracture. I think your bones were not in good shape either because you never reached your maximum bone mass, your genetic history or your RA meds weakened your bones.
Don't throw the baby out with the bath water. Do what you can now to become as strong as you can.View Thread
Women need 1200 mg of calcium a day. Because the body can only absorb about 600 mg at a time, it can be tricky to get in the required amount every day. That's why it's probably a good idea to take a supplement.
The good thing about calcium supplements is there's no good or bad. We do tell our patients to avoid oyster shell because of the small risk of lead.
Read your label carefully. Many health food stores sell a calcium that requires many pills a day to get in your required amount.
Look at the serving size. Calcium carbonate - like Oscal and Viactive - are one pill per serving. That would get you 600mg.
Calcium citrate, like Citracal, require 2 pills per serving to equal 600mg.
Get a supplement that also has Vitamin D. Take them with meals for better absorption.
Also look at your food labels. Many products have calcium in them. It's not just about milk now. For example, Orange Juice with calcium has 350 mg per 8 oz serving. That's more than milk!
Read the label for the calcium per serving. If it's given in a %, simply drop the % and replace it with a 0. So..OJ with 35% calcium would equal 350 mg. Earth Grains bread with 10% per slice would be 100 mg per slice.
Keep track of what you normally consume in a day, and make up the rest with a supplement.View Thread
Start with the Reclast. Use Prolia only if you get no positive results with Reclast.
The way you'll determine if you've had positive results is not by an increase in T-score, just as a decrease in T-score does not necessarily mean a loss of bone mass.
Two years after you begin the Reclast, have your test repeated at the same place. The technologist doing the test should, according to a specific formula, determine whether any change in your BMD (not T-score) is within the parameters set forth by a precision test done on their equipment. That is the only way you get an accurate reading.
What this means is that the testing center does a precision test on the machine to determine how closely they can replicate a DXA reading. It's quite involved and many places don't do it. It requires taking either 30 patients and putting them on the table for a DXA, taking them off, and immediately repeating this. Or..they can use 15 patients and do a test 3x. The then compute (according to a strict formula) the LSC or Lowest Significant Change for each site (hip and spine). In our center the LSC is .029 and .028. This is basically a margin of error. If your test results fall within this range you are considered stable, and that's good. If they are outside this range, depending on whether greater than these numbers in a positive or negative reading, you are considered to have a "significant" loss or gain.
This is how you can tell if your medication is working. Period.
If the place where you're tested does not have an LSC, go somewhere else because you're not getting a quality test. The harm in this is that you may or may not be taking a medication you may or may not need.
Also remember to consume 1200 mg of calcium each day, taken a few hours apart. We suggest that our patients take one supplement with lunch and one with supper. The body can't process more than 500 mg at a time. You also need to take 1000 IU of Vit D each day. This is what sends the calcium to the bones.
So what are your T-scores? Have you had a fracture? Are you on estrogen? Do you have a family history of hip fracture or osteoporosis?
Reclast is a good drug and is only given once a year. It has been proven to reduce your risk of fracture, which is the goal of all osteo drugs.
Prolia is a different class of drugs and is not to be considered just another choice in the array of osteoporosis medications. It is to be used after all other meds (except Forteo) have been tried with no success.
Just make sure with any medication that you consume 1200 mg of calcium a day - doses separated because your body can't absorb more than 500 mg at a time. Also you need 1000 IU of Vit D to send the calcium to the bones.View Thread
The good news is that you don't have severe osteoporosis. You have osteoporosis. A -2.5 in an otherwise healthy 66 year old with no history of fractures is not alarming. It just means that you have to take steps and interventions so that you don't fracture.
Glad you're doing the Boniva. It does come in injection form should you not tolerate the oral. The acid reflux can interfere with your calcium absorption. Do you take your Caltrate pills with meals and at least 4 hours apart? Don't take both at the same time.
Sounds like you're on the right track. If you don't see improvement at your next scan, don't fret. As long as there's no loss,you're considered stable. And don't let the T-scores fool you. A loss isn't simply having a lower T-score. You can go from a -2.5 to a -2.6 for example and not be experiencing a loss. It's all in the BMD calculations as determined by your testing center's precision test. Ask the tech doing the test what their LSC is. If she looks blankly at you, ask if they've done a precision test and what is the determining number to signify change. If she still doesn't understand or says they don't do a precision study, have your testing done at a place that does.View Thread
You broke your hips and ankle because you have osteoporosis. That's what the disease does.
How old were you when you went through menopause? Did you have a hysterectomy? Did you keep your ovaries? Did you go on hormone therapy? An early menopause puts you at a higher risk for osteoporosis, especially if you didn't take hormones for whatever reason.
The medications do not cause fractures. They reduce your risk of having a fracture.
The medical director of the osteoporosis center where I've worked for 18 years is an osteoporosis expert who currently serves on an international osteoporosis organization's board. She recently gave a community talk specifically about these hip fractures and the fosamax link.
Taken at face value, it's scary, but you have to know all the facts.
First - who did the study? Second - was it a controlled study with verifiable data and results? Third - who sustained fractures?
The answers will give you insight into the study.
It was done by a group in New Zealand who got a sustaining grant to study this. They have received numerous monies and have made this their life's work to prove a link. If they don't, the money ceases.
It was not a controlled study; thereby making the results invalid.
What is not being said because it doesn't suit the desired outcome is that just as many people had this type of fracture who were NOT on medications as did people who were.
It also needs to be said that these are subtrochanteric fractures, not the common femoral neck fractures that are mostly seen with osteoporosis. Subtrochanteric fractures affect the long bone of the hip only.
I think too many people see a headline or summary of a story and take it at face value instead of digging deeper.
You've already had 3 fractures. Prior to that, you were diagnosed with osteoporosis at an early age. That gives you more years to have thinning bones and fractures than someone who is diagnosed later in life. You want to take care to safeguard your active and independent lifestyle. It has already been compromised by the fractures.
I think you should take your doctor's advice about the Forteo. There has been NO documented case of Forteo causing cancer in a human being. The sentence about cancer was because in the initial study some rats developed cancer. That doesn't mean a human will. And so far they haven't.
Forteo is a good drug. It can build you new bone. After your two year course of treatment, you take a bisphosphonate to strengthen the new bone you have.
Stay away from Dr Brown's program. It is not for people in your condition. There is NO natural way to reduce your risk of fracture once you're as deep into osteoporosis as you are. It may work for those people who have numbers in the low normal to high osteopenic range.
It also needs to be said that arthritis makes the bone look denser. That shows up in a higher T-score. People often believe their bones are improving because their T-scores are higher when it just means their arthritis is worse. Bone health is not determined by T-score alone. There are many factors that go into play here.
The USA practices EBM or Evidence Based Medicine. That means no medication is released that hasn't been tested and proven to be effective in many controlled drug trials. It's wonderful that we have this. It doesn't mean that there can't be side effects. Everything you put in your body has the potential for side effects. Not everybody has them. Ever seen someone on prednisone? They're miserable and bloated. Why do they take it?? Because it saves lives. You have to weigh your risk of having another fracture (high for you) against any possible side effects.
I also need to assure you that I do not work for a drug company, nor do we in our hospital based osteoporosis center, recommend or prescribe any medications. The patient's personal physician is the only one who does that. We do DXA testing, offer rehab/education classes, facilitate an osteoporosis support group and osteo exercise classes only.View Thread
Based on the information you've given, if I were you, I'd go back on the Fosamax. It appears you had a good response to it. Or maybe even Reclast as it's given annually.
If you started medication at age 49 and went through menopause at age 56 with no HRT, your bone density would have decreased somewhat simply due to the lack of estrogen. Your biggest drop came when you switched from Fosamax to Evista.
I'm not aware of a 7 year rule for Fosamax. What we suggest to our patients is that IF they want a drug "holiday" and they've not had any fractures, stop the meds. If they remain stable at their next testing, they can continue without meds. However, if they have a drop, they are to resume treatment. Looks to me like you fit that criteria.
Love Sara Meeks. She's given several workshops here at our hospital for our osteoporosis team of healthcare workers. Good that you have her book. I'd be real careful with the zumba and pilates though. Make sure your instructors know you have osteoporosis and that they are aware of safe moves to make.