What do you mean over the line into osteoporosis? T-score? have you had a fracture, especially hip or spine, as an adult?
Your health issues complicate your bone density, but then you already know that. Your doctor is right to want you on a medication. However, I can only say that our osteoporosis center medical director is a rheumatologist with patients just like you and she won't prescribe Prolia until all other osteo meds have been tried with no success. Prolia is not a first choice or first experience med.
As for side effects.....I'm sure the meds you take for your CREST have the possibility of horrible side effects. I know they do. Yet you must take them because of your serious condition. Same with osteoporosis. One vertebral fracture can change your life and independence (and clothes you wear) forever and there is no cure. Just prevention.
The meds, whether injection or pills, all stay in your system for 10 years. If you take a pill for 6 months and then stop, it doesn't vacate your body. Don't worry about injection vs pill. Same thing.
Whatever you take, you need to consume 1200 mg of calcium a day and 1000 IU of Vit D with it in order for the medication to work. If you don't, you're wasting your time and money on a medication. The calcium will be absorbed in 500 mg increments only. That's all the body can handle at one time - so spread it out. If you take supplements, take 600 mg at lunch and 600 at supper for maximum effect.
As for your activities. I know you don't want to hear this, but you either have to switch to others or be very very careful as you could have a compression fracture in the blink of an eye. The way it works is that your spine is made up of thick cortical bone that is the vertebrae you feel when you run your hand over your back. Those are the bones you see in spine illustrations. Inside those vertebrae are the trabecular or honeycomb bone. These are actually tiny tiny struts. When your bone density is low, the smallest bones break first. You do not feel a thing when these struts break because the outside bone is holding it all in. When a majority of the struts break and cannot hold the vertebrae in place, wham! they crash together and you have compression fracture. There is no doubt when you have this. The pain is extreme.
That's why the recommendations for people with low bone density are to avoid pounding of the spine (horseback riding, jogging) bending forward from the waist (Pilates and some yoga moves) and twisting of the spine (golf) Your risks are just too great.
Go online to the National Osteoporosis Foundation (www.nof.org ) for a lot more info about this. You can also order their booklet "Boning Up on Osteoporosis" for good information and guidelines for living with osteoporosis. We also use it as a teaching tool for our rehab classes.View Thread
The 26% loss statement throws me. We don't measure that way and I work in an internationally certified osteoporosis center within a hospital. Been here 18 years.
My question to the doctor would be, "26% of what?" If you don't know what your maximum bone mass was - and nobody ever does because it isn't measured at your peak time - how do you know if you've truly lost or if your bone mass never reached its full potential?
What we do to determine loss is compare the current DXA to the last one. Then there is a series of standardized calculations that occur to determine the amount of loss between the current and past. This calculation is based on a precision study that is done on the DXA equipment itself every couple of years. It's done by taking 30 volunteers, doing their bone density then having them get off the table and get back on. Another bone density is done. Those two are compared. After all 30 people are measured, a forumula is used to determine, based on the findings, what the LSC (Lowest Significant Change) is. That is basically a margin of error for the machine. If someone's bone density score is greater than the LSC - either by gain or loss - they are said to have experienced a significant change. It is never given in %. It is given in BMD. So for your doctor to say you've had a 26% loss is confusing. What does he mean?
Do you have the test done in his office or in a osteoporosis center? I'd ask if the testing place is certified with the ISCD (International Society of Clinical Densitometrists.) Are the techs who perform the test certified by the ISCD? I'd also ask what was the LSC based on the machine's precision study. If you get a blank look or the runaround, find another place to be tested because you're not getting a quality test.
As for the sit ups - don't do them - ever. Or Pilates or any kind of crunch that bends forward at the waist. Ever.
Glad you're restarting the Fosamax. Why the wait till after the Vit D? They all work together for your benefit.
Get the booklet. It even has illustrations on the best way to do household chores in addition to exercises.View Thread
Check out the National Osteoporosis Foundation website. www.nof.org . They have sections to answer all of your questions.
Soy milk doesn't naturally have calcium in it, so check the label carefully. Canned salmon is the one with the most calcium because of the bones. Lots of foods now have added calcium. Just read the label. If the calcium is given in %, you drop the % and add a 0 for the amount. Ex: 25% = 250 mg of calcium.
Your body won't absorb more than 500 mg at a time so be sure to spread it out throughout the day. You also need about 1000 IU of Vit D. That sends the calcium to the bones.
As for medications, you have to weigh your risk for fracture agains any potential side effects of a medication. If you have osteoporosis (is your diagnosis based on T-score or fracture history?) your risk for fracture is likely high; however at your young age that does mitigate the risk. The thing you don't want is for your bone density to decrease. Once it gets really low, you can't bring it back to normal.
The meds have gotten a bad rap over the internet. No cases have gone to court, much less been won. They do work to lower your risk of fracture, and that's what you want.
You need to be careful with your yoga. Be sure to tell your instructor you have osteoporosis and cannot do any forward bending or twisting of the spine. Those cause tiny fractures within your vertebrae and can lead to a compression fracture.View Thread
You're awfully young to be losing that amount of bone. When did you go through menopause?
There is no 5 year rule for Fosamax. Doctors will often re-evaluate patients who've been on 5 years. If their bone density is staying basically the same (stable) they will consult with the patient about going off. Then, when they have their next DXA, if the patient is still not showing any change, they can remain off the med. However, if there is a loss, it is advised to remain on the medication.
In your case, with your amount of loss no matter the T-score, I'd restart a med. There are lots to choose from. If Fosamax was working for you, go back on it. Your risk of fracture is greater than any risk of side effects from the med.
Yes, there is a list of exercises/movements to avoid. You can go online to the National Osteoporosis Foundation and order their booklet "Boning up on Osteoporosis." It costs $5 and is full of all kinds of pertinent information for you. We use it as a supplement to our Osteoporosis Rehab classes. You can also browse around the NOF website (www.nof.org ) itself for tips and advice as well as documented information.View Thread
Go online right now to the National Osteoporosis Foundation (www.nof.org ) and order their booklet "Boning up on Osteoporosis." It costs $5 and will be your Bible. We use it as a supplement teaching tool in the Osteoporosis rehab classes in the hospital where I work. It has all the information you need, complete with illustrations of moves to make and not make.
You should not be lifting more than 10lbs at a time. When you do lift and use the hedge trimmer, hold them as close to you body as possible. Your spine curvature could indicate prior compression fractures.
The pain in your neck, shoulders and ribs would not be caused by osteoporosis unless you were fracturing.
Beginning immediately you need to consume 1200 mg of calcium each day in diet and/or supplements. Spread it out throughout the day because the body won't absorb more than 600 mg at a time.
You should get a calcium supplement - I'd suggest a calcium citrate like Citracal - with Vit D included. This sends the calcium to the bones.
After you receive your booklet (you can also get good information from the website itself) read up on the medications. You should be taking one. Then, armed and education, have a serious talk with your doctor about strengthening your bone density and reducing your chance of a fracture.
There's also a good section on fall prevention. Living alone, you should take precautions about falls.
I hope this information is helpful. There are solutions for you. You just need to become proactive and not wait for the doctor to tell you what to do. Become your own best advocate.View Thread
What was your T-score in your spine? Have you had a nontraumatic fracture as an adult? 26% loss since your last bone density? If so, that's huge and your doctor should be ordering some follow up tests. Have you gone through menopause? If so, are you on hormones? Do you take corticosteroids for a chronic condition?
Here's the thing about these precautions: Your vertebrae are made up of trabecular bone. The outer bone is hard and dense in each vertebra. Inside each one is what we call the honeycomb bone. This is made up of tiny tiny bones called struts that crisscross and support the outer bone.
If you repeatedly lift heavy objects, bend forward from the waist or twist side to side and your bone density is low, the first bones to break are those tiny struts. You won't feel a thing and won't know this is happening - until...the last one inside a vertebra breaks. Then the entire vertebra collapses. This is called a compression fracture and believe me, you WILL notice this fracture. Then you'll be twice as likely to have another.
There is no cure or do-over for this. The only thing you can do is try to prevent it. Talk about changing your exercise routine - this will do it.
The doctor saying you had 26% bone loss is quite confusing. It's not a terminology we use. If this was your first DXA, there's no way to know what kind of "loss" you had because we don't know what your maximum bone density was. You can't measure loss until you have something to subtract it from.
If he's saying that you're 26% less dense than others your age - again that's a weird way to phrase it, but that's scary. It would be helpful to know the answers to the questions I asked.View Thread
Your fractures give you a clinical diagnosis of osteoporosis. Forget the osteopenia. You now have to deal with reducing your risk for further fractures, and you are at high risk.
Your doctor is right to put you on a med. Is your concern about dental implants because you have them, are considering them or just worried in general?
Osteoporosis causes you to lose bone all over your body - but at different rates. That means you also lose bone in your jaw. In fact, many dentists send their patients to us for testing when they notice that dentures are getting loose or teeth are becoming loose in their patients.
The dental complications would not disqualify you from using a drug. In fact, your risk of having more fractures is much much greater than any risk you have from a medication. Sometimes there are no clear cut answers. You just have to treat the more severe problem.
If you don't want to do a bisphosphonate, you can try Evista or hormone therapy. It is imperative that you consume 1200 mg of calcium a day to maximize the effectiveness of any osteoporosis medication you take. Also you need 1000 IU of Vit D. This sends the calcium to the bones.
I would urge you to go on the National Osteoporosis Foundation website (www.nof.org ) for a lot of helpful information. You can also order their booklet "Boning up on Osteoporosis." It is chock full of info and tips for you, especially on movement to do and movements to avoid - such as bending forward at the waist. It also has a good section on the different medications so that you can research them and then have an educated conversation with your doctor.View Thread
You need to be on them for 2 years (4 shots) then be retested at the same place you had your last DXA. Whether you continue with the Prolia or not would be determined by your test results. If you are stable, that is no significant loss, or improved your plan of treatment is working. Talk to your doctor at that time about either continuing or switching to a bisphosphonate.View Thread
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