When did you go through menopause? Have you had any fractures as an adult?
You say you had an 11% loss the first year. Loss from what? Unless you know your starting point, how did the doctor determine your degree of loss? It may very well be that you hadn't had any loss but were always low.
What are your T-scores? Are you getting a DXA every year? If so, why? Unless you're on high risk medications, like prednisone, chemo, etc. the recommendation is every 2 years because bone is so very slow to respond to change.
As for Prolia, it's a good drug, but the recommendation is to not use it until all other options are exhausted. Why is he suggesting it now instead of Actonel or Boniva?
A 58 year old person, even with extremely low T-scores, is not at as much a risk for fracture as an elderly person would be. It may be that Actonel would work well for you unless you have gastric issues.
Side effects?? Anything you expose your body to has the potential for side effects. Breathing in pollen just tears up my sinuses, peanuts kill children, prednisone makes you miserable, but saves your life, antibiotics give you yeast infections and make you nauseated, but kill the really bad stuff. There's nothing that doesn't have a side effect.
The trick is to weigh you risk of fracture against the possibility of a side effect. Most people take the meds with no noticeable negative effect. People who do have side effects are the ones who are most vocal. That can make them seem like the majority. They're not.
Having a fracture makes you twice as likely to have another. Half of people who have a hip fracture will die of complications of that fracture within a year. That's a side effect I'd pay attention to. Fractures can take away your independence and way of life. They can restrict travel, sexual activity, picking up grandchildren, carrying groceries, housework and gardening - just everything that makes your life YOUR life. If a medicine can reduce your chances of having a fracture that would impact all of this - take it.
Be sure to consume 1200 mg of calcium each day. Spread it out because your body is only going to absorb 500 mg at a time. You'll pee out the excess.
Good luck to you. You're headed in the right direction.View Thread
If she's continuing to lose bone mass, Forteo may be the best thing for her to do. If her insurance doesn't cover it, call Eli Lily to inquire about their program to help those who can't afford the drug.
That said - if she doesn't get enough calcium every day the medication won't help. ALL osteoporosis medications need calcium in order to do their job properly. That may be why her Boniva was working well. She needs 1200 mg each day. A good supplement with Vit D taken at lunch and at dinner should be sufficient. Probably a calcium citrate (like Citracal) would be best because it's less constipating than a calcium carbonate. With a citrate, though, be sure she takes the right dosage. Most citrates are 2 pills to equal one dose.
The exercise bike is good cardio exercise, but not bone building. You're right to encourage her to walk. We ask our patients if they're on their feet at least 4 hours a day. Walking 1/2 hour a day is also good. Doesn't have to be done at one time. The main idea is to be putting all your weight on your feet at least 4 hours a day.
Her not having had a fracture is very good news. If you're not wanting her to explore the Forteo, explain to the doctor about her less than optimal calcium intake and ask if he'd consider her continuing the Boniva - only this time, making sure she takes the necessary calcium. That might be enough.
Forteo is for the frailest of the frail because it builds new bone. It's the big guns of osteo medications.
If her T-scores are very low (say -3 or lower) given her age, he might insist on the Forteo, especially if she's living on her own. One fracture would end the independence.View Thread
If the doctor noticed frail bones on a regular x-ray, you did indeed have something going on. Bone loss doesn't usually show on x-ray unless there's significant loss. They aren't designed to pick up bone density.
Have they looked for illnesses that could cause osteoporosis to be a result of that?
How old are you? Are you still premenopausal? Were you on Depo-Provera for birth control? Were you ever bulimic or anorexic? Any IBS or Crohns?
Forteo is a good drug. It's the only one that will actually grow new bone. Because you've tried others with no success, it's likely to be a good thing for you.
How was your lack of improvement measured? When our patients don't lose bone, they're determined to be stable - and that's a good thing. The goal of osteoporosis treatment is not to improve T-scores (although in your case it would've been Z-scores) in themselves, but to reduce fracture risk.
You can have a score to remain the same or even drop a little. This is not alarming. T and Z-scores do not determine change. The BMD does, and it's determined by a very precise formula. A layperson cannot simply look at her T-scores and say whether or not there's loss or gain.
Just make sure when you're taking any kind of osteo med, that you get 1200 mg of calcium a day. Spread it out. The body can only absorb 500 mg or so at a time. You also need about 1000 IU of Vit D so that the calcium will be sent to the bones. If you don't do this, your medication loses effectiveness.View Thread
It won't. Sorry. If for no other reason than bone does not respond to change that rapidly. That's why bone density tests are recommended every two years.
As for this doctor, I haven't seen the video, but will check it out. Does he also sell some of these or other products or a book?
His way might work if you're still building bone. It won't work if your T-scores are below -2.5. People do more harm to themselves by wasting time doing something "natural" than they would by taking a proven verified prescribed medication for osteoporosis. If you do this and your bone density hasn't changed, you have to wait two more years for another result. During those two years you could've been doing something that really would help your bones instead of giving them time to weaken further.
All natural is alway all good. Peanuts are all natural, yet can kill. Same with strawberries.
The weighted vest won't hurt you unless you've had vertebral fractures. Then you wouldn't want to put any weight on your spine.
You also have to be careful with Vit K, etc due to the blood clotting issue.
So many people are hoping for a natural, cheap, easy fix to osteoporosis. There's not one that's proven to decrease your risk for fractures. There's sooooo much more to bone health than a T-score. T-scores can be artificially elevated by arthritis and strontium - giving you a false sense of success.
You're not doing yourself any favors to go this route if you truly have low bone density or a history of fractures. There's no shame in taking a medication that works for a condition you have. I am thankful we have medications that prolong our lives, make us feel better and allow us to remain independent for a long time.View Thread
I doubt that a physician will respond to you. If one on this board does, it won't be subjective. They are bound by the rules of posting to be objective only.
I can tell you that there is no clinical diagnosis given to premenopausal women. It makes a difference when applying for insurance or when making treatment options. Doesn't mean your bones aren't fragile - just no clinical diagnosis.
That said, even though your numbers are in the normal range, the fact that you've had nontraumatic fractures would give you a diagnosis of osteoporosis (regardless of T/Z-score) if you were postmenopausal. The fact that you have had fractures does indicate that there is a problem with your bone density. Healthy bone would not have broken. You lose bone at different rates in different areas of the body. We normally only scan the "hot spots" (lumbar spine, left hip and possible forearm). Your thoracic density could be low or you could have low bone density secondary to something else.
At age 31, it's entirely possible that you hadn't finished building your peak bone mass. It's also possible that during your bone forming years, you didn't consume enough calcium and/or Vit D to get them as strong as they could be.
Bottom line is - you're where you are and have to deal with it.
Having one fracture makes you twice as likely to have another - as you've experiences. Are you on any high risk medications like prednisone, depo provera shot, antiseizure meds, diabetes treatment etc?
I agree with you that the Forteo seems extreme to start with, but then I don't have your health history and I'm not a doctor. Ask your doctor why he believes you should start with the Forteo?
Go online to the NOF website for a lot more information on everything osteoporosis (www.nof.org ) you need to pay particular attention to the body mechanics. You NEVER should bend forward at the waist or twist the spine. There's a whole section on this. You can also order their booklet "Boning Up on Osteoporosis." We use it in our osteo rehab classes and it's a wonderful resource book. Costs $5.
It may be too that you're peri-menopausal and your estrogen is getting lower. You wouldn't know this without lab work.
One other nugget of information to have, especially when you're talking to a doctor. If this was your first bone density test, whoever told you that you had any kind of loss, much less a 22% and 25% doesn't know what he's talking about.
You won't know you have a loss until you know where you started. Something to measure a loss from. When you have another DXA, then with those numbers you can compare them to this DXA. Then you'll know if you're losing or gaining or remaining stable.
It may very well be that you're losing bone density. We just don't know what your peak mass was. Or you may never have reached your maximum bone mass and were always on the low side.
As much as it hurts, a broken toe doesn't count when looking for osteoporotic fractures
Good luck in your mission for healthy bones!View Thread
How old are you? Have you gone through menopause? Are you on hormone therapy? Do you take steroids for an inflammatory illness? Have you fractures a bone as an adult? What were your prior T-scores and your current one?
A 22-25% bone loss is a lot. In what amount of time? 2 years? more?
There's not enough information to give a valid suggestion. If you've already had a fracture, that ups the ante as you'll be twice a likely to have another. If you're under 65 or so and at a -2.5 T-score with none of the above risk factors just the strong family history, you'd probably be fine with Fosamax
If your T-scores are low and are continuing to drop, don't even entertain the idea of a "natural" solution. There isn't one. You'd be wasting your time and money and continuing to worsen.
The best advice I can give is to go to the National Osteoporosis Foundation website (www.nof.org ) for a lot of answers to your questions. They have a section on medications that compares and contrasts them. It's very helpful. They also have a wonderful booklet called Boning Up on Osteoporosis. We use it in our osteoporosis rehab classes. It gives illustrations too of movements to make and to avoid.
As for your activity.....do not do any forward bending at the waist. Bend from the hips, keeping the back straight. No pilates or jogging. You can do yoga if your instructor is educated in adjusting the positions to make them safe for you. No twisting of the spine. Ever. You'll want to be on your feet at least 4 hours a day total.
Whatever medication you decide on (wacky is scary) be sure to consume 1200 mg of calcium and 1000 IU of Vit D each day. The body will only absorb 500-600 mg of calcium at at time so be sure to spread it out. Take your supplements with food for best absorption. Without the calcium and D, any medication you take won't work effectively.View Thread