OT: Osteoporosis & Premenopausal

[SleepingUgly]

I've had several bone densities in the past 5 years, and my bone density keeps tanking. If I were post-menopausal, they would call it "osteoporosis" (at the hip, osteopenia in some other sites). There is no known primary cause for this. Anyone have a clue what I should be looking into, reading, asking, etc.?

[BlackSpinner]

I've had several bone densities in the past 5 years, and my bone density keeps tanking. If I were post-menopausal, they would call it "osteoporosis" (at the hip, osteopenia in some other sites). There is no known primary cause for this. Anyone have a clue what I should be looking into, reading, asking, etc.?

It is osteoporosis, it has nothing to do with menopause except that in women the lack of balance of oestrogen & progesterone at menopause seems to encourage it. I had male massage clients who had it.

Some people have had some success with topical yam cream with progesterone in it.

Pop seems implicated too.

The body needs magnesium and vitamin D to absorb calcium.

Weight training seems to rebuild bones.

These are the things I found when I was diagnosed with it during menopause except that after menopause it seemed to have gotten better

Good luck

[Starlette]

Ditto what Blackspinner said.

I'm not sure if this answers your question, but this is the way FIL, DH and I are handling it.

Funny that you would create this post. Next Thursday, I have my bone density exam (DEXA scan). For the last four years, I've been stable. I think I've been taking Andronate for the last four years, DH hasn't had to, FIL was taking it. However, not so with my father-in-law. Because of the Andronate for him, he's experiencing one of the side effects related to his teeth (I atm don't remember what the issue is). MIL cut him off immediately. We both WERE avid soda drinkers. When both of us found out about consequences of soda, we stopped drinking it immediately, I'll have occasional Diet Pepsi. (NOTE: 1) When drinking soda, the calcium goes down the toilet, literally; 2) MIL asked his physician that if he takes one vitamin D3 (1,000mg) in the morning and at night, glass of milk and a slice of cheese everyday would that be enough calcium for him. Doctor said yes). I plan on duplicating his approach once I get off the Andronate.

Check this link out: http://www.usatoday.com/news/health/sto ... _multiline
When Hubbs and I found out the consequences of too much calcium from this article, we both stopped taking calcium immediately. SIL (the doctor) said for her patients, they neither get Andronate nor calcium. We never asked how she treats them. As previously stated, the only thing we're taking now is vitamin D3 (1,000mg twice a day. NOTE: When we went to Costco today, we couldn't find the vitamin D3 1,000mg, only 2,000mg. So when we're ready to start using this new bottle, we'll do 2,000mg once a day. I have to see my PA-C on Tuesday, I'm going ask her about doing it this way just to make sure all is still good.) SIL state as long as we continue with the vitamin D3, we're good to go.

Since I found about FIL quitting Andronate immediately/cold turkey, my desire is to quit also. I haven't experienced any side effects, I'd like to keep it that way. However, I'm taking a different approach. I talked to my PA-C about this. Told her I'd like to discontinue taking the Andronate. She said that if my DEXA scan again is stable which is next Thursday, I may go ahead and quit. One less pill I have to take. Keep in mind as one of the techs explained to me, the Andronate stays in your body for several years. We're suppose to take the Andronate for approximately five years. Because of the side effects my FIL is experiencing, I'd like to quite sooner.

Starlette

[Julie]

What I don't understand is why your doctor (presuming he/she is the one to give you results) is not talking about it with you... why you need to come to an internet site to find out you do have osteoporosis! Something is definitely off and you might want to think about seeing someone else.

[jnk]

A different opinion:

Low bone mass (osteopenia) is the term healthcare providers use to describe bone density that is lower than normal but that has not yet reached the low levels seen with osteoporosis. A person with osteopenia does not yet have osteoporosis, but is at risk of developing it. People with osteopenia have a T-score between -1.1 and -2.4. . . . The results of a bone density test are expressed either as a "T" or a "Z" score. T-scores represent numbers that compare the condition of your bones with those of an average young person with healthy bones. Z scores instead represent numbers that compare the condition of your bones with those of an average person your age. Of these two numbers, the T-score is usually the most important. T-scores are usually in the negative or minus range. The lower the bone density T-score, the greater the risk of fracture. . . . People with normal bone density have a T-score between +1 and -1. People who have a score in this range do not typically need treatment, but it is useful for them to take steps to prevent bone loss, such as having adequate amounts of calcium and vitamin D and doing weight-bearing exercise.-- http://www.uptodate.com/contents/bone-d ... the-basics

One professor's ideas on problems with use of the term "osteopenia" and a choice not to use it at all:

Four problems with ‘osteopenia’

Although it is sometimes useful to think categorically when dealing with a continuous variable, the category of “osteopenia” creates problems in at least four ways.
•The WHO classification was specifically meant to apply to postmenopausal white women; applying a medical label such as osteopenia to a healthy young person can create considerable anxiety that may last one’s whole life.

•It was meant to be applied only with DXA and only to specific skeletal sites; using the WHO classification with peripheral measurements (eg, heel, finger, tibia) or other techniques (eg, quantitative computed tomography, quantitative ultrasonography) is not appropriate.

•Many postmenopausal women who are in the upper part of this borderline range are perfectly normal. After all, “normal” for most biological variables is defined as the mean plus or minus 2 standard deviations.

•Postmenopausal women who are in the lower part of this range are almost as likely to have fractures as patients on the lower side of the arbitrary cut point (or maybe more likely, depending on other risk factors for fracture).

I try to avoid using the term osteopenia in reporting DXA results and in patient care. For patients with T scores between –1.0 and –2.5, I use the term “low bone density,” which does not sound like a medical problem in and of itself, and (I hope) is a nonjudgmental term that should force the clinician to think about the clinical context.

Postmenopausal women in the upper part of this range (–1.0 to –1.5) should usually be reassured and monitored, perhaps every 5 years or so. Patients in the middle part of this range (–1.5 to –2.0) rarely need pharmacologic treatment but should be monitored every 3 to 5 years. Patients in the lower part of the range (–2.0 to –2.5) should be monitored at least every year or two and may even be candidates for pharmacologic intervention, depending on how low their BMD is and if they have other risk factors for fracture.

Most patients who have fragility fractures have T scores above -2.5

. . . •Apparently healthy patients in the upper range of low bone mass should be reassured and monitored periodically; -- http://www.clevelandclinicmeded.com/med ... /watts.htm

Just trying to give the other side in this controversial topic.

I think it very important for all women to be particularly concerned with bone health. But creating undue anxiety based on test results can sometimes do more damage than good, in my opinion.

Please be gentle with SleepingUgly. Thank you.

----

SU, what are your numbers, and what exactly did the doc say? (If you don't mind my asking.)

[squid13]

My wife has osteoporosis and she has used the Fosamax, Actonal which gave her a blood clot in her eye. Her rheumatologist now has her getting a Prolia shot twice a year. It's an expensive shot about $1700 but it's covered by medicare. It seems to be working for her, she's not loosing anymore on her dexiscan and maybe she'll gain a little we hope.

[SleepingUgly]

As jnk noted, it's not called "osteopenia" or "osteoporosis" in premenopausal women because those terms imply a fracture risk in conjunction with the low bone density, whereas there isn't a substantial fracture risk in someone like me (my risk is greater than another woman my age without my bone density, but my absolute risk is very low).

I was on Boniva for 14 months a couple of years ago and went off because I developed joint pain (which very well may have had nothing to do with the Boniva) and my second opinion doc didn't like women like me to be on those drugs. Since then my bone density has continued to decline. He is not sure what to do with me, as he doesn't want to treat me but also doesn't want to let me just continue to lose bone density. I'm going to do a urine test of bone breakdown that may tip the scales toward treatment, but if it doesn't come out as problematic, we'll be in the same situation we are in now of not being sure what to do.

I wouldn't know which of the numbers to post, jnk, but my t and z scores at the hip are in the abnormal (aka "osteoporosis") range, and the rest are in the "osteopenia" range (maybe my wrist is normal).

[jnk]

"Lifestyle modification should be encouraged among premenopausal women in order to improve BMD [bone mineral density]. This would include weight-bearing exercises, adequate dietary calcium intake, smoking cessation, limiting caffeine, and reducing excessive alcohol consumption. . . . Women who are estrogen deficient, either clinically or subclinically, benefit from estrogen supplements. . . . The role of estrogen supplementation for women who are not estrogen deficient is controversial. . . . Low BMD can be due to genetically predetermined low peak bone mass. Environmental factors, such as inadequate calcium intake, alcohol and tobacco excess, low body weight, and estrogen deficiency, can contribute to development of lower peak bone mass or to bone loss in the premenopausal years. Osteoporosis among premenopausal women is diagnosed in the presence of fragility fractures and diagnosis is not based solely on the results of a BMD test. Secondary causes of bone loss should be excluded, and any underlying condition contributing to low BMD should be corrected. Referral to a metabolic bone clinic is appropriate for patients with fragility fractures or progressive bone loss . . . -- http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed

[Janknitz]

I've just spent a week listening to the Real Food Summit podcasts. To a person, everyone mentioned a the following for bone health (as well as general health and well-being):

1. Vitamin D, preferably from sunshine but also supplements if necessary.
2. Grass fed whole fat dairy (raw if possible) because it is a great source of vitamin K2 which helps the body take and use calcium from the diet. Fermented dairy (kefir, yogurt, cultured butter, etc) is an option if you have trouble with lactose.
3. Bone broth as a source of dietary calcium and other minerals.
4. Fermented foods which help your gut stay in good condition and utilize the nutrients in your food.
5. Grass fed meats and their organs and wild caught fish--particularly to provide Vitamin A which your body needs synthesize what your body needs.
6. Everyone except Cate Shanahan recommended fermented cod liver oil--Dr. S was concerned about the mercury content. She also was against supplements, ESPECIALLY calcium--it's been associated with higher levels of atherosclerotic heart disease and cancer. as well as bone spurs and other orthopedic problems. I finished listening to that podcast, opened my newspaper, and found an article saying exactly the same thing.

In addition, avoiding grains and legumes, because they counteract all the above.

If the suggested things aren't already part of your diet, it's worth considering adding them in because they don't have side effects like osteoporosis drugs and they are likely to at least stop bone loss and improve your overall health.

[GatorLord]

Second everything Janknitz said and would add the following to consider:

MAGNESIUM. If you are deficient in magnesium you are at risk for all sorts of calcium related problems. Sadly, most Americans are deficient in Mg.

You may also wish to have your primary order D3, Parathyroid hormone (PTH), and blood calcium levels to rule out any problems with your parathyroids.

[SleepingUgly]

I've had a bunch of labs, and I am on Calcium+D, vitamin D, and Magnesium. My 24-hour urine calciums have been normal and my vitamin D, with supplementation, is in the 50s.

I've heard mixed things about caffeine. My doctor says that if my caffeine intake was an issue, it would be via disturbing calcium, and that would show up on my urine calcium test, and they don't. He said I'd have to consume A LOT more than I am, but elsewhere I read even 2.5 can be an issue. It seems that most things that can be a problem exert their influence on Calcium or Vitamin D, and if those are OK, then those things are not a problem.

BTW, low BMI is associated with greater risk! This might be the only domain in which being obese is actually protective against an deleterious consequences.

I think I'm doomed to be idiopathic in every aspect of my life. An enigma.

[squid13]

Most of the women in my wifes family had osteoporosis and my wife has it so probably some of it is inherited in the genes, her mother had it bad. Does anyone in your family background have or had osteoporosis?

[SleepingUgly]

My grandmother had it. My mother died young, so we don't know if she would have had it.

[GatorLord]

SleepingUgly, I'm not too sure about the caffeine, but I'm absolutely certain about the magnesium. Also, unless your doctor ordered an Exatest for cellular magnesium levels (highly unlikely), then any blood test results are not very helpful unless the readings were very high or very low. The reason for this is that the heart requires the blood magnesium levels to be within a band and the body will steal or store from tissue to keep it that way. Not surprisingly many seriously magnesium deficient people show up normal on blood tests. Only 1% of the body stores of magnesium are present in blood, the rest is intracellular.

Your Vitamin D levels seem good, although ~80 is considered optimal by many. Vitamin D's main function is to be used by the gut to enable the absorbtion of calcium, so as long as it's good and your blood calcium levels are good, and your parathyroid hormone levels are good, then you're looking somewhere other than calcium uptake and shed for the cause of your osteopenia or osteoporosis.

Just for grins, start drinking magnesium bicarbonate water (it's homemade, so Google for the recipe or just ask me), making 'magnesium oil' out of distilled water and Epsom Salts and rubbing that on large areas of skin, and/or soaking in warm water with Epsom Salts in it. Do this daily for at least a month, a couple would be even better, and then see how your calcium issues are doing. Unless you have late stage kidney disease you can't hurt yourself with this and will almost certainly do an amazing amount of good. Please do not brush off this magnesium recommendation. Frequently the first sign of a serious magnesium deficiency is sudden cardiac arrest...osteopenia is a canary in the coal mine.

While you're at it you may want to include Vitamin K2 (the MK7 subvariant) and convince yourself of the wisdom and safety of employing the old timer's 'Borax finger dip method' of getting your boron safely on the cheap. Boron gluconate is available online if the Borax thing is a turn off. Adequate boron can decrease calcium loss by 50% and magnesium loss by 33%.

The osteoblasts in bone require pressure to stimulate strengthening, inactivity will result in atrophy, or bone loss. So, if you're not already doing some form of resistance exercises, even light calisthenics or using bands, then please consider doing some, or more if you're doing a little already. Lifting weights and walking or running would be the absolute ideal. This will pay off in many ways, but the bones need to be told to get stronger and have to be placed under load for that to happen. This is why you see astronauts using resistance bands including when they run on the treadmill on the space station. Otherwise they would develop rapid and severe osteoporosis.

It's only idiopathic until the process is understood and variables are eliminated. Then it becomes knowledge...and knowledge is power.

Good luck, God bless, and please update. Thanks.

[jnk]

Just for grins, start drinking magnesium bicarbonate water

As long as the grin doesn't turn into a frown from allergies, side effects, or overdoing it.

http://www.livestrong.com/article/31358 ... e-effects/