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How Do I treat Osteoporosis?
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1eddie posted:
I just found out that I have osteoporosis and am very worried. I am trying to find out the best way to treat this. I wanted to try a more natural approach but am not sure that it isn't too late for that. Help
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bonebabe responded:
By natural approach I'm assuming you mean without prescription medication. Doesn't work. The purpose of the medications are to reduce your risk of fracture. If you risk is very high (and this encompasses more than just a T-score), you would need to take a medication. If you've never fractured, are young (< say 60) and your T-score is right at -2.5, you might try just the calcium and Vit D until your next bone density test. But...the fact is that more people with osteopenia (-1.0 to -2.4) fracture than do people with osteoporosis itself. If it were me, I'd do everything available to me to lessen my chances of breaking a hip or having a vertebral fracture.

Look at the National Osteoporosis Foundation website (www.nof.org ) for a lot of reliable information and beware of other internet sites that may not have accurate information.
 
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NATIONAL OSTEOPOROSIS FOUNDATION
Susan Allison, RNC, BSN, MPA responded:
Unfortunately, there are no "natural" or alternative treatments available at this time with enough research to demonstrate the safety and effectiveness to reduce the risk of broken bones in people with osteoporosis. Preventing broken bones in a person with osteoporosis requires a comprehensive approach that incorporates the following four critical components: 1) a prescribed osteoporosis medication; 2) calcium, 3) vitamin D; and 4) exercise. Calcium, vitamin D and exercise alone are insufficient for preventing fractures in people with significant bone loss (osteoporosis).

In addition to calcium and vitamin D, there are other vitamins and minerals that are important for bone health. For example magnesium and vitamin K are often added to "natural" supplements for bone health. Research studies, however, show that the amount of magnesium and vitamin K that is necessary for bone health can be obtained from a well-balanced healthy diet that is rich in fruits and vegetables.

There are many supplements on the market that claim to treat osteoporosis naturally. It's important to be cautious as many such products lack sufficient evidence to show that they positively impact bone health, reduce the risk of fractures and are safe. Here are some helpful resources about natural and alternative medicine from the National Institute of Health, National Center for Complementary and Alternative Medicine:

Using Dietary Supplements Wisely: http://nccam.nih.gov/health/supplements/wiseuse.htm

Evaluating Web-Based Health Resources: http://nccam.nih.gov/health/webresources/
 
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An_223950 responded:


Fourteen months ago I had osteoporosis. Now I don't.

I broke my wrist in March of 2009 and discovered out that my bone density was low enough in my lower spine to earn the label osteoporosis. I had lost 8.7% of the bone in my lumbar spine in nine years -- 1% per year! But until I fell and broke my wrist I didn't even know there was a problem. I was 68 years old, on the sedentary side, fairly active for a person who works at a computer, but with no structured exercise program.

Although my doctor advised me to start taking bisphosphonates, I decided to try strength training, without using drugs, for one year and see if that would reverse the trend of bone loss. So I enrolled in a women's strength training class.

I have given strength training a high priority in my life this last year. I do it, vigorously and wholeheartedly, for one hour three times a week, including at home whenever my class is not in session. I've taken calcium and Vitamin D supplements, and I've tried to fit in aerobic exercise also three or four times a week. (But I must confess that I miss my aerobics sometimes and have been somewhat less diligent about it than about strength training.)

All year I was wondering whether my bones were getting stronger. My body certainly felt more comfortable. I felt stronger. My clothes began to fit more loosely around the waist. My sense of well-being increased throughout the year. And although I used to fall down quite often (more than once a month), I have now not fallen in almost a year. Even if my bones were not getting better, strength training was proving well worth the effort.

Last month (April, 2010) I had another bone density test.

The bone in my spine had increased by 2.8% in 13 months. Although my scores are still below optimal, they are no longer in the osteoporosis range. My bone density has stopped decreasing and started increasing. My doctor said he no longer advised me to take bisphosphonates.

"But keep on with your strength training!" he said as I walked out the door.


--Diane Porter

 
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bonebabe replied to An_223950's response:
Your strength training is obviously giving you many benefits. You should definitely keep it up. I would urge caution with the aerobics, however, because any regular pounding of the spine or twisting movements can cause the tiny struts within the cortical bone of the vertebrae to fracture and you would be totally unaware of it until the last one gave way and you had a compression fracture. Just be careful in your movements.

As for the medications, you obviously don't want to take any. I can totally understand that. Nobody (well very few) people want to take a medicine - especially when they aren't hurting. However....you meed the NOF criteria for treatment because of your osteopenic T-scores along with the presence of a fracture history. This makes you twice as likely to fracture again. Too - more people with osteopenia fracture than do people with osteoporosis. I don't know if it's because they think they're home free by not having a number indicating osteoporosis and they take more chances or what. But the data bears this out.

The purpose of bone density testing is not to give you a number to determine whether you pass or fail. It's to assess your risk of fracture and then take steps to prevent that fracture. My guess is that you're not on hormone therapy either. However you feel about them, not being on hormones raises your risk of osteporosis. I'm not advocating one way or the other for hormones, just stating a fact.

As for the 2.8% increase in bone density. Ask the tech who performed your DXA what lowest significant change is for their machine. This is a number derived from doing a precision test whereby a number of people (usually 30) are put on and off the table 3 times so that the tech can most precisely duplicate the scan. A formula is then applied to see how closely this can happen. That number is the lowest significant change. At our osteoporosis center, it's 2.9%. That means that any score less than 2.9% - whether it's a loss or gain - is deemed not significant. It's basically a margin of error. So ask. It's a little bit more information for you.

Did the tech scan your forearm - the one not broken? Sometimes that can be a better indicator of bone density due to arthritis in the spine. Arthritis can artificially inflate a T-score. Because the bone in the wrist and spine are alike, we will often do a forearm scan. Just asking.

That's wonderful that your balance is better. That in itself will reduce your fracture risk. Sounds like you're on the right track. And now you have some more information with which to research and talk to your doctor.
 
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An_223951 replied to bonebabe's response:
Thank you for your thoughtful advice --Diane
 
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birdwatchingdotcom replied to bonebabe's response:
One further thought, though, is that my 2.8% increase in bone density was an average of the scores in all five lumbar vertebrae. It seems to me that it is statistically much less likely for an average of several numbers to be off all in the same direction than for a single score to vary by the same amount. That is why the software that my clinic uses reports its results as an average rather than reporting each vertebrae individually. -Diane
 
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bonebabe replied to birdwatchingdotcom's response:
You're right - the DXA shows the score of L1-L4 - an average. It then compares to your prior average. The result should be a significant change of a particular percent in order to accurately track progress. Individual vertebrae are not looked at.
 
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An_223952 replied to bonebabe's response:
I am so confused! All over the Internet, we see headlines such as this: STRENGTH TRAINING INCREASES BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN--that one is a news release from the American College of Sports Medicine. "But if you persist with your weight training, even a 1% change in bone density every year adds up to a 10% difference after ten years"026.that's a lot of bone."-Clinical Director of the National Osteoporosis Foundation (NOF), Felicia Cosman, MD. The university studies such as those done at Tufts and the U. of Arizona show increases in bone density. Don't these studies show that it is possible to actually slow bone loss and sometimes gain bone back with adequate strength training?
 
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bonebabe replied to An_223952's response:
It is confusing. Bone density testing compares your current bone density to your last one. It can be grafted to show trends over the years, but most testing centers update their equipment and/or software that makes an accurate comparison impossible. A 1% change is a non-change. It's marked as "stable in response to care."

I have to say that I've been doing this for 15 years, and I've never seen an accurate tracking of anyone's bone density over 10 years. To add to that, I've never seen anyone's bone density significantly improve over a series of years. The nature of osteoporosis is that our risk increases with age. We don't see people's bone density improving to a normal range when the bones have become osteoporotic or low osteopenic. Doesn't happen.

Strength training and weight bearing exercise do impact bone positively and can slow bone loss in some people. But there are way too many factors in bone loss to make it a blanket statement. A person's own genetic makeup and medical history have a huge impact on bone health, in addition to any medications they may be taking for other health issues.

Don't stop your exercise program. It is a very beneficial thing to do for your body. But don't expect it to be the sole answer to your bone density.
 
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SquashBlossom replied to bonebabe's response:
Thank you for your thorough response.I appreciate it very much.
I wouldn't expect that exercise would be the sole answer to bone density issues, just one of the ways to improve it.
Have you ever tracked anyone's bone density who has been doing high to moderate-high intensity strength training consistently, 2-3 times a week, for a number of years?
Are you aware of any studies going on in this area?
Thanks!
 
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bonebabe replied to SquashBlossom's response:
The short answer to your question is "no." When we do a bone density test, there is very little time allowed (1/2 hour per appointment) to go into detail with a patient about their exercise routine. We ask the questions that need to be asked to obtain the information necessary to render a result of whether or not the patient meets standards. The standard is to be on your feet at least 4 hours a day. Only in our rehab classes do we get into specifics.

Because bone density testing is done every two years, to be able to track someone who's been doing strength training as you suggest, we would have to look at DXA's for about 8 years, and then, because of aging and other health/lifestyle changes, the number may or may not be improved. It's really so very subjective that to identify exercise as a single altering factor is not reliable. I feel like I'm rambling here trying to explain. If we could track you every month for a year, then we might get some identifiable data, but bone is slow to respond to change and getting it analyzed every two years doesn't allow us to tell what's making the change - except in the addition or deletion of osteoporosis medications.

Now I can tell you that in young people who are very athletic, don't smoke, get a high calcium intake and build up their bone density to a maximum mass, unless they encounter some serious medical condition, their bone density will be better later in life than that of someone who's come late to the table regarding exercise and calcium.

If you've never reached your peak bone mass, no matter what you do later to build bone strength, it will never be what you're aiming for.

I hope I've not confused you more. There's a lot more to bone density testing and bone health than a T-score. And sometimes, you do everything just right according to standards and your bones are just crappy. Then there are those who do absolutely nothing extra and their bones are fine.

The bottom line is everybody needs to get their calcium, vitamin D and weight bearing exercise. But if your bone density is low, only a medication will strengthen it and only Forteo will actually grow new bone. Strontium may be something in the future that will be an answer, but right now it hasn't been approved in the US and for those who take the strontium citrate, the software for DXA's can't measure it, so you don't really know what you're getting.
 
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1eddie replied to An_223950's response:
I would like to know if you took just calcium with D or you added Fosamax or one similar to that. I am going to add strenght training to my routine
 
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An_223953 replied to 1eddie's response:
I am Anon_29099, but I can't seem to get in to WebMD this morning, so I've registered again under a different email address to access the forum.

My doctor urged me to take Fosomax or another bisphosphonate. However, because of concerns about the drugs' side effects, I decided to postpone doing so for one year while I tried Vitamin D, Calcium, and strength training. I made strength training my top priority and did it for a full hour three times a week, hardly ever missing. My plan was to reconsider taking the drugs if my scores did not improve in one year. I knew I was taking a chance by not taking Fosomax, but I figured that taking it was not risk free either.

The results of the bone test 13 months later were encouraging enough that my doctor said he no longer urged me to take the drugs, but that I should by all means continue strength training.

It will be interesting to see my bone density test scores next April.
 
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GreenofEye responded:
I am living proof that you CAN increase your bone density without medication. I tried Fasamax and Actonel. Both made me quite ill. I discontinued them, and I now have blood clots which I believe they caused. What I did to increase bone density after these horrible meds was: took a daily multiple vitamin, increased my vitamin D intake to 1,000 units a day and began walking 10,000 steps a day, walking up 3 flights of stairs slowly x2 a day and working out moderately with weights 1-3 times a week. I also increased my dairy (yogert, cheese sticks, cottage cheese). In 2 years after doing this and telling the MD's and the pharmaceutical companies and (Sally Field) to count me out, I improved my bone density (per the more recent dexa scan) up to 28% in the lower spine. Don't get sucked into the miracle drugs they hawk on tv. Increase vitamin D, calcium and exercise. Also, don't fall down. Some meds are necessary. My experience with bones meds was very bad. Don't let them frighten you into taking these bone meds. Time will show that they are BAD. Take control of your own body and fix it.


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