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Drug treatment for premenopausal osteoporosis?
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An_224024 posted:
Hello Dr. Cohen,

I am a 38-year-old woman who was diagnosed with osteoporosis after a vertebral fracture two months postpartum with my first child four years ago. I had the same vertebral fracture (T10) at the same time (two months postpartum) following the birth of my second daughter last summer. Both fractures involved minor movements (no trauma). I have chronic back pain and this most recent fracture does not seem to be healing well, though I am eight months postpartum. My doctor has recommended against osteoporosis drugs at this time. My T score was -3.8 in the spine at my last scan in November. What would you recommend? I'm terrified of fracturing again, and my baby is very heavy (22 pounds), so I'm constantly stressing my spine. Any advice would be gratefully received!
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bonebabe responded:
I'm so sorry about this, for I know it's very hard taking care not to fracture when you have small children.

Your doctor is right. The osteo meds have not been approved for premenopausal women and especially care needs to be taken when you're still childbearing.

Also, you may or may not know, pregnancy and breast feeding deplete bone mass, so it's extremely important that you get enough calcium into your body. Prenatal vitamins aren't enough. You need to be getting around 1200 mg each day. This can be in the form of pretty much any supplement out there, including Tums. Just be sure to read the label carefully and see what the dosage for 600 mg is. Your body won't absorb more than that at one time. Take your calcium with meals - usually we tell our patients lunch and supper or with a bedtime snack.

Also, if your doctor hasn't checked your Vit D levels, that should be done. If it's in the normal range you need to get 800-1000 IU each day. If you get a calcium supplement with D, that should take care of it.

You really need some immediate instruction in body mechanics to avoid further fracture. Right now, go online to the National Osteoporosis Foundation (www.nof.org ) and order their $6.50 booklet "Boning Up on Osteoporosis." It gives you lots of information in addition to illustrations of body mechanics for daily living. You could also ask your doctor for a referral to physical therapy for additional instruction.

I'm hoping one of the PT's on this board will chime in with some tips for handling the baby. At the very least, try not to do any forward bending of the spine when picking up toys, laundry, etc. Use the golfer's stance instead. Watch them on TV when they pick up their balls. Also no side to side twisting of the spine. Every time you do one of those moves, it weakens the bones in your spine.

As far as your osteoporosis diagnosis and T-score....because you're premenopausal, you don't get a diagnosis yet. You also look at your Z-scores, not T-scores. That doesn't mean you don't have to worry and take action, it just means you don't have a diagnosis. It may seem petty, but if you're completing any kind of medical or legal document, it's an important distinction.

So...get started on your calcium and D today, if not already and order your booklet. The website also has information on it too that you may find useful.

I hope this info is a start for you and you get some more help soon.
 
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NATIONAL OSTEOPOROSIS FOUNDATION
Adi Cohen, MD, MHS responded:
Pregnancy and breastfeeding are both known to be associated with decreases in bone density that are followed by recovery. However, when bone density remains below the expected range for age, or when there is a history of low trauma fracture, a thorough evaluation for additional secondary causes of bone loss and bone fragility should be considered.

For detailed information about low bone density and osteoporosis in young adult women, please visit the following link www.nof.org/aboutosteoporosis/whatwomencando/youngadultwomen
 
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An_224025 replied to bonebabe's response:
I'm 53 now, and my osteoporosis started in my 20s. It wasn't treated for the same reasons. Now I'm crippled from fractures that won't heal, because no one knows how to treat PRE-menopausal osteoporosis! I can barely walk, even with a cane, have 3 pelvic fractures on the left that have never healed, and multiple vertebral fractures, and have lost 5" in height. We now know the culprit was kidney disease I suffered as a child. However, now that I *am* entering menopause, I have other conditions that make it difficult to treat my osteoporosis with traditional drugs. More--much more--needs to be done to prevent what's happened to me, and what is currently happening to this patient. She's young. Don't let her end up like me because there's more money treating menopausal age women. Treat the young ones before it's too late. Find out WHY they're losing bone. Do 24-hour urine tests first. Good luck.
 
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mama4girls replied to Adi Cohen, MD, MHS's response:
I also have premenopausal bone loss. My z-score for femoral neck is -2.7 and for lumbar spine is -1.9. This was found out when my urologist ordered a DEXA scan after I had large calcium kidney stones. He does not want me to take supplemental calcium any longer and suggested evista or fosamax-both of which I refused as I may have more children and do not want the risks. I have four children and breast fed all four. I stopped breastfeeding the last one several months before the DEXA scan. Do you think it is possible that I may still have some recovery of my bone loss? My primary physician has done a work-up to rule out secondary causes. I do have a very strong family history of osteoporosis, so I feel I need to try to do whatever I can to improve. I have been trying to add more weight-bearing activity. Do you have any further suggestions? A pharmacist recommended possible use of Miacalcin because of the short half-life(so if I did become pregnant it may be less of an issue). Any thoughts would be appreciated.
 
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bonebabe replied to mama4girls's response:
You need to get as much calcium as possible through your diet. Do it continuously throughout the day for better absorption.

Has your doctor talked to you about birth control pills? They do help with bone density. You might also ask for a referral to an endocrinologist or osteoporosis specialist. If you don't do something now, you will fracture as you raise your children and that can be extremely debilitating for you and difficult for them.
 
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lurlm replied to bonebabe's response:
I would suggest that anyone with these clinical manifestations and at her age have a full blood and lther lab test to rule out Hyperparathyroidisim. This problem is overlooked far too often as a causal factor.


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