Bone Health
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Got my results, should I start meds or try to improve with exercise?

Total T score of spine L1 to L4 is -2.3

L3 -3.1

L4 - 2.4

L1 and L2 are - 1.7

Femoral neck, normal

Total hip, normal

FRAX interpretation high risk. DJR1 does this make sense to you? Do you know why top of spine is not assessed?

Do you think I can improve this through exercise and diet? My vitamin D is 110nmol and all nutrition good. How much exercise would I need to do to make a difference? What is the best exercise for the spine?

I've been prescribed Alendronic Acid but I'm reluctant to take it after reading all the side effects. What is your experience or best advice?

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With those results there is no need for you to be considering any medication. You should, however, make sure your diet is optimum. Lots of leafy greens, cheese like brie, yoghurt, kefir, other fermented foods (sauerkraut best known but there are many others). Cut sugar intake if you happen to like indulging a sweet tooth, and basically try to avoid processed foods, and not too much meat.

Supplements normally include moderate amount of calcium with Vitamin D3, but you should consider also taking Vitamin K2 as that necessary vitamin is lacking in typical Western diet. Sometimes a little extra magnesium is also a good idea. But most other micronutrients will be in a well balanced diet full of healthy vegetables.

Weight bearing exercise, can be as simple as walking, is very important. I bought a good quality weighted walking vest and I think this has helped my spine readings. You can add a couple of ounces at a time and gradually build up the weight. I'm sure others will be along with suggestions about exercises, I know there have been some good posts on here not long ago about exercise.

Look on these results as a heads up that you need to do more to keep your bones strong. I and others have been able to improve bone density through these natural measures alone. :)

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Hi there. I have recently had a reading of -2.3 in my lower spine which is the lowest of my T scores (can't recall the figures exactly). I am 53 and post menopausal. This is a 16% loss in bone density since my last scan age 47 yes. My GP has put me on aa. I am wondering if taking as is the best thing I can do? I have a BMI of 18.5 and exercise regularly and eat lots of soya yoghurt and lactofree milk. I am going to eat more oily fish and will take K2. I wonder if there are other meds I can take that actually help to build bone density or whether I'd be better off trying to improve it with diet and exercise or am I too old now to do this? Would really appreciate replies. Many thanks.

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Never too late! I'm well into my 71st year now. I was 68 when I was told I had low bone mass. I understand liquid milk is not the best dietary source of calcium. It's better to use the fermented forms, like yoghurt, some cheeses, kefir (don't eliminate liquid milk of course especially if you like it on your cereal or in your hot drinks). Leafy greens (not all, kale, collards, broccoli good, spinach not so much) are real calcium powerhouses. I eat leafy greens every day and now I crave them if I don't get any. I also eat fermented vegetables like sauerkraut and its many relatives, just a little. Good idea to introduce fermented vegetables, kefir and kombucha very slowly in small amounts if you aren't used to them. Apparently having a small helping of yoghurt (I eat plain, full or 2% fat organic) with your calcium supplement helps with calcium absorption.

A study showed that nutrition and exercise can improve bone density, despite some doctors' claim that you must have medication.

hindawi.com/journals/jeph/2...

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Hi HeronNS,

Many thanks for this. I will read the articles. My GP prescribed aa. But when I spoke to the National Osteoporosis Society UK they said not necessary as I have osteopenia not Osteoporosis! So I'm going to ask for a referral to a specialist but due to NHS cuts they are reluctant to do this! In the meantime I'm going to see a dietician/nutritionist and do more weight bearing exercise! Leah

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I think it is standard only to assess the lower spine. this must be where the load bearing is occurring. I don't understand your high risk of fracture, especially with normal hip readings and only one vertebra even in the osteoporosis range.

There are ways to protect your spine while your bone density improves over the next few months. Can you consult a knowledgeable physiotherapist?

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This link explains the FRAX scores ncbi.nlm.nih.gov/m/pubmed/2...

The top of the spine is not scanned as the ribs and sternum are in the way.

The L3 vertebra has brought the FRAX into high risk as there is a lot of bone loss here. My advice is limited as I was involved in diagnosis only.

What I will say that it is possible for vertebrae to collapse if they are very osteoporotic. This is serious as it traps nerves and can cause a lot of pain and may affect movement. You need to weigh up the side effects of the AA with the risk of further bone loss in that vertebra which may possibly cause subsequent collapse.

I hope others on the forum can advise on the side effects of the medication. With what I know I would take it. The aim is that the drugs stop further bone loss and usually they are effective. Exercise will not improve bone density it is a preventative measure and can prevent further bone loss. Advice should be taken on the type of exercise you do as you must protect that vertebra from anything to rigorous. I hope you get some further posts with personal experience which may be more helpful.

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My spine results did improve in less than a year and I credit my exercise as well as the nutrition and supplements. It IS possible to improve bone density without drugs, and to do it as quickly as the drugs do.

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Hi DJRI

I agree with what you wrote, "What I will say that it is possible for vertebrae to collapse if they are very osteoporotic. This is serious as it traps nerves and can cause a lot of pain and may affect movement. You need to weigh up the side effects of the AA with the risk of further bone loss in that vertebra which may possibly cause subsequent collapse."

This is my worry.I could not tolerate the AA or risedronate but have taken strontium ranelate for quite a time. This was withdrawn last year unfortunately. I had no known side effects from this drug. I take the supplements and do the exercising and walking. The doctor says that with my spine in the condition it is in, with a total spinal T-score of +2.5, this figure is unreliable because of scoliosis and degenerative changes in the spine. This was the result of my dexa in 2015.

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DJR1 - Correction - Weight-bearing exercises, and walking, WILL improve bone density. Drugs currently available have many adverse side effects. Believe me, I have experienced this first-hand! I would NEVER fall for any of these so-called solutions!

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This is the definition of osteoporosis from the NOS.

“Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure.”

You cannot strengthen bone that has been lost. You can improve bone density by medication and exercise if there is sufficient bone in the osteopenia range. Low T scores of -3.5 indicates bone loss is severe and the remaining bone structure is fragile. You cannot make more bone by exercise. Understanding low T scores is vital for the correct treatment and professional advice should be taken.

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Thank you. DRJ1. I wanted to know if you can make new bone because I don't understand it all yet. So if T score is -3.5 does it mean you cannot replace bone in that particular vertebra? I've got another docs apt at beginning of March so I can ask doc for more info then. I'm still digesting the bad news.

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Hi Nanaedake I am afraid you can’t make new bone. The medication works to stop more bone loss and strengthen the remaining bone. There is a photograph on the NOS website that shows bone loss. We used to do trials of the new drugs and it was very rare anyone dropped out due to side effects. I cannot speak from personal experience on side effects but I saw many people crippled with vertebral collapse as they had not been treated. I would ask a lot of questions when you see the Consultant if you are unsure. You have just one osteoporotic vertebra which means that it has been caught in time and you can stop the situation worsening. The advice on the NOS is good regarding exercise as you must protect that vertebra. Every patient is different and the important thing is your T scores. Different scanners will give different results too so the trick is to always have scans at the same unit. Some differences in pt results are down to scanner calibration. Consistency is important as in all types of scanning and some people may attribute big changes in bone density wrongly to exercise or nutrients when in actual fact it was scanner calibration differences. Be wary take the advice of your Consultant.

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Thank you for that information DJR1. Very helpful. I've printed off the exercise info on the NOS website as I do various types of exercise. It looks like walking is pretty safe and I have a walking pole if the ground is rough.

I need to get my head around why the osteoporotic bone can't make new bone to replace the old bone. I don't understand why it stops regenerating and I find it difficult to come to terms with the fact that it's permanent.

It's very reassuring to hear most people didn't have side effects to drug treatment but I wish I'd found out before it got this far.

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If osteoporotic bones can't make new bone, how can they heal themselves? We know fractures do heal, even if they take longer to do so. As bone throughout life creates new bone and removes old bone, how can it be possible that an osteoporotic bone cannot make new bone? Have all the osteoblasts died?

How do the drugs work? Most of them work by restricting the action of the osteoclasts (bone remodelling cells which remove old bone). The bone becomes more dense because the osteoblasts (bone building cells) continue to work. Teriparatide is a drug which enhances the action of the osteoblasts instead of inhibiting the osteoclasts like the bisphosphonates and denosumab do.

The action of the osteoblasts can be encouraged by the right nutrition and by appropriate exercise. This should be done whether or not drugs are taken. Far from it being impossible to make new bone, this is exactly what is happening when the bones are treated with drugs or naturally or both.

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HeronNS Do you have links to any good scientific documents I can read up about how bone rebuilds (or fails to) in osteoporosis? I don't have a consultant to speak to, just the GP so I need to read as much as possible. I'm looking into everything I can. My nutrition is very good and I've taken supplements for a while although I didn't know I needed calcium. I need more exercise but have improved it a lot in the past 12 months with classes or the gym every other day. I've recovered a lot of core strength without realising my spine was dodgy. This is something I'll maintain whether I take prescription drugs or not.

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I have spent some time trying to find the answer. Of course most of the literature which pops up deals with medication, and that's not what we are looking for. However when I found this question:

how does osteoporosis affect the bone matrix and the normal bone remodeling cycle

and put it in the google search line it came up with a number of articles which look interesting.

I didn't find anywhere that bone ceases to be built, only what we know already, that the breakdown of old bone begins to exceed the construction of new bone once we are past middle age. This is what the medications are designed to correct, but it is proven that many of us can use natural means to achieve the same end. This is not just anecdotal. Those of us who believe this have proven improvement from our own successive DXA readings. And for those who have very serious OP then it is possible that a couple of years of medical intervention along with the natural method will be beneficial. This, I believe, is the way that medication should be used, as a treatment for a serious condition to help the body as it begins to heal itself. It should not be necessary for most people to have to rely on meds, certainly not as the main source of healing, and certainly taking them for many years is becoming more and more questionable. If we can manage without them we are in the long run better off, because what we do to heal our bones through nutrition and exercise will help all our other body systems.

ncbi.nlm.nih.gov/pmc/articl...

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hindawi.com/journals/jeph/2...

If you do elect to take medication is is likely best to limit it to only two years to gain the most benefit and limit the possibility of side effects. Personally I was too terrified of the meds to try them and am very glad that I didn't. My bone density improved enough that they are no longer recommending medication. My doctor asked me how I did it. :)

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nos.org.uk/about-osteoporosis/

This website will give you a very good explanation about diagnosis and treatment.

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From my own personal experience, I would definitely say NO to the medication, and emphasize the importance of walking, weight-bearing and flexibility exercises, and a good diet - in other words, basically what HeronNS said above. And don't forget to take sufficient calcium, magnesium and Vitamins K2 and D3. All the best!

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I have eaten a good diet eating much of what is recommended for years and my readings are still terrible. I have a T reading of -4.9 in the lowest part of my spine - I haven’t seen anyone else have anything near that since reading these posts so far. This makes me think exercise alone won’t do much and medication can’t be avoided. I am adding supplements now and will get hold of vit K2. I’ve just taken my second AA pill because the doctor said any referral to a specialist is pointless until I’ve taken AA for a bit. I’m waiting till the week after I’ve taken the 3rd one to see her in person and ask for a referral since I am on levothyroxine as well and this may have exacerbated the osteoporosis. I think more exact monitoring of calcium and vitamin D is also necessary than just relying on my diet to cover it which is what she thought.

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Very helpful since I'm on Levothyroxine too. I think the poor quality levo on NHS between 2008 and 2013/14 may have contributed

Did you take TEVA Levothyroxine?

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If you get vit K2, see if you can get it in the form of MK7. Apparently the Japanese prevent bone deterioration by eating Natto which is a fermented bean and MK7 is the form of K2 in Natto. I don't think there is much research in UK but research has been done in Japan. You could look onto it.

Prunes for boron and magnesium seem to be important. Has anyone on this forum found it had helped?

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Thank you. Someone (I can’t find the post now) mentioned a lengthy interview online with a Dr Keith McKormick. This listened to this morning. He’s written a book available on Amazon about osteoporosis. I don’t have the title of it to hand but will post when I do. He sounded extremely knowledgeable about every part of osteoporosis and how the body needs to be looked at holistically so that treatment is about getting everything in balance - in particular establishing if there is any chronic inflammation in the body of any sort even if there are no symptoms. So if there is any liver or kidney diseases or coeliac disease or a problem with the immune system for example. Any of these can cause the process of absorption of the correct nutrients from the gut not to be maintained and therefore a deterioration in bone health. I think I need to get the book rather than attempt to explain more from my scrambled notes - interestingly he has had been an extremely active athlete and eaten very well and still has osteoporosis. He decided as a doctor he must get to the bottom of understanding how the process occurs rather than throwing drugs at it. He says it’s key to work as a team with your physician but that physician needs to do the right tests. On calcium, vit D levels, magnesium, and the correct ph level in the gut. (Not too acidic). Hope this helps. It’s making me think I need to find a physician who is very holistic minded and prepared to do lots of readings. Taking AA doesn’t really solve anything without much more info about the patient and his/her other health issues.

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What you are saying is correct. I had a long term illness which affected my body's vitamin D levels. I was never given proper advise and so now I have a beginning of osteoporosis in my spine and osteopenia in my hip. Now that I know what the imbalance was I am taking steps to correct it. I have never broken anything and I am working hard with supplements, diet and exercise. I have also bought the same vest as HeronNS to use when I do not make it to the gym or even at the gym in the future. Everybody's situation is different but oseoporosis is not a death sentence. It is my experience that doctors do very little to help us prevent problems, but when we have them they are very quick at prescribing drugs telling us that the side effects are rare. Be aware that some medication's damage is not reversible, so factor this in when you make your choices.

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That’s really helpful re meds and side effects. Thanks v much.

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I have taken levothyroxine for 51 years since having a nodular goitre removed in my teens. I just took what was prescribed for me with annual blood tests. At one point I noticed a lump appear in my throat and on seeing an endo he told me that too much thyroxine can weaken bones. I had been taking too much apparently ( had had a recent blood test via the GP and one done via the endo and that was when the error was found). On having a dexa scan all was ok. It is much later that I was diagnosed with osteoporosis. Hey ho!

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Thyroid hormone is complicated and swings up and down in meds may be a problem if swinging over and under lab ranges. If FT4 and FT3 are in range it isn't a problem I believe. I don't think there's enough research on what not enough or too much Levothyroxine does to bones. The interaction between hormones is complex.

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After my terrible experience being diagnosed as osteoporitic on the basis of low T-scores, and consequently being given a drug called Prolia which has caused me to be in agony ever since, I would say, do your own homework, go to a good natural therapist and concentrate on the basics: diet, weight-bearing exercise and walking. It seems to me (as a former nurse) that the medical world has gone crazy, prescribing drugs that have more adverse affects while offering no true solutions. Because of the horrific effects of the injection I was given, I have been unable to exercise as I've been living with excruciating pain ever since. I've been back to my GP once since then. All he offered me were stronger drugs that have severe side effects!!

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I will try to avoid Prolia then. I feel I have no option but to take meds as my readings, ages 57 are so dire. The specialist I saw is well-renowned and a previous chairman of the NOS board. At a T reading of -4.9 in L4 he says there is no way any changes to diet and exercise will change the readings of my v bad hip and back. I don’t agree with him entirely of course but it sounds b pessimistic. I am wondering if the daily injections mentioned elsewhere, of a very expensive drug (for only 2 years) is safe and well-tested.

Bone renewal is definitely difficult to achieve post menopause it seems, especially with my readings. I have just started goat kefir this morning. Can’t say I go for it really!

My consultant is testing for coeliac disease next. If I have that that’s not a bundle of laughs either.

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Keep an open mind about Prolia. There is the possibility of rebound vertebral fractures should you stop the Prolia after a number of years and not continue with another OP drug. You can always call the NOS helplines and chat to them about your OP medication options.

Forsteo, daily injections, for a maximum of 2 years appears to have positive reviews but also has possible side effects and you do have to continue with another type of drug afterward the two years. So once again you have the dilemma, as to which one to continue with.

All medications have possible side effects and as we all react differently there is no way of knowing how it will go unless there is of course a particular possible side effect where you are not prepared to take the risk for whatever reason.

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