Should I be doing more

[Stickman]

Hi little under a year ago I was diagnosed with osteoporosis, my score is-3.5 in spine and-3.0 in right hip, I’ve been told I should go on prolia but have refused, my diet is poor, I don’t take supplements but I do get quite a lot of exercise, I’ve been told “why don’t you want to improve your bones it’s reckless” truth is I don’t feel any different and I guess I’m in denial about the whole thing, am I being reckless, should I be doing more?

[Met00]

My first question would be why prolia rather than alendronic acid or risedronate? If you take prolia, you can't just stop it (risk of rebound fractures if you do), so have to transfer to a bisphosphonate for a year. Apart from that though, I fully understand your reluctance to take any meds, but the alternative does need a lot of hard work and commitment, with no guarantees it will work. Have you had any fragility fractures? If so, your risk of further fracture is high, regardless of your t-scores. If you haven't fractured, there's a chance you never will, as t-scores alone don't tell you everything - bone density and bone strength are linked, but aren't the same thing.

Have you been tested for underlying causes of your osteoporosis? Things like low Vitamin D levels, issues with thyroid or, more commonly, parathryoid, some long-term medications (eg steroids, PPIs). If not, before you go any further, I'd go back to your GP and ask to get all this checked out.

If you definitely want to try a more "natural" approach, here are the things you should consider. First, you need a good Vitamin D blood level, as Vitamin D plays a crucial role in absorbing calcium. The usual UK recommended range is 50-150nmol/litre, but many experts say it should be at least 75nmol/litre, some say 100 or even higher than that. To achieve those levels you'll definitely need to supplement in the winter months, and probably all year round. Doctors will prescribe 800iu Vit D3, but for many people this is nowhere near enough. The only way to tell is to have regular blood tests.

Second, you need to eat healthily, to make sure your bones get all the nutrients that are needed. This should include plenty of calcium and protein (it's recommended to get calcium from diet and only supplement to make up any shortfall, although a lot of GPs are still prescribing calcium despite this - see theros.org.uk/information-a..., and a wide range of healthy foods, including nuts and seeds, and as little sugar as possible.

Third, you need to make sure the exercise you get is weight-bearing - walking as a minimum, as brisk as you can, running, dancing, jumping, skipping if you can do that safely (swimming and cycling are good for health overall, but don't do anything for our bones). Also add in exercising with weights and resistance bands - research from Australia shows that even those who've had fractures can do this safely, but make sure you're properly supervised to get the technique right and avoid injury.

Finally, most of us doing the natural route take a load of supplements - most important of all Vit K2-MK7 or K2-MK4 to direct calcium to your bones (otherwise the additional calcium absorbed by the extra Vit D could end up deposited in your arteries or cause kidney stones). Also many take magnesium and boron, and many take Vit C, zinc and maybe silica.

There's a lot of good information on the Royal Osteoporosis Society website I mentioned above, and you can use the search button here to read more about different people's experiences. Google is good too, but don't believe everything you read - make sure the source is sound and the research thorough - look for references to actual research, not just opinions. There are also various facebook groups that are very supportive.

[Stickman in reply to Met00]

Thank you, I can’t take AA because I have a hiatus hernia, so was offered hrt which caused me health issues so came off this and want me on prolia, I have had fractures of arm x 2, leg, hip and wrist. Did have blood done at the time and all was ok

[Met00 in reply to Stickman]

Ask what they'll put you on if/when you stop prolia. You could have a bisphosphonate injection/infusion instead of AA. That bypasses the digestive system so should be ok with a hiatus hernia.

[Stickman in reply to Met00]

Thank you I will check with my GP

[Hidden in reply to Stickman]

Yes, I have Zoledronate infusions, usually given annually. theros.org.uk/information-a...

[strongmouse in reply to Stickman]

You ask if you are in denial about having osteoporosis, but as you have had broken bones that seems unlikely, although not impossible.

I would ask the same question as above about why your diet is poor, as it could be for a whole host of reasons. Diet alone is no the answer to osteoporosis, but can help. Personally my diet is limited by lots of food allergies. The treatment for osteoporosis has moved on a lot in the last thirty years and what motivates me is having seen the effect it had on my mother who suffered from it for many years and lost several inches in height and suffered the consequences of that too. Although she had arthritis she made sure she walked everyday to keep her bones strong so well done for excersing.

I have not needed prolia yet but I am on zolendronic infusions and due a dexa scan this winter. We are individuals. Simply do the best you can to stay informed and look at ways of improving your diet one step at a time.

[Beeblebev in reply to Stickman]

I have a hiatus hernia and I'm on AA and have been for over two years. What is the problem with taking AA if you have this type of hernia? I was not told this...

Mind I do feel I was put on the medication without any discussion.

[Dribble in reply to Met00]

Terrific summary. This corroborated much of what I have learned and do. I do take alondronate - exactly as prescribed. All this has improved my spinal number from -3.6 to -3.0... I will stop the meds in 6 - 12 months, so we will see how it goes...

Best of luck with all the changes....

[BigBerth in reply to Met00]

Very comprehensive advice, Met00. Well done.

[Kathleen22]

You are not being reckless. It is reckless to take prolia which is the worst of the osteoporosis drugs. It is extreme.

Is there any reason your diet is poor? Eating lots of veggies and fruit is the best diet. Have yoghurt and bony broth as well as prunes and avocado.

Vitamin K2 is the best supplement because it aims the calcium onto the bones. Check your levels of vitamin D, calcium and magnesium. Magnesium has been found lacking in many women with osteoporosis. Vitamin D as well!

Try the natural route for a start.

My tscores are worse than yours. Have you actually broken any bones? I would not even consider the drugs if no bones have been broken that could not be explained such as bashing a toe or falling hard, etc.

[Stickman in reply to Kathleen22]

Yes broken 5 bones

[walk21]

I wonder why you have a poor diet? If it's because of the hiatus hernia I can understand. Small amounts of good nourishing food - vegetables and dairy if you can take them - would be a good start. The supplements Met00 has listed would be excellent. I would avoid Prolia (I do) but you need to do something to avoid further fractures. I would have thought if you have fractured hip and leg you would try eating better to avoid more fractures.

[Walkingdogs]

Hi, I was the same as you when I was diagnosed 8 years ago. My diet was ok and I had loads of exercise. Last year I got two fractures in my spine and when I had an mri scan, there was two old fractures as well. I lost 7cm in height and it was a very stressful and painful year. I take supplements and Alendronic acid now. I wish I’d done it 8 years ago. I mightn’t have had the fractures. Be very careful lifting things and bending your back over.

[Bernieisinthe]

Prolia is a shot you get every six months. IF you stop, you should take something else .

Before you take Prolia, be sure your thyroid is healthy.

Get all your teeth cleaned and fixed. Pull out any bad teeth and let your jaw heal.

.

[HeronNS]

There is so much you can do I wonder why you are reluctant? Please do not agree to prolia. Even if you have to take a medication there are others which are not nearly as problematic.

You can improve your situation without drugs if you are prepared to put some energy into it. You may be a bit depressed which can make it hard to get going, but do try. Set yourself a weekly goal, perhaps. For example: this week make sure your supplements are right and you are taking them at the right times and therefore getting the best benefit from them. Next week add a short walk - start walking if you don't walk at all, or increase the time if you do already take a little exercise. The week after, research other activities like Nordic walking and wearing a weighted walking vest. At the end of a month decide what you are going to add to your exercise regimen to keep youself on course. make sure you get out of doors every day. The week after that examine your diet critically and start making changes which will introduce foods that build bones (yoghurt, kefir, some cheeses like brie if you can eat dairy, more leafy greens like kale and broccoli) and cut back on things which don't help (too much animal protein including liquid milk, empty carbohydrates including sugar). Do things gradually so you don't feel overwhelmed or deprived. You will start to feel better and that will give you more energy and so on....