Osteoporosis worries

[Acorn26]

Hi all, I have had severe rheumatoid arthritis for 39 years. In later years I’ve had both hips and knees replaced. Recently I suffered a fractured shin. At the bone density scan I had , because of the bilateral hip replacement, the nurse said she could only measure my spine. The rheumatologist said the results showed I only needed to take calcium tablets but I’m not convinced. Years of low activity and weakness leave me worried about osteoporosis?! Any advice appreciated 🙂

[Met00]

NICE guidelines for osteoporosis recommend that for most people calcium should be obtained from diet. Did the rheumatologist explain why you need to take a calcium supplement? You can use this tool to check how much you're getting in your diet: cgem.ed.ac.uk/research/rheu.... It is important, however, to ensure that you get enough vitamin D, so I would ask your GP to do a Vitamin D blood test. At the same time you can ask him to do a range of tests, including calcium and parathyroid (they need to be done at the same time) and thyroid. I was advised by a consultant to raise my blood D level to at least 75nmol/litre, preferably 100, so once you get your Vit D results you can see how far off your own level is from this and supplement accordingly. Vitamin D plays an important role in absorbing calcium. On average it's reckoned that every 1000iu of Vit D supplement will raise the blood level by 25nmol/litre, so that will give you a starting point, but you'll need to check your Vitamin D again in 4-6 months to make sure your blood level has gone up by the right amount, and continue testing, preferably twice a year, to monitor this. I hope you have a supportive GP, but if not, it's possible to test your own Vitamin D with a private kit from an NHS lab (vitamindtest.org.uk/). Along with Vitamin D it's recommended to take Vit K2-MK7 or K2-MK4, as that helps send calcium to the bones. It's usually recommended to take magnesium too, with magnesium glycinate considered the gentlest on the stomach.

Supplements alone, of course, won't be enough to protect your bones. You also need to have a healthy diet (high calcium, protein, magnesium, low sugar, caffeine and alcohol), avoid smoking and exercise as far as you're able. I assume with rheumatoid arthritis that exercise is likely to be difficult, but any weight-bearing exercise you can do will be beneficial. There are some good exercise videos on the ROS website, including seated ones for those who cannot stand for long: theros.org.uk/information-a...

[Acorn26 in reply to Met00]

The rheumatologist told me the results showed I was in the at risk area but not quite in the osteoporosis range. After stressing I would like to start some form of treatment- for future protection, I was informed the consultant has suggested calcium tablets with vitamin D was sufficient.I am confused why during my bone density scan an alternative site such as my forearm was not tested? Can they have an accurate picture of overall body bone density from only a spine measurement?

[Met00 in reply to Acorn26]

In theory you only need to scan one area, because bone thinning is systemic, meaning it normally occurs at the same rate across the body. However, DEXA scans aren't totally reliable anyway (for example, you can't compare results from different machines, which means there has to be a significant margin of error). If you're in the "at risk area", I assume that means you have osteopenia. So it depends whether your fractured shin was a fragility fracture (one that happened with little or no impact, for example falling from standing height, and which wouldn't have happened to other people in the same circumstances). If you did have a fragility fracture, that raises your risk of fracturing again. If not, then your fracture risk would probably be quite low. I would guess that if the rheumatologist said you don't need osteoporosis medication at this stage then he must consider you to be at low risk, as they're usually quite quick to prescribe. There are other things you can do, apart from taking Vitamin D (and maybe calcium, though that isn't usually recommended), as I explained in my previous post. I know it's very worrying to be told you've lost bone density, but if you don't have full-blown osteoporosis yet, you're in quite a good position to help your bone health.

[walk21]

Met00 has put it better than I could. Vitamin D is important and Vitamin K2 to go with it

[fraid]

Taking calcium will help your bones,other treatments can have dreadful side effects,why I didn’t accept Prolia.

[Kaarina in reply to fraid]

Me too. So relieved I said no and the doctor did not "argue" with me either. I said I would not take the risk of more aches and pains than I already have from arthritis and a revision total shoulder replacement that has not worked that well.

For what it is worth. I had to keep calling for a dexa scan that I should have had 15 months ago. Due to the pandemic they were not doing scans for quite a while.The only machine the hospital had was broken for SEVEN months. I phoned last week and she said the new machine had been installed two weeks ago and the first appointment she could give me was the middle of August and I said I shall take it.