When should you take medication?

[FJMG]

I had a scan 3 years ago and got scores of -2.6. I decided not to take medication at that time and stuck with calcium and K2 supplements as well as exercise. I am vegan so eating dairy was not an option. I am sure that if my scores are worse on this scan I will get a lot of pressure to start on medication. When are scores bad enough to make medication truly worthwhile? I am terrified of the side effects as I am a very active person and have a physical job.

[Met00]

It shouldn't be your t-scores alone from your DEXA scan that inform any decision re medication. They should do a fracture risk assessment that predicts your fracture risk in the next 10 years and takes into account other risk factors, such as previous fragility fractures (from little or no impact, eg falling from standing height), certain medications, family history, smoking etc. If you're very active and have no other risk factors, your bones may well still be very strong - bone density and bone strength aren't necessarily related, but sadly at the moment DEXA scans can't measure bone strength, apart from a very small number of them that have added software that measure trabecular bone score (TBS) which gives a much better indication of strength. When I was first diagnosed, despite a t-score of -3.2 for my spine (-2.3 hip), I was told I didn't necessarily need to take meds. My GP persuaded me to take them, warning me that I otherwise risked ending up in a wheelchair or worse, but those scare tactics were uncalled for and misleading! I did take meds for a year, but they didn't agree with me and I've taken nothing further for the past nearly 7 years.

High impact exercise and progressive strength training are the most effective way of improving bone strength, alongside eating healthily and ensuring you get all the nutrients you need. You don't mention Vitamin D, yet that's the one thing that's almost impossible to get sufficient of through diet and in the UK it isn't possible to make it from the sun from about September to March.

If it hasn't already been done, I would also ask your GP to run blood tests to check for underlying causes for your osteoporosis: Vitamin D, calcium and parathyroid in the same blood draw, thyroid, coeliac and a full blood count.

[FJMG in reply to Met00]

Thank you - a very informative reply. I have been told I will have an assessment as well as a scan so hopefully we can negotiate the best way forward. I am afraid of getting railroaded into taking meds. I need to stand firm. And yes, am taking Vit D. Even in Cornwall there is not enough sun.

[SpaghettiIsGood in reply to FJMG]

very informative indeed. And I agree with met00. If you've noticed you fell before and haven't broken anything, chances are you're not likely to. Bone strength is different from bone density. Also, some foods, like spinach, stop calcium from working. So look up anti-calcium foods to learn which foods not to eat at the same time as calcium. Some of them are sweet potatoes and whole grains. I am having a hard time trying to figure out exactly what inhibits calcium absorption and for how long. I think i also read that if you eat something that contains insolluble fiber, that it binds to calcium. So that the calcium doesnt get absorbed, but instead gets flushed out of the body. A poster on here suggested a two hour window between the time you have calcium to the time you eat other foods that diminish calcium absorption.

[FJMG in reply to SpaghettiIsGood]

I heard caffeine but a blocker for calcium. That's a hard one as I have my tablets in the morning with my coffee. Have to be more creative with my schedule I guess.

[mHettyR in reply to FJMG]

I was diagnosed with Osteoporosis after a DEXA scan following an ankle break. Difficult to tell if the circumstances were minor or major trauma. I was devastated - my mother had had Osteoporosis so I knew what it meant. I did some research and decided i wanted to avoid the Alendronic acid if possible - not least because at 62 with teeth that are not great and often need dental work i was worried about ONJ. I discovered REM scans in my research and decided to have a REM scan to verify DEXA scores and to provide a base reading for yearly checks which i intend to have. The DEXA scores turned out to be inaccurate, not uncommon apparently, and the REM score diagnosed Osteopeania rather than Osteoporosis. The REM scan also measured Bone hardness, which turned out to be rather good. It is an ultrasound test so completely harmless, so you can have as many as you like - it cost £175. They have been shown to be as accurate as the DEXA scan. So, feeling like i had been given a bit of a reprieve but obviously not out of the woods, I am planning on a year of taking ADCAL, doing resistance training and i have started on HRT, all in order to strengthen my bones and avoid Alendronic Acid. Hopefully my REM scan will show an improvement next year.

[SpaghettiIsGood in reply to mHettyR]

Thank you for mentioning REM scans. One doesn't hear about that everyday, yet it could prove most valuable in diagnosis .

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