Osteo Help ff 1st Endocrinologist Visit, Advised Cortisol Testing

[FlowerPreciousLover]

I'm 77; have been on osteoporosis meds since 2008 including Fosomax, Forteo & 5 yrs, Reclast. FF annual Dexa scan in Aug. 2020 was told to stop Reclast for 1 yr.

Prescribed Metformin for pre-diabetes Jan, 2019. Became nauseated with loss of appetite and weight. Stopped Meformin May,2019 but wt loss/continued. Lab and Ultra Sound found no cause of wt loss. 27 lb wt loss from 128 lbs 1/19 to 101 lbs, 3/21. I also take 3 prescribed drugs for COPD.

Took 2 requests to get the Endo referral for supplemental/other help for osteo in addition to 1200 mg calcium, 5,000 iu Vit D3 and 1,000 mg fish oil. Specifically asked about magnesium, Vit K2, and few others. Told studies have not shown any bone improvement with these or other supplements. Very disappointed.

Told to go off 2 of COPD drugs and PCP prescribed appetite enhancer, Megestrol which I'd just recv'd Sat before Mon's apptmt. for 2 months in order for Cortisol testing. Called back but didn't get return call on purpose of Cortisol test and which kind...blood or salavia..read cortisol levels change throughout the day.

From reading, high cortisol levels indicate wt gain; only 1-2 suggest low levels and wt loss. Figure I have high levels because I'm on an anxiety med. and worry wart.

Asked about dietitian and p.t. referral for bone & wt loss and was told walking was the best for bones...3 x's/wk for min 20 mins. I already do that as well as 3-5 hrs tending landscaped yard for flowers, weather permitting. Nothing further until cortisol testing scheduled for June.

Not sure the role cortisol plays for bone density; not sure of intent for cortisol testing; not sure if I want to go off 3 drugs until seeing my pulmonologist in April and seeing if appetite enhancer leads to wt gain.

I eat a healthy home prepared diet with few processed foods; I know wt bearing & balance exercises are good and do some bal. ex. at home.

I know that traditionally prescribed strong muscle relaxers which knocked me out helped less with pain relief than acupuncture for a back injury yrs ago and still helps when I have a back flare up.

Can others share improvements made in your Dexa reports from taking additional supplements that both my PCP and Endo do not recommend? Can cortisol testing suggest more ways of helping strengthen my bones?

[restlesspegs]

Sorry to hear about your troubles. Regarding K2, magnesium etc, there's plenty of evidence to suggest they are helpful. Some examples:

Vitamin K2:

medicalnewstoday.com/articl... A 2018 review, for example, concludes that vitamin K supports bone health in various ways and may help prevent osteoporosis.

pubmed.ncbi.nlm.nih.gov/320... At the endpoint, the bone loss of femoral neck was significantly lower in postmenopausal women in the two 90 µg groups (treatment × time, p = 0.006) compared with placebo, but no effects in men

ncbi.nlm.nih.gov/pmc/articl.... K2 did not affect the DXA-BMD, but BMC and the FNW had increased relative to placebo. In the K2-treated group hip bone strength remained unchanged during the 3-year intervention period, whereas in the placebo group bone strength decreased significantly.

pubmed.ncbi.nlm.nih.gov/235... MK-7 intake significantly improved vitamin K status and decreased the age-related decline in BMC and BMD at the lumbar spine and femoral neck, but not at the total hip. Bone strength was also favorably affected by MK-7. MK-7 significantly decreased the loss in vertebral height of the lower thoracic region at the mid-site of the vertebrae.

hindawi.com/journals/jos/20... Vitamin K plays an important role in bone health. Low vitamin K intake, low serum vitamin K values, and high levels of ucOC are associated with risk of fracture (especially hip fracture) in observational studies.

melioguide.com/osteoporosis... A 2015 study (12) looked at absorption in mice to see whether consuming more than one fat soluble vitamin at a time increased or decrease the absorption of the others. The study showed “significant competitive interactions for uptake” between Vitamin D, E, A and K. It seems that the only fat soluble vitamin that did not lose out was Vitamin A when taken with vitamin E. The recommendation on Consumer Lab is that if you want to benefit from maximum absorption on your Vitamin K that you take it at least 3 hours apart from other fat soluble Vitamins (D, E and A). To learn more about this listen to my interview with ConsumerLab’s CEO, Dr. Tod Cooperman on Calcium Supplements for Osteoporosis.

Magnesium

academic.oup.com/ajcn/artic... Greater potassium intake was significantly associated with greater BMD at all 4 sites for men and at 3 sites for women (P < 0.05). Magnesium intake was associated with greater BMD at one hip site for both men and women and in the forearm for men.

ncbi.nlm.nih.gov/pmc/articl... Although the evidence is still fragmentary, most of the experimental and clinical data available in the literature point to Mg as a contributor factor to bone health. Consequently, optimizing Mg intake might represent an effective and low-cost preventive measure against osteoporosis in individuals with documented Mg deficiency, while doubts remain about supplementing the general population with the mineral since too much Mg seems to have detrimental effects on the bone

academic.oup.com/nutritionr... At the end of the 2-year study, magnesium therapy appears to have prevented fractures and resulted in a significant increase in bone density.

medicalnewstoday.com/articl... / link.springer.com/article/1... In middle-aged Caucasian men, low serum magnesium is strongly and independently associated with an increased risk of fractures. High blood magnesium levels were defined as more than 2.3 milligrams per deciliter.

[FlowerPreciousLover in reply to restlesspegs]

Restlesspegs, Thank you so much for responding and taking time to provide me with some excellent further reading/consideration resources.

I really appreciate the help and know that traditionally trained docs don't always have all of the answers.

The doc actually returned my call late yesterday and said the cortisol testing was to check for "adrenal insufficiency". I appreciated her call. Now to read more about that as well.

[Mark_ABH]

Hello! Thank you for sharing your story on our forum. Many people ask us about supplements for magnesium, K2 and other nutrients. When we discuss this with our expert Medical and Scientific Advisory Board, they explain that evidence isn't strong enough to support taking supplements of these nutrients to improve bone density. There are some studies out there (restlesspegs shared some links), but you'll notice they have "n" of 200 or 300 people -- small studies. We know that being low on nutrients like magnesium and K2 is bad for the bones, but that doesn't necessarily mean you should run out and take supplements.

As far as cortisol testing, that's one of many tests that health care providers might order to assess why you're losing bone: americanbonehealth.org/bone...

Re. your medicines: Metformin actually seems to reduce fracture risk, whereas some other diabetes medicines can increase fracture risk: americanbonehealth.org/bone...

If you have been taking corticosteroids for your COPD, that could have led to your osteoporosis: americanbonehealth.org/bone...

I hope you and your health care team are able to get to the bottom of your health issues!

[SjRinKS]

Let's hope it's not adrenal insufficiency as the meds for that are steroids and that's part of why I have osteoporosis. I also have hypothyroidism as well and my TSH was too low right after starting meds for the adrenal insufficiency. So it took awhile to get good balance. Since then I've been weaning off the prednisone and hope to be able to get off it some day.