Medication

[Capan24]

I meet with my doctor this Monday to discuss my bone density results. I am sure she is going to want to start me on medication for osteoporosis. I read about all the medication side effects and it scares me. I was wondering how many are doing well on the medication? What kind of side effects you are experiencing? I am 62, very active, bike, walk, resistance bands for exercise, vegan diet, don't smoke, consume little alcohol. I am on the fence about taking medication and want to gather info before making a decision.

Findings from recent bone density:

Lumbar spine T-score: -2.5

Left femoral neck T-score: -2.3

left femoral neck BMD: 0.713

left total hip T-score: -2.2

right femoral neck T-score: -2.6

right femoral neck BMD: 0.675

right total hip T-score: -2.4

left forearm (33%): -2.6

[Met00]

Unless you have other factors (specific health issues and/or medication) that raise your fracture risk, you shouldn't be prescribed medication with those results, as they're only just within the osteoporosis range. The decision about medication should be based on a fracture risk assessment (eg FRAX), which takes into account a range of risk factors, not just t-scores, and medication shouldn't be recommended unless you have more than a 10% risk of fracture in the next 10 years. To my mind, even a 10% risk, if you turn the figure around, is still a 90% chance that you won't fracture, which to me still wouldn't warrant meds. The bisphosphonate meds (standard prescription) only reduce fracture risk by 50%, so if you had a 10% fracture risk, it would reduce to 5%. Put another way, that means if 100 people had a 10% risk, without meds 10 of them would fracture, 90 wouldn't; with meds 5 would fracture, 95 wouldn't, but of those 95, 90 wouldn't have fractured anyway. This is explained clearly in a NICE (UK health regulator) patient decision aid: nice.org.uk/guidance/ta464/...

[Capan24 in reply to Met00]

Thanks. I did have a fracture of my left hip, not serious though. It was from a hard fall off my bike. I actually got side swiped by a car. I was very lucky. Definitely will look into my risk factor.

[Met00 in reply to Capan24]

It should only be fragility fractures they're concerned about, ones that occur with little or no impact. Being knocked off your bike by a car definitely isn't a fragility fracture!

[dcdream in reply to Met00]

Thanks for sharing this information. Seems like doing nothing isn't as bad as I thought it would be.

[FearFracture in reply to dcdream]

Increasing calcium intake along with other needed vitamins and minerals and cutting foods/beverages that can harm your bones (caffeine, colas), and exercising isn’t doing nothing. 👍🏻

[dcdream in reply to FearFracture]

That's what my doctor said to me. He said no amount of exercise or food will help you. However, learning body mechanics and bone health factors is good for anyone and helps prevent fractures from falling.

[FearFracture in reply to dcdream]

I’m not a doctor and I don’t know the all the details of your health, but I would be leery of any doctor who said that. One might not be able in increase BMD via natural means, but I recently read Dr. Brown’s Better Bones, Better Body and she as well as other medical professionals seems to think that just taking calcium and vitamin D supplements can help women w/ osteoporosis, not necessarily by increasing BMD but by potentially warding off fractures.

[Capan24 in reply to FearFracture]

I take Citracal Maximum Plus. It has calcium, vitamin d, zinc, copper, and manganese. I was looking into taking vitamin k2. I read that it is suppose to help with bone mineralization.

[dcdream in reply to FearFracture]

Thanks for the info. I'm going to check out the book you mentioned.

[Alisa25]

It’s a tough decision. I’m 63. When my scores were similar to yours, I opted not to go on meds. Unfortunately, my T-scores in my spine and femoral neck got worse and further Iab work showed I was still losing bone too fast, so I decided to at least try to slow it down with the meds. I’ve been on an oral bisphosphonate (Alendronate Sodium) for 4 months now and haven’t had any issues so far. My CTX score dropped considerably since I’ve been on this medication. My hope is to get off of this drug after a year and keep monitoring my bone turnover through CTX lab work and Dexa scans. I know its a hard decision to make. Best of luck to you.

[Capan24 in reply to Alisa25]

Thanks for your reply. My bone loss is significantly getting worse From my 1st scan. That's what I'm afraid of. I don't want to fracture something and be laid up. I'm very active. I know the medication is scary. It's nice to hear that you haven't had any side effects.

[dcdream]

At your age, my scores were very similar. My doctors began pushing meds even before that and still do today. My scores have gotten worse the last 10 years and like you, I'm very healthy and active. I have a 16% chance of fracturing at my age of 68. I still am holding off on meds due to side effects and how they produce brittle weaker bones that are more prone to fracture as one ages. I saw my mom go through this off and on cycle of fosamax in her 70's and once she stopped them in her 80's she began to fracture. The research is clear that once you begin, you tend to need them for life, as the failure of the bones to build new bone by removing old bone isn't the same after you put this fake bone onto your bones. For some reason, the bones can't remove that fake bone. It becomes a chronic health situation with meds. That said, I may be forced soon to begin meds if I fracture but I am continuing with my lifestyle, eating habits and attend body mechanics classes / therapy so that I can avoid fracturing in the future. I am hoping to avoid falling, which is the primary reason for fracturing. Good luck with your decision. The rest of the world is also concerned about developing meds that don't have this side effect, so that women will not hesitate to use them. You are not alone in this because research also demonstrates that many women won't use said drugs because of these fears and that the current meds are not meeting the needs.

[Capan24 in reply to dcdream]

Thanks, that helps a lot. I guess what I need to consider is what my fracture risk is. I'm leaning on holding off for the medication also. I have read the same thing about the failure of the bones to build new bone by removing old bone.

[dcdream in reply to Capan24]

yes, that's my focus too as the meds are all based on fracture risks.

[FearFracture in reply to dcdream]

I took alendronate for 1.5 yrs and quit due to digestive tract issues and I had my 1st zoledronic acid infusion in November 2021. I took the meds because my endocrinologist pushed me to take them. I’d asked him about natural remedies and he really gave me no advice, he didn’t even mention vitamin K2.

After my zoledronic acid infusion, I started doing research and found this website, and although it might not be the easiest thing to do, it seems there are ways to improve one’s BMD w/o meds.

Although my endocrinologist is planning on my having another zoledronic acid infusion in November 2022, I’m currently not planning on doing it. I’ve made lots of changes in diet, supplements, exercise, I’m even planning on buying zero drop shoes, so I hope you are wrong about being stuck on meds.

[HeronNS]

I just want to let you know about my story as it has some ideas in it which you could find helpful:

healthunlocked.com/pmrgcauk...

It is possible to improve bone density with appropriate exercise and nutrition. If your doctor hasn't checked you for secondary causes of osteoporosis that would be a good idea:

osteoporosis.ca/medical-con...

[Capan24 in reply to HeronNS]

I did have hyperparathyroidism in 2014. This has resolved since I've had 2 of my parathyroid glands removed due to tumors. It doesn't help that I have Hashimoto's. I have to watch my thyroid levels, because sometimes they go too low. I'm sure this has a lot to do with my bone loss. I do eat very healthy and exercise daily at least an hour. I'm looking into supplements because I am vegan. And thinking maybe I am lacking in some things. I appreciate your input, thanks.

[HeronNS in reply to Capan24]

I'm vegetarian (which means I eat dairy and very occasionally fish) so do get some calcium that way, but I iunderstand that calcium is readily available in many leafy green vegetables. and depending how they are prepared it can be better absorbed than from animal sources. As you'll have seen from my story you'll have noted that I really believe in taking Vitamin K2, especially as it is so lacking in the modern diet. Apparently we aren't very good at converting K1 (from those same leafy veg) to K2, so most of us are probably deficient. It, as well as magnesium, sends calcium to the bones, which Vitamin D cannot do. you are really aware of how other health conditions can affect the bones, so I wish you all the best. 🍀

[Capan24 in reply to HeronNS]

Just wondering, how much vitamin k2 you take daily? When I walk, I usually do 4 to 6 miles, but have not tried adding weights. Besides walking, I bike ride, use resistance bands, and yoga. Might try adding weight when I walk.

[HeronNS in reply to Capan24]

Hi, I take two 100 mcg capsules a day, which is pretty close to the Autralian RDA of 180 mcg. Haven't seen any other "official" recommendation. I credit it for curing my previously very sensitive teeth! Respect for your lengthy walks. Because of sporacid knee problems I can't alway do what I'd like. Used to be able to manage 10,000 steps a day, but now I'm happy if it's 7000, and that is not always in one go. But I am also getting older and osteoarthritis is taking a toll.

I do quite a lot of physio exercises and tai chi daily.

[Capan24]

I decided to try taking the Fosamax, since my bones have been getting progressively worse with each scan. I feel I have done what I can to improve my bone health. I did have a biking accident last year with a hairline hip fracture. I am too active to risk another fracture. I know these meds for osteoporosis are not the greatest and many are against taking them. I hope I do okay on Fosamax. I just started taking Vitamin K2 also.

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