Slightly thinning bones

[bunnymom]

Had my first dexascan last week. Nurse called tonight and said it showed slightly thinning bones. I was told to take 1500 mg calcium which I thought I was but now realize it was only 1000! I really thought I was on top of it all but my brain just does not due the job any more. Also I walk a couple times a week. Somewhat disappointed that I didn't get a better report but maybe it's good? Any suggestions of questions for gp next week. Don't see rheumatologist for 6 weeks. Thanks to all on this site who help keep me straightened out.🐰

[PMRpro Ambassador]

I wouldn't just accept "slightly thinning bones" as a result! I'd want numbers - I got my full report in the post yesterday. I saw the results at the time though - and I suppose you COULD say my bones were "slightly thinning" with a t-score of -1.5, down from -1.3 over nearly 4 years. But that is still slap bang in the middle of normal and acceptable for my age.

Without being able to see a trend you can't really say anything much - but if all she suggested was a bit more calcium that's fine as long as you are also taking vit D. I take 1200 mg which is the normal suggestion here in Europe when on pred. Heron will know the other stuff that helps so I'll leave that to her.

Can you increase the walking? And resistance work with weights has been shown to improve bone density - done carefully that's fine even in PMR.

[bunnymom in reply to PMRpro]

I would like to use some light weights on my arms as they look so bad but can I do repetitions? Reading this forum thought that was advised against. Thanks for your help. I will get numbers when I go. Just checked and I am taking enough vit d.

[PMRpro Ambassador in reply to bunnymom]

It isn't DON'T, it is BE CAREFUL. If you start with almost no weights and just maybe 4 or 5 reps and then build up SLOWLY, you should be fine. It is just that if you dive straight in, as most trainers would have you do, and do 10 reps and repeat with a significant weight then you will suffer sore muscles afterwards which can take days to recover. Everyone would be a bit sore to start with - but our muscles don't recover in the same way and it might put you off doing anything!

I take 800 IU vit D with the calcium supplements - which isn't really enough in the winter so i take a bit more. I live in Italy, spend a fair bit of time outdoors with no sunscreen but my blood vit D level isn't sky-high despite the supplements.

[bunnymom in reply to PMRpro]

You make me feel brave to try my arm exercises without weights and be very slow with it all. I used to love to exercise but now just do stretches and balance.

[tgca in reply to PMRpro]

I'm taking Adcal 3 twice a day. Any advice about extra supplements would be most welcome please.

[PMRpro Ambassador in reply to tgca]

I don't take anything - if you have a good diet you don't really need any. I take extra vit D to what is in AdCal in the winter though. I use magnesium if I get cramp - but only then, not every day.

[tgca in reply to PMRpro]

Phew, honestly don't want to take any more pills!!

[PMRpro Ambassador in reply to tgca]

Then don't - but you do need enough vit D when you live in a country with not a lot and have an autoimmune disorder. The magnesium I take is only when I need it - same as taking an aspirin for a headache. Which actually I never take!

[polkadotcom in reply to bunnymom]

I used resistance weights for several years but I found little and often better than a big effort. And at times I was using the weights machines but without the weights! It did help and I wish I could find a gym round here but all we have are the expensive ones which is annoying as ALL I'd be able to would be the weights. I can't even use the pool as I am allergic to chlorine.

[PMRpro Ambassador in reply to polkadotcom]

Same here - except no pool which I could use...

[bunnymom in reply to polkadotcom]

We have an indoor pool here but they heat the air and not the water. Would that do any good? I am not a water person but I can swim ok. Good for bones? Cold water sounds no fun to me.

[PMRpro Ambassador in reply to bunnymom]

I couldn't use a pool that wasn't at least 28/29C - cold water just made my back muscles seize up!

[bunnymom in reply to PMRpro]

I love anything warm😊

[polkadotcom in reply to bunnymom]

Yes, like Pro I need a warm water pool. Last time I tried it gave me a whole body spasm - not fun at all.

[bunnymom in reply to polkadotcom]

Think I will skip the pool and sign up for the walking track this winter, thanks

[HeronNS]

First off, please don't take too much calcium. It can lead to other nasty things, like kidney stones, or even increasing risk of stroke, etc. It's best to get about 600 mg through supplements and the other half in your diet. You need also to take not just D3, which should have been advised when you were told to take calcium, but also Vitamin K2 and magnesium. Most micronutrients will be available in a balanced diet, but sometimes we can't get enough K2 so that will probably need to be supplemented. You can get it from grass fed (never grain fed) animal products including dairy, as well as a small amount from fermented foods like sauerkraut and its kin.

The greatest risk factor for fracture is falling, so strength training (sensibly as PMRpro says) and improving your balance are key. Weight bearing exercise and optimal nutrition will keep your bones strong and healthy and encourage normal bone remodelling.

[bunnymom in reply to HeronNS]

Dr is advising 1500 mg daily of calcium. I believe I am getting 100 percent in diet. I was shocked I didn't get a better bone report but my walking is sporadic at best. Now aiming at daily. See the rheumatologist in 3 weeks. Should I add a multi vitamin? I do work on balance and flexibility,

[PMRpro Ambassador in reply to bunnymom]

IMHO (and that of many others) if you eat a decent diet with a wide variety of foods then you don't need multi-vitamins. Especially if you get a lot of some vitamins in your diet - too much of some is worse for you than not enough. It's probably better to either adjust your diet or use specific ones you may be depleted in.

Even if you get 100% of the RDA for calcium in your food, it does help to have some extra because pred makes you lose more through the kidneys so the idea is that there is more present to be captured (if you see what I mean). You are replete in vit D I take it? Because if THAT is low, calcium isn't used properly, and diet will not help vit D - too few foods with a lot of it.

[HeronNS in reply to bunnymom]

Read up on the other micronutrients. I respectfully disagree with PMRpro about the Vitamin K2 not being a necessary addition. Many of us live in places where our food supply is much corrupted - no access to grass fed animals for example - so our diet is deficient. I have to say I'm feeling better since I a) cut back on my calcium supplements and b) added Vitamin K2. Another thing is to avoid foods which can leach calcium out of the bones. I understand that a diet high in animal protein - and yes that includes dairy - is also high in phosphorus. And the usual advice, cut back on refined carbs and avoid sugar. I think Americans, for example, consume vast quantities of soda pop and whether artificially sweetened or not that's a bad choice.

[PMRpro Ambassador in reply to HeronNS]

I didn't say anything about vit K2 so I don't see you have anything to disagree with me about. I was talking about multivitamins - and to my knowledge you don't get K2 in them. Even Chris Kresser, the big K2 proponent says multivitamins are unnecessary.

[HeronNS in reply to PMRpro]

Thanks for clarifying. It did seem from the way you described not needing extra vitamins that you were referring to everything except the necessary calcium +D. I used to take multivitamins until I learned better. Much better to get things through diet and targeting particular issues with individual supplements when required.

[PMRpro Ambassador in reply to HeronNS]

Exactly.

[barbara1234]

I don't know your age, obviously, but it is a known fact that there is some bone-thinning in EVERYONE as they age.

[PMRpro Ambassador in reply to barbara1234]

Not necessarily! I have two friend with PMR/GCA. One is in her mid-80s and has a bone density near to 1! The other was told in her mid-70s that her bone density was 98% of "normal". If they had had some thinning - the mind boggles what it was in their mid-20s which is when it is probably at its peak!

[HeronNS in reply to barbara1234]

I think one of the things which muddies the water is we are all, no matter our size or ethnic origin, measured against the same standard. I'm beginning to think that because I have what are called small bones I'm naturally going to show up as someone with low bone mass. Of course. Different countries actually have different standards for what counts as osteoporosis because of this fact so a woman in India may show up as perfectly normal whereas in North America she could be diagnosed as having low bone mass. If I have time I'll try to find the reference for this.

[HeronNS in reply to HeronNS]

ncbi.nlm.nih.gov/pmc/articl...

Specifically looking at Indian population in relation to generalized Western population. Which I think begs the question that the Western population is extremely diverse.

[bunnymom in reply to barbara1234]

Only spoke with the nurse and not the dr yet but asked if it was more than to be expected at my age (60) and she said yes. I am interested to hear a number.

[PMRpro Ambassador in reply to bunnymom]

The number that is taken as the line is said to be just a number pulled out of the air! Based on the bell-shaped curve of what bone densities are found in the general population. There is supposed to be no real research that says definitively "this is safe" or "this isn't" - I am willing to be convinced if someone shows it to me.

However, I think I said earlier: people with "low" bone density don't have fractures, people with "normal" bone density do. They might assume I have a problem as I have a history of fracture. But you have to look at why - it was a fall skiing, at speed though not at high speed. I still landed very hard!

[bunnymom in reply to PMRpro]

I don't have to worry about getting a fracture from skiing in the plains of Illinois. I wish I had better context for all this. Curious to see what dr says. Thanks as always that you took the time to reply.

[PMRpro Ambassador in reply to bunnymom]

You could pick up the same fracture I had on a motorbike! When I got home to the UK the orthopaedic specialist at the fracture clinic asked which I'd done: bike or skiing! I asked did I LOOK like a biker...

[bunnymom in reply to PMRpro]

Not a hobby I need at this stage of life.

[PMRpro Ambassador in reply to bunnymom]

No - but it is very interesting here. We have a LOT of bikers up in the mountains and I'd say way over half are over 60!

[Sandy1947]

Sorry about your bones. Eat lots of yogurt, cottage cheese, green leafy vegetables. Increase walking, weight bearing exercises., if you are strong enough, lift some weights.

I have osteoporosis and can't take calcium pills. Went through gamut of treatments. Had Prolio....10% improvement but Dr. Is going back to Reclast because I'm on Pred