Dexascan shows bone deterioration. Not keen on adcal so looking at Vit D3 supplement. Need to avoid K2.

[Ebiker]

Those who have read my previous posts will know that after discussion I had a flare (we think due to bivalent covid vaccine) so now back up to 12mg.So need advice and ideas from any of you good folks with medical science experience, knowledge or background re vit D3 etc.

Dexascan compared to 3 yrs ago shows scores

Right femur -2.6, previous was -1.8. Apparently 13% drop.

Left femur -2.4, previous was -1.6 so 12% drop.

Spine L1-L4 -1.7 a drop of 6%.

As now getting into osteoporosis range doc wants me to take adcal which I have tried twice before and digestive system just didn't like it.

I have a duodenal ulcer (healing) and have to be careful with intake of food or meds as silent reflux. Manage with 20mg daily omeprazole. He also suggested alendronic acid. I said no to that one.

As a starter I want to purchase 'clean' vit D3 alone -(no K2 supplement because of warfarin) and work at getting enough K2 from diet... possibly.

Any thoughts or comments appreciated.

[PMRpro Ambassador]

There are other calcium supplements besides Adcal - the calcium carbonate often causes gastric problems. Try a different one or just up your calcium intake in your diet and get a good vit D supplement and take 2 to 4000 IU a day, Vit D alone isn't enough.

K2 isn't particularly involved in blood clotting, that is K1. K2 is only found in fermented food like kimchi and sauerkraut and it is K2 whether it is as a supplement or in your diet. However, you can eat what you like on warfarin providing you eat it regularly and consistently and the warfarin is adjusted to your regular diet. Don't go mad on something on one day and not eat it for weeks, or the other way round. If you decide to eat something 3 times a week, you need to eat it 3 times a week, not suddenly not bother for a week or two.

[Ebiker in reply to PMRpro]

Thanks PMR pro. You are so speedy with replies and it encourages me to do what I think is best for me at present. I have a very good balanced diet and know that my calcium intake is sufficient, plus blood tests show levels fine.I can purchase vit D3 supplement alone.

Most are sold with K2 as the two work together. Are you saying that good diet with regular broccoli and other foods for instance will give K1? Do I need K2? Still a bit confused about vitK.

The nurse practitioner who checks INR said something similar when I first started warfarin.

Given the dexacan scores I am not too bothered about bone density decrease as they said they are about average for a woman my age!

Many thanks.

[PMRpro Ambassador in reply to Ebiker]

K2 is the one you need for bones - it is only found in a much more restricted range of foods and any recommendations of how much you need tends to refer to clotting

webmd.com/diet/foods-high-i...

It is like the B vitamins, they do have different names but are given numbers within the B vitamin group. Very confusing!

[Ebiker in reply to PMRpro]

Thanks. Useful link. This forum does a lot to educate us. Decided to buy a good quality D3 with K2 as I can have a daily smaller amount, 2000 iu of D3 with 50 mcg of K2, than with some others. Will give this a go initially and speak to nurse practitioner when she next checks my inr.

[PMRpro Ambassador in reply to Ebiker]

I'll lay odds she won't have a clue!!! But as long as you take the dose regularly and get the INR checked regularly and get the level sorted to go with what you are taking it is fine.

[Ebiker in reply to PMRpro]

Good getting inr checked etc was what I thought to be the best idea and not going over the top with anything different. No rush as currently getting on top of the pmr 'flare' hiccup...recall?...possibly activated by the bivalent.Re np I know what you mean but our health cenre here in a rural area is outstanding in more ways than one, in comparison to most. I know all the staff from doctors, 3 full time 2 of whom are partners, to nurses, reception staff, dispensers AND they know me well. They always answer calls and queries and deal with efficiently. The np I see often has a lot of experience and is the one who does inr. More importantly I can talk to her and if she doesn't have the answer she makes sure someone on the team deals with it.

This is one of the advantages of living in a community where I know most of the families. I taught many of them some years ago! Unusual know. How lucky am I?

I'm rambling now but hope you are in good spirits and that there is some sunshine in the Dolomites. Has there been enough snow yet for skiing?

[PMRpro Ambassador in reply to Ebiker]

Our ski area has been open since the end of November, initially with a base of man-made snow but there have been light falls at intervals all winter and a big dump of a good 20cm at the weekend. It was cloudy most of last week but now the sun is out. I picked cousins up from Innsbruck on Tuesday and delivered them to Corvara yesterday for 10 days skiing before coming back to me for a few days. Today must have been utterly glorious - if maybe a bit chilly early doors!

[Ebiker in reply to PMRpro]

Innsbruck and over the Brenner Pass....Aahh, I can picture it. My no 1 go back to holiday is to a village just south of Innsbruck to have an autumnal week of walking with a friend. Last trip was 2019 as Covid then scuppered travel. Fingers crossed for this year. I enjoy planning and booking travel through Europe by train as far as possible. I get double pleasure from the trip as we have become good friends with the owners of the apartment.

Enjoy your visitors and hopefully some sunshine.

[PMRpro Ambassador in reply to Ebiker]

Where do you come to? Mutters, Natters, Havers and Blethers as we used to say nearly 50 years ago with a VW campervan! I have only done the train from Innsbruck once - I wish they'd set up the Euregio region we have as a unified travel region that took my Mobilcard ...

[Boss302Fan in reply to Ebiker]

I was taking up to 750 mg Calcium citrate daily and blood workup before, during and after showing my blood levels stayed constant in the middle of the reference range regardless. I do know that for men not to exceed 800 mg of supplemental Ca. No max limit on intake via diet. Maybe this is attributed to how the body regulates calcium balance? It took 4,000 IU D3 (2,000 IU 2x/d) to get my Vit D levels to 38 ng/ml.

optimaldx.com/blog/vitamin-...

I take 100 mcg K2-MK7 which includes 16 mg Nattokinase (Vitacost K2) as it activates transfer of Ca to be deposited to the bone as well as activates another pathway that prevents Ca deposits to the arterial walls. A paper I read indicated a study showed, for women, a minimum of 180 mcg/d was required and 2 years to see improvement. This was a few years ago and possibly there has been other studies. There was no mention as to optimal dose for men. My follow-up dexa-scan (2 yrs) showed minimal degradation and I’m still showing mild osteopenia. I’m 68.

I still take D3 and K2-MK7 but have stopped taking supplemental Ca. Been off pred just over 4 months.

[Ebiker in reply to Boss302Fan]

Thanks for this. The link document will take some digesting. I have noted your comment about needing 4000 iu of D3 per day.If I don't have a digestive reaction I will be able to double the dose.

[choirsinger1986]

Hi. Are you not taking Alendronic Acid to prevent osteoporosis?

[Ebiker in reply to choirsinger1986]

No. Am avoiding it at moment as I have a duodenal ulcer and I am suffering again with awful gerd as increased pred. Unfortunately my stomach reacts badly to meds etc.

I am extremely careful with diet for gerd but had to increase the prednisolone. That is another catch 22 situation.

[choirsinger1986]

Sorry to hear your dilemma 😞 Hope you get the right and best form of help 👍

[Ebiker in reply to choirsinger1986]

Thanks for your wishes. Funnily enough after some awful days I upped the omeprazole another 10mg so now 2×20mg daily and the difference is amazing. I have spark again!Also I am managing to drop the pred. That is important.

[choirsinger1986]

Great to hear 👍