Both my mother and mother-in-law broke a hip and ended up in a nursing home, where they spent the remaining years of their lives (in my mother's case, 10 years), only to be carried out by an undertaker. Osteoporosis is no joke! I have it, and am currently on Prolia, which many, with no medical background, are quick to label as "poison." For any woman who is diagnosed with this disease, I recommend that you not rely on a gynecologist or primary care doctor to treat you. You would be better served by finding an endocrinologist or rheumatologist who specializes in osteoporosis. Yes, these drugs may have side effects, but what drug doesn't. Just listen to the list of side effects on any televised drug commercial! Also, take stock of any aches, pains and/or other quirky things that may be going on in your body before taking any drug. (Two years ago I had a relentless case of hives that lasted 8 months. I was not only any medication and doctors could not find the cause. If I had been on Prolia at the time, I would surely have attributed it to that.) And, yes, I even had to have a wisdom tooth extracted while on Prolia, with no negative consequences. Ask yourself this question, if you had cancer, diabetes, heart disease, high blood pressure, or any other disease, would you refuse treatment? So, why refuse to treat your osteoporosis?
1
I had my bone density tested in January this year. My density had been borderline at my test two years ago, and my spine showed that I have moved to positively testing for osteoporosis in my spine as of January. The statement I received from Medicare lists my "Bone Density measurement using dedicated X-ray machine" as a service that is not approved by Medicate, and therefore not covered ($317.00)." The notes read: "(J) Medicare does not pay for this item or service. and (K) YOu didn't know this service isn't covered, so you don't have to pay. If you paid and do not receive a refund from your provider, you have 6 months to send a copy of this notice, your provider's bill, and proof that you paid to the address on the last page of this notice. Future services of this type won't be paid." It is a disservice to readers to state that testing is covered by Medicare. Clearly, if I want to monitor the deterioration or recovery of my condition, I will be paying out of pocket.
I think the current movement to diagnosing women with osteopenia--NOT osteoporosis--is to promote medicine.
Same as the new pre-diabetes cp diabetes.
Same as the new pre-hypertension cp hypertension.
Same as the new BMI cp older BMI.
And on and on and on.
Yes people are fatter etc. but all these lower "standards" are just med-selling.
And I only fit osteopenia, but I feel no reason to "treat" it.
If any of these tests were available for last five+ generations our relatives would have been dead and we would not exist.
RELAX and do not feed the Pharma Pig.
4
After 14 years on Fosamax, recommended by both my internist and rheumatologist, my right femur snapped and I had a 17-inch rod put in my leg. I joined the online Femur Fracture Suppory Group and have found both emotional comfort and solid advice from members of this group. I had a nuclear bone scan of my left leg to make sure it is okay. I walk two miles and do 20 minutes of yoga daily plus vitamin D. I had my last bone density test in July, 2011, two months after my fracture. My orthopedist told me to do weight bearing exercise and avoid bisphosphonates, because, he said, they are “evil.” I found a new internist and quit going to a theumatologist.
7
Obviously, a "test" for one's fracture risk based on a questionnaire needs nothing more than a properly set-up computer (maybe a scale and a tape measure) to administer and score.
The body is an entirety. Everyone needs to know that if you need dental implants you cannot take the various meds to increase bone density. To avoid falls … lift up your feet when you walk, look before you step and possibly learn to use a cane.
Most of the people know that vitamin D, K, C and trace minerals are important for the bone health. However few people realize that everyday tap water damages bones and brain.
Osteoporosis
https://www.endocrineweb.com/news/osteoporosis/2851-fluoride-overconsump...
Insomnia
https://www.globalhealingcenter.com/natural-health/everything-you-wanted...
I was amazed by frequent comments by readers (including some doctors) telling tap water is best. Nearly a quarter of tap water in the U.S. is contaminated, In addition, fluoride and chlorine are toxic to humans and animals. You need high performance water filtering like reverse osmosis filtering.
1
Men may have a higher risk of death or severe disability after hip fractures than women, but this statement isolates the event from the patient. Men who have hip fractures often have serious comorbid conditions that lead to the falls and fractures, while in women often the problem is isolated osteoporosis. What is the evidence that screening men reduces morbidity and mortality? The evidence is there for women; I'm having trouble finding it for men, as did the USPSTF.
4
Once again, an utterly ridiculous cartoon depicting an older woman as aged and grandmotherly! Please check your biases at the door. As I write this I am on an Amtrak from Washington returning from a very invigorating business trip and began the morning with a brisk 60-minute walk at 6AM, did my white hair in a contemporary style and full makeup. Yes, I am over 65 and have my bone density tested, along with all the other tests, and I don’t look anywhere remotely close to the ageist caricature your editors seem to think is perfectly fine. For the record, I’m wearing comfortable stylish shoes. Get with the times, NYT!
29
Being over 65 and having had a mother who had osteoporosis, I'm very grateful for the DEXA test, which I have had every two years for two decades. Now if only knowing that I have osteopenia would help me exercise more...
5
Mathematical question. The article states " The test is painless and noninvasive, and involves a level of radiation 50 times lower than that of a mammogram".
So how low is the radiation from a mammogram? I know what 50% lower is. I know what 1/50 is. But what is 50 times lower?
10
@Larry Israel
Very deceptive, as this and any scientist would tell you.
2
"There is also solid evidence that treatment with a bone-preserving or bone-building drug is beneficial when a bone density test reveals a level of bone loss defined as osteoporosis in the spine or a hip."
FALSE. These drugs have dangerous side effects and more people experience them than is reported, they can only be taken for a limited term, and once a patient stops these drugs, bone density numbers revert to previous osteoporotic levels. The so called bone building aspects of biphosphonates, for example, leave the 'rebuilt bone' in a very brittle condition, not like normal bone. Osteoporosis is generally a genetic condition / predisposition and better to mitigate with excellent diet and exercise, specifically tai chi.
26
@florida Absolutely. Took Fosamax on Doctor recommendation in the late 1990s and experienced severe leg pains requiring pain killers daily. I was told that was not a known side effect. The pains stopped when I stopped taking Fosamax. I decided to cease taking the scans that showed osteopenia because I had no intention of taking medicines with bad side effects that might show bone being built, but not necessarily lead to fewer falls or fractures.
9
"it’s time to stop thinking of osteoporosis as just “a lady’s disease.”."
And there are a whole bunch of diseases (hyperparathyrodism, [manifestations of] Crohns et al.) which effect both men and women. There are significant numbers of men prone to problems.
2
Bones are basically stiff muscles. They are a protein-mineral matrix filled with fat that make a variety of cells (RBC, for example).
Bones, like muscles, grow stronger with weight-bearing exercise and adequate complete nutrition.
DEXA simply isn't a very strong predictor. The Gold Standard is pQCT (Evans).
Although the traditional focus is on the elderly, a significant number of otherwise healthy teenagers have poor bone status (Lappe). This is both a function of poor exercise and poor nutrition.
In the recent AF study, 25% of female recruits and 9% of male recruits entered with iron anemia. Remember all had passed a fairly comprehensive physical. Correcting the anemia dramatically reduced injury and attrition rates.
The most comprehensive body of bone work has been done by NASA....which supports the same conclusion.... you need BOTH exercise that stress the bones and complete nutrition.
The final problems are: how do you know you have nutrient deficiencies and isn't a "healthy diet" good enough? If you read the USDA research on current foods (nutrient levels are declining) and the CDC NHANES reports (significant pockets of deficiencies exist) plus the very tightly controlled Westphal study (a well-designed diet malnourished Subjects), the only objective way is to get a comprehensive blood chemistry panel (you can ask your doc or buy online) to start an evidence-based health program.
Otherwise, you're just living your life based on fairy tales.
9
I want to share my experience. I’m a man now past 60 and I’m lean and strong. In 2005 or so I had an inflammatory condition. Not hereditary and out of the blue. After a very long course of prednisone by internist/rheumatologist says time fir a bone scan. The results were not very good as prednisone can create bone loss. Ok. On yo treatment with calcium and vitamin D and Fodamax scaring myself reading side effects because I trusted him. He says don’t worry. Next phase bone test after I think over a year or two and no improvement. Next Forteo self injected -easy - but again scared myself worse - he says don’t worry -
The course is limited and then another bone density test. He says didn’t work let’s see an endocrinologist- his read was different - he said there was a slight improvement and looked at me and said that’s improvement. I’m off prednisone for years - I’ve improved to moderate - active weight bearing and strong. Guys I’m telling you get the test, have a good internist and that’s it. My experience and my opinion of course.
4
My experience with DEXA scans (bone density is measured using a CT scanner, as well, provided it has the right software) and some 20+ years of osteoporosis (triggered by prolonged steroid treatment) is that it is particularly valuable when comparative measurements, over time, are done. While osteoporosis can be diagnosed based on the standards in the scanner software, an important factor is bone loss over time. My initial diagnosis was made when a rheumatologist in the United States saw some 20 year old spinal x-rays taken in the Netherlands after an accident, and noticed bone loss. So hang on to your old X-rays, and bring them in when new ones are taken.
6
To all my post polio brothers and sisters, get a bone density. Every polio friend l know has osteoporosis, but it is treatable with better meds than a decade ago.
3
I have severe osteoporosis which my dentist noticed when my teeth starting moving. After a bone density scan, I was put on a bisphosphonate (Actonel) for many years, but it didn't help and I kept getting fractures. Now I am on a two-year course of daily injections of Forteo, which seems to be helping. I haven't broken anything since I started Forteo. My bone density is very bad since I was anorexic for twenty years starting in my late teens. There is nothing wrong with bone density scans if you have severe osteoporosis!
1
I have been sent for DEXA scans since my early 50s. I refused to take HRT, but I took Fosamax for about 6 years. Fosamax is no longer recommended. I started taking Evista at age 66 and 7 months later I had a pulmonary embolism in a pulmonary artery (found with a routine CT scan with contrast). I don't think any of these drugs do anything for bone density. I go for another DEXA scan next month. So far I have osteoporosis only in my forearms. Before anyone takes any of these drugs, they should check for possible side effects. You don't want to trade one problem for another.
16
All of the friends and relatives I know have had bad side effects from biphosphonate drugs prescribed for osteopenia and osteoporosis. These include Barrett’s Esophagus (a precursor to cancer), severe bone pain that caused severely reduced movement (now wheelchair-bound), severe joint pains (reduced ability to exercise), severe swelling of the ankles and feet . . . I could go on.
If there is a different treatment modality available in the future, I will re-evaluate. But for now, knowing that I can run, jump, do the exercises in the advanced Pilates repertoire, and actively lengthen my spine, along with a healthy diet, will have to do. I do not think the DEXA scan is a true evaluator of bone health.
17
@Susan
I have refused to use Fosamax not to my doctor’s liking. I was penia only. I agree with you. I do yoga and weight training plus walk with the dog and sometimes treadmill. At 74, I don’t feel like putting poison in my body.
11
@Susan
• The DXA assessment's 1-2% error (though small) on repeat tests on the same machine can lead to misinterpretation and poor clinical decisions.
http://depts.washington.edu/osteoed/questions.php?caseID=4&qID=16&am...
• Numerous caveats about the DXA reliability appear in the following article. For instance:
"DXA is not capable of detecting changes in bone architecture… [A] reduction in bone mass, or the amount of bone material, is absolutely not the only determinant of a reduced bone strength or of the presence of osteoporosis. Rather, an increase in bone size or a more peripheral distribution of bone material, which are putative adaptive processes to aging and bone loss, are disregarded by DXA or, worse, are erroneously detected as reduction in BMD and bone strength."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811354/
• Precise positioning for testing is critical, particularly in comparing serial results.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891842/
@Susan; I have been dx'ed with osteopenia at relatively young age but you are right, I keep moving, what the heck I broke bones when younger and moving too, I just keep going on.
And when said took too long for a broken ankle to heal, did not taken into account three broken ribs healing same time too-provider didn't know and I suspected but no point to add costs. And more hassle.
Now seen unrelated chest X-ray, no wonder!
Thanks for the reminders and for emphasizing the risk to men.
My primary Dr. had me tested well before 65 - to get a baseline not long after menopause, but after I stopped taking estrogen. The next DEXA done a few years later showed how far bone density had dropped ( For women, it WILL drop post menopause - I 'd be interested if anyone can show evidence refuting this - no matter how much exercise and what you eat).
At least then you have a sense of what's going on - how you are holding up, and whether you should consider measures including meds ( which have intimidating "side" effects).
As time goes one, the approach to prevent osteoporosis will become more sophisticated. Nutritional research may pay off; perhaps the hormonal approach can be tailored so that it presents less apparent risks as a cancer stimulant.
Our bodies have complex integrated systems -- whatever affects one, affect others. All of them.
It's no longer: "Got scurvy? Take vitamin C."
It's more like: Bone loss? Is it diet, poor absorption, interference from other meds, lack of exercise when you were young, lack of exercise in the present, the wrong kind of exercise, lack of sleep, exposure to to radiation or chemicals ?? and so on endlessly in expanding loops.
With a mom who didn't fit the stereotype(slim, sedentary, smoking and drinking), yet lost her ability to walk too early because of osteoporosis, this prospect frightens me as much as heart disease or stroke frightens others.
3
Thank you, Dr. Brody, and earlier was trying to find your advice in a previous column about keeping one's balance and the best way to walk with equilibrium.
Hoping my sibling past seventy does not read this latest, or he will be discouraged and fret. We had an exchange recently on whether he should take a bone density test and he is at present deliberating on having knee surgery.
Difficult because he has endured two hip operations, but your article on the benefits of reducing pain and discomfort with this further procedure came to mind.
Neither of us has ever suffered a bone fracture, and yet a test this month revealed a case of osteoporosis in my medical file, and joining other commentators who might ask for your opinion on treatment.
Many thanks and looking forward to your next column.
2
Your wuote Dr. Cauley as saying there is an effective treatment for osteoporosis.
Why don't you tell us what it is??
18
Please skip the pharma treatments as they only preserve bone as it is, making it brittle and prone to fracture. Bone building is not a static process. There are other side effects including jawbone destruction. There's a reason your dentist asks if you are taking these drugs. RESIST!
Other solutions? Osteopenia3 dot com is a great place to sign up and peruse for fair-minded information. I've been receiving the site owner's research for nearly a decade and highly recommend. Free, of course, without ads and she doesn't share your email.
After I received a DEXA scan 12 years ago (slim, white female) and was heavily-pressured to conform after being told I was an osteopenia candidate, I rebelled and looked for something safe.
I exercise, work on my balance and take natural Strontium and calcium (never take both at the same time because they will cancel each other out) for maximum effect. Presto, increased bone density.
Don't fall for the fear campaigns.
15
The pharmaceutical treatments for osteoporosis are not exactly risk free either. Subthrocanteric femoral fractures, esophageal cancer , severe heart burn are side effects that medical osteoporosis "treatments" bring with themselves, and should be considered before we decide to chemically alter our physiology to reverse a normal process of aging.
15
Folks who have had radiation for head and neck cancer, which is most H&N squamous cell carcinoma patients, ought to consider that they are at higher risk for jawbone deterioration already, due to osteoradionecrosis. And that osteonecrosis of the jaw is a side effect of most bone density meds.
I'm taking a less well understood drug, raloxifene, due to this, as it is the only one that doesn't have osteonecrosis of the mandible as a possible side effect. My jaw is already very compromised.
6
The risk of osteoporosis increases in both sexes as a result of the use of Nexium for reflux or GERD. Nexium is a very widely-used medication, so this should also weigh into the decision tree.
7
My 78 year old mother and my baby sister (who went into menopause in her early 20s because of a genetic condition) both suffer from osteoporosis. My middle sister is very thin - but also very active - so whether she will develop the condition remains to be seen..
I went through menopause a couple of years ago - but was tested in my 40s when I had a stress fracture in my foot - turned out that my density was 15% above the age adjusted norms....but like one of the other commenters, I also have a Vitamin D deficiency probably because I stay out of the sun and have since my early 20s.
Time will tell if I follow my family genetics....but at least the extra 25 pounds I carry may have some positive effect.
5
@37Rubydog
The extra weight may help because fat cessl generate a little estrogen: that's what I am hoping, anyway.
1
Because I'm a huge milk lover, I thought I didn't have to worry about Vitamin D, calcium deficiency, or thinning bones, but alas, a bone density scan revealed borderline osteoporosis and blood tests showed severe vitamin D deficiency.
Turns out, common knowledge to many but not to me, the vitamin D in milk is only a small fraction of the daily requirement, and 15 minutes of sunlight a day meets all the needs of the body for vitamin D. And that lack of vit D3 and K2 contribute to bone disease, heart disease and the whole cascade of metabolic disorders.
I've been avoiding sunlight for years due to sun damage, but now am keeping it off my face only.
As for the osteoporosis, I'm glad others can take it with no consequences, but I took one pill of Fosamax and two days later was hardly able to hobble, with pain in all my big joints. It's been six months, and the effects still linger.
It makes me angry that my doc wouldn't bother to report it to the drug company as is required. I guess it's work and time she wouldn't get compensated for; besides, my outcome is only an outlier, so why should she care.
I just wish I knew how to cure the crippled, painful joints I'm left with.
21
Both of my parents had osteoporosis. My mom was on Fosamax with no complications, but my dad was not diagnosed until he broke his hip after a stroke (he couldn't remember not to get up at night by himself). He never recovered his ability to walk. Mom did OK on the meds and never broke a bone.
I take raloxifene, which has not been studied as much but is safe for people like me who already have a compromised jaw bone, for osteopenia. So far, so good.
5
@Susan
I took raloxifine for osteopenia for many years. It has little or no effect on spine osteoporosis. As for hip and othe r bones, you’ll be lucky if you just maintain your bone density on it. The one thing raloxifine did for me was to positively effect my tendency to develop breast cancer (runs in my family on both sides and I had a surgical breast biopsy about 16 yrs ago for what turned out to be hyperplasia).
@tishtosh
Thank you for your input, and joining you in the sun now for fifteen minutes a day, while maintaining a high affinity for dairy products.
Apparently the latter was not enough to avoid a severe vitamin D deficiency, and while not enjoying a tour in the garden at high noon, well, I appreciate your mentioning the effect of Fosamax, and hope that you will soon recover from the impact of the above medication. Perhaps Dr. Brody may have some advice to the benefit of all when it comes to this crippling joint pain you have been experiencing.
4
I am not opposed to the bone density testing even though not convinced the medication has much impact and plenty of side effects. Strange that a tape measure around someone’s abdomen is never done to highlight belly fat that does more harm. Why is that? Weighing someone does not call out the belly fat in men and women. Seems odd.
5
I'm glad that my gyn recommended a bone density test several years ago. I was diagnosed with osteoporosis and was treated with medication, which helped, but had to be discontinued after two years. Now on Medicare, I continue to have the test and am on new medication; there is improvement. I also do weight bearing exercises and take vitamin D supplements.
4
I just got diagnosed and am only 59. I feel very disappointed since I'd been doing weights in the gym for many years and am not too skinny.
I'm doing the meds, and we'll see if they work. I'm grateful to my gynecologist for sending me to get tested.
What age should my younger brother get tested? I'm going to guess 65 because of my bad luck.
@H
Relax. I was diagnosed with osteoporosis at 59: at about 64 , it was osteopoenia -- calcium intake and vit. D levels more or less OK) already with problems walking because of bad knees; osteoporosis again , now in the back at about age 70; knees replaced at 70 and 71 -- finally can walk again ; and dental implants -- if one is on a bio-phosphonate they cannot do implants.
Sometimes it is best to wait even years before opting for a medical procedure (knee preplacement good for about 20 years) or to use a particular medication. (And IMO it should be illegal to advertise drugs on TV.)
PS very careful not to fall and to get daily brisk exercise.
GOMAD or Gallon of Milk A Day.
This actually makes me gain weight in both muscle and fat.
Moderate weight training can also help with bone strength
My gynecologist recommended a bone density test when I was in peri-menopause in my early 50s to have a baseline against which to compare future tests. Early diagnosis, some degree of osteopenia, and a mother who had suffered for years with untreated osteoporosis and several fractures -- including 3 hip fractures -- enabled me to take action so as not to suffer her fate. Had I waited until 65, my current age, surely far more damage would have been done. For several years I have been under the care of a highly qualified rheumatologist, a specialist in osteoporosis, whose expertise I trust when drug intervention is necessary. Gynecologists and internists also can prescribe drug treatment but I don't believe they possess the specialized experience, training, and knowledge required to make the best-informed judgments.
13
Heredity is a big factor.
I had an X-ray for an injury in my early forties, and was sent to an endocrinologist for bone density testing. Bad news ensued. Turns out both my parents had osteoporosis. My mother, a "strong farm girl", had refused testing until that time. My father was blind-sided.
Americans are rightfully suspicious of expensive tests and drug treatments, but my family is Canadian. So find a doctor you can trust, get tested, and stay healthy.
7
@KJ
Obviously parents still on feet and OK, why hassle them and yourself and expose them to side effects of meds?
Your parents would loose bone mass as they age, same as you.
ALL people do.
They keep changing the standards and never would have tested your parents at your age the test not exist.
Stop hassling them unless a clear problem.
We age, our bodies wear out then we die. It's a process that can't be miraculously reversed. No matter the amount of drug therapies. It's genetic too. You're either big boned or you're not.
Diet and exercise throughout one's life can help some but our beyond ripeness or expiration dates come to us in many ways.
11
@CC, I told my rheumatologist, I just want my bones to last as long as I do. My mother had severe osteoporosis and "outlived" her bones. It was not a pleasant 25 years, including multiple disfiguring fractures, back pain, and height loss. Had she been diagnosed and properly treated the last third of her life would have been far higher quality. I don't want to sit back and accept my destiny; I'll fight, educate myself and get the best advice to change its course.
21
NO, bone densities are a waste of time ans money. Bone density and fractures are not the same measurement. 50% of the fractures in older adults occur in those with normal bone densities.
Recent reviews report that the many "follow up" BMD studies ordered by physicians are not necessary since they rarely change the treatment. Most are ordered because they are "due" on the schedule , not that they will change treatment.
There is a controversy about the value of Bone Density studies and the ability to diagnose osteoporosis. It seems these studies are not that accurate at predicting the chance of fracture (which is the real concern). In addition to the bone mineral density, it is shown that the actual structure of the bone is important. It is bone fragility and resultant fracture that is trying to be prevented. BMD is only one of multiple factors associated with this condition. The size of the bones, the propensity to fall, the actual architecture of the bone are all important factors. The architectural structure of the bone is the most important.
Present use of bone density has a moderate ability to predict who will get a fracture. Bone histomorphology ( a microscopic method that provides information on bone metabolism and remodeling) is a much better tool.
See discussion on osteoporosis at letswakeupfolks.blogspot.com for complete info.
31
@RichardHead I believe your remarks illustrate the difference between bone "quantity" and bone "quality". Although I was diagnosed with osteoporosis, I had an MRI as part of a study, and told that my bone quality was excellent.
It is worth reading about the Liftmor study out of Australia, which concludes that a heavy weight lifting protocol grows more bone. I had been going to a strength classes where we lifted low weights for many repetitions. Now, I am lifting 85% of my weight capacity for 3-5 repetitions, for 3 sets. I am doing deadlifts, back squats, overhead press, etc. Also I am jumping 20 times a day. I am using a coach during my weight lifting to insure correct form. I am surprised that the Liftmor study is not mentioned in the article. I also eat 8 prunes a day (which is supposed to be an assist in bone growth).
4
I've had three bone density tests and I won't be 65 until next year. However, my 88-year-old mother is crippled by osteoporosis and had her first hip fracture at 40. Needless to say, I take supplemental calcium and exercise religiously. However, I was grateful when they tested my 62-year-old brother's bone density before a hip replacement last year. Yes, men can suffer from low bone density, and should consider family history.
9
Tests, tests, and more testa. How about more articles about healthy eating that supports bone health, what supplements may help or hurt , and the significance of exercise in staying strong-boned as we age.
34
@Lola
Vitamin K2 daily.
7
@Lola, the Times runs plenty of healthy eating articles and also runs plenty of articles on the right tests and timing to diagnose disease. Both are important and one doesn't preclude the other.
11
Wow. If you have osteoporosis, and it’s a silent disease until something breaks, 65 is too late to really do anything about it.
12
Most folks have the fractures later than age 65, and some can avoid them, like my mom did, by taking their prescribed meds and Vitamin D3.
@Minnesota Progressive
Yes. But if you break bones like I do, from a long-ish life of aggressive outdoor physical activity, it really should not freak out your MD if reads history and demands bone scan and meds!
Mostly I NEVER wrecked, when I did, often broke something.
Most doctors are not used to seeing older 50s females who were and are active throughout life.
So what I broke a bunch of bones, I wasn't stuck in a house with kids I was doing field work and skiing and biking etc.
• Read the Task Force Guidelines and associated editorials and you will find many qualifying statements, including:
“This review has several limitations. First, it focused on treatment with prescription medications only; it does not address other interventions that might reduce the risk of osteoporotic fractures, such as functional assessment, safety evaluations, vision examinations, exercise or physical therapy, vitamin supplementation, and diet interventions.“
“Risk factors beyond bone density, such as microarchitectural deterioration of bone tissue and decline in bone quality, contribute to osteoporotic fractures: therefore, approaches that rely on BMD measurement wholly or in part may not be the most accurate approaches for identifying patients at highest risk for osteoporotic fractures.”
Plus numerous statements on the accuracy limitations of BMD tests/assessments (very poor to good, low to moderate).
• Look at the World Health Organization’s 2016 disavowal of the FRAX assessment tool.
http://www.who.int/bulletin/volumes/94/12/16-188532.pdf
• Look at "Osteoporosis: the emperor has no clothes" (Journal of Internal Medicine, 2015). The 100-study survey finds current treatment guidelines flawed.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497616/
27
@xyz this was the best article I've read in over 10 yrs of researching the subject. Early menopause and low bone density assessments have meant many discussions with providers about pharmacotherapy. This article validates my own decision to avoid that treatment. Many thanks for sharing this-I wish it was more commonly available to the many women facing this issue, not to mention the many providers who don't seem to have this thorough analysis at hand.
2
@Marilyn Here's another really helpful article (May 2017 in Frontiers of Pharmacology): “Rethinking the Appraisal an Approval of Drugs for Fracture Prevention”
It reviews studies of drugs used for fracture prevention over the past 30 years and challenges the general belief that drug therapy is a solution. Bottom line: “After decades of widespread use, effectiveness of drugs for osteoporosis remains uncertain, yet adverse effects are more apparent.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430022/
1
I am a man with a number of risk factors for osteoporosis, most notably family history. I wanted to be tested when I was about 50, but my doctor didn't think it was an issue for men, especially athletes. I switched doctors when I was 55, and learned that I have serious osteoporosis. In the 8 years since I have had multiple fractures, including in each hip and compression fractures in my spine. I have to wonder if my life would be better if I'd had an earlier diagnosis.
15
@Steve My late husband didn't know he had very serious osteoporosis until he had a major fracture at 68. With good treatment and care he was able to live a (mostly) productive live for another 13 years, though during that time he had 6 more fractures, the last of them caused his death. By the his osteoporosis was dx his bones were, according to a specialist, like swiss cheese. Yet he had no warming and was always healthy, fit and physically active. Men get osteoporosis as you have discovered. I truly wish doctors would stop putting their head in the sand about it!
How about insurance that pays for it first - then maybe I could get tested! Especially since the last time I had coverage I was found to have osteoporosis and now I can't even find out if it is worse, get medication or any treatment
10
After a wrist fracture at age 56, the physical therapist insisted on a full bone density assessment even though the doctor did not think it was necessary - turns out I did have osteoporosis, fairly advanced which I believe is due to a short bout with anorexia as a young teen, not taking estrogen after menopause and genetics. The doctor was just going to prescribe calcium and vitamin D but looking into the numbers, I realized I needed Fosamax and another doctor agreed. I have increased my weight bearing exercising but need to do more to avoid having my spine crumble later on like my elderly aunts. My younger brother was just diagnosed with osteopenia and has terrible back problems so getting tested is worth it for quality of life later on. The side effects of bisphosphonates are trivial compared to hip fractures that are strongly associated with a high mortality rate!
5
Mother, aunt, and great aunt all had hip fractures and add my mother a forearm and leg break. Scandinavian ancestry. I am not overweight, size 6 but athletic (hiking, dance, gym weights). No smoking or alcohol. In my early 40s bone mass down 64%. Fosamax worked tho I cycle on 5 years, off 5 years and do annual bone density which shows I am holding. No jaw problems which I check annually. I offer this in the face of all the negative posts. I am so glad Fosamax exists. My mother's hip break at 52 left her crippled until she died at 94 and cost the family a fortune. Use medicine and science wisely and well with care and thought.
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I stopped having bone densities about 15 years ago as knew I never would take the prescription meds given for low bone density due to their side effects and making bones brittle. Before I stopped I did have a result of osteopenia in the hip neck. At the time I asked my yoga teacher for hip strengthening postures and was given some that I did 3x weekly - took about 10 minutes each session. The next & last density I took a year later the Dr was amazed as I'd rebuilt my hip neck to almost normal. I was told to just keep doing whatever I'd been doing.
Now, after learning a lot more about bone strengthening (but not from MD's as those I saw still had outdated beliefs), I supplement with a small amount of calcium (350 mg daily), 1000 - 2000 mg D3, and vitamin K2 - very important but often left out of bone regimens. K helps get calcium into bones and keeps it out of arteries.
I also exercise with weights and still do yoga. The way to build up bones is to create muscle tension on them. So far so good; am in my early 70's.
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@Ann You hit the nail on the head! Exercise and muscle strength are far better in strengthening our bones than these medications based on a "scan" (developed by Merck).
These drugs make your bone older-not stronger. Where are the studies comparing these drugs (with half lives of 11 years--meaning it takes 11 years for half of the drug to leave your body) to an active lifestyle?
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When I first took the bone density test I didn't realize it was designed for prescribing drugs. Based on my osteoporotic results five physicians prescribed Fosamax. I said No to all of them. Possibly because of exercise my bone density scores improved in recent years (I'm 69). Had I taken the drugs, they would have been credited with the improvement.
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A good friend was concerned because of family history and started requesting bone density tests when in her 50s. “Fine, you’re fine, normal” came back the results year after year. Now in her 60s she has shrunk four inches in height and clearly has painful osteoporosis, despite the testing.
Part of the problem is that only the most wealthy (she is not poor) have access to one doctor that they see regularly. A doctor who would have noted her change over time, despite the tests. But now we can rely on neither the tests nor the doctors; what to do?
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I have had several bone density scans done in my 30’s, because I used Depo for a number of years. The risk to using Depo was bone lost, which I wasn’t told while I was using Depo.
The initial scan came back that I had indeed lost bone mass. I was never prescribed drugs because of my age, instead I began to lift weight and other high impact exercises. My bone density did increase, but never to “maximum” bone density. Another doctor during this time looked at some regular x-rays I had done for another issue and he questioned the validity of the test for me because of size of my bones.
Now I’m in a quandary, do I pay for a test that may not be a good fit for me or do take a test and possibly medication to prevent something that may not be a problem for me.
Besides exercises, did you also increase your calcium intake? Calcium is not so abundant in an average diet. You have to go "out of the way " and look for sources rich in it and in vitamin D, which helps the body absorb that element. If I were you, I'd look into this diet issue and do the test now and again in three or four years.
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Calcium is not the only mineral in your bones. It's also an electrolyte and you shouldn't take it to the exclusion of other minerals. A lot of people are short on magnesium, for instance. Plus not all supplements are the same. You want a chelated mineral form, not the bare mineral or you will have ion channel conflicts. So get a good multimineral supplement. You also need fat in your diet (animal fat, fruit fat, and tropical oils) and the vitamins D3 and K2 (mk-4 form) to aid mineral absorption. And finally, any exercise that causes your muscles to stress your bones. Weight-bearing is best (not just walking... actual weight training), and apparently yoga is very helpful too.
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No recommendations for testing men seems to me very ill advised. I am a 52-year-old man who discovered, at the age of 39, quite by chance, to be suffering from low bone density, especially in the spine. I started a regimen of alendronate once a week and calcium supplements twice a day. Bone density tests over the years have shown that the treatment was successful. Now I only drink milk fortified with extra calcium and vitamin D once a day. I'm sure that, if bone density tests were carried out more often, many people would be very surprised indeed with the results.
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As usual like any other test, even if it is a legit test like this one, unlike PSA type scams, it can be abused.
I had a low vit. D level and started taking Vit D supplements which easily solved the problem.
My doctor insisted I take a bone density test (Ker Ching!, with our de facto criminal health care system, ie make the medical community rich in lieu of cost control).
I had to lose a whole day taken the test and my scan revealed my bone density was higher than normal for my age.
I jokingly (had to be careful) asked my doctor if she wanted me to take a dengue fever test next to run up the medicare bill.
The said fact is, she is one of the better doctors, I had others who wanted me to take more expensive, more evasive, more useless tests for everything under the sun.
I learned to educate myself on what is needed and not needed, what works and what doesn't.
By and large you cannot trust the medical community because of our de facto criminal for profit system.
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@Paul
Agree Paul. Remember the pen is mightier than the sword. Doctors are quick to order test and quicker to prescribe drugs.
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@Paul, If you believe that doctors get rich from ordering tests you are sadly mistaken. Yes, there are many unnecessary tests done, thanks to litigation and defensive medicine, but doctors do not profit from these tests.
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@Paul All day for a bone density test? It takes about 10 minutes. Did you have some other type of testing done?
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Necrosis of the jaw as a side effect is something that once it starts will stop when it wants to.
Take calcium with Vitamin D3 and lift those weights.
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"Take calcium with Vitamin D3 and lift those weights."
While probably well-intentioned this approach will do little for someone with a family history of osteoporosis. All drugs have side effects, and the one you mention is fortunately very, very rare. People should educate themselves instead of being guided by fear and folk wisdom...and seek the advice and counsel of a qualified rheumatologist who specializes in osteoporosis.
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@Judy--the side effect is not rare for people who have had radiation for head and neck cancer, since we are at risk of osteoradionecrosis already. And few doctors understand this. I found out by doing my own research into the osteo drugs, almost all of which have osteonecrosis of the jaw as a potential side effect. A very ugly side effect that can cause us to lose our jawbones altogether (especially since the radiation has done a lot of permanent damage to our vascular system in the jaw.
I talk raloxifene because of this.
@Judy My dentist said it's very common for Caucasian women of a certain age to experience some loss of bone density and unless it was a dire situation not to take any of the Bisphosphonates and go with other alternatives.
I'm a 57 year old woman with a long history of anorexia. I started getting bone density tests every two years (what insurance will generally cover) when I was about 50 and they all showed osteopenia until a year ago when the results showed osteoporosis. I was prescribed Fosamax. I've been in recovery from the anorexia since 2013. I'm 5'5" (I used to be 5'6") and I currently weigh between 120 - 125 lbs. The main reason for the downward trend were the steroids I needed to keep going on and off of for the adult-onset asthma I developed in 2015. It was hard to control and difficult to find the right combination of medications. I had dental implants last year, and when I went back to the oral surgeon several months ago for additional implants, he ordered a panoramic x-ray and said not only had he never seen such extreme bone loss in a year and he could not do the planned surgery, the original implants were failing. My doctors now say it is medically necessary for me to get another bone density test one year later to see if the Fosamax is working.
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@Andrea Throw out your carpets. I had adult onset asthma and one day I decided to get rid of the trillions of dust mites living in my rugs and voila - asthma disappeared.
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@Andrea I feel for you, as I also have adult onset asthma. The suggestion of getting rid of all dust mites is great, but I would like to add to that, with the disclaimer that it's only my experience, not medical advice.
My asthma is a combo of allergies, which rarely strike me, and a burning bronchial infection which left my lung tissue thin and fragile. So this is a mixture of asthma and low-grade traumatic COPD. After years of rescue inhalers, which work, but don't stop attacks, the doc Rx'd Anoro, and voilà, one puff a day, no more attacks.
I believe the warnings against asthma patients taking it are because it would be dangerous to take multiple puffs as a substitute for rescue inhalers, but you need to consult your pulmonoligist, which btw, I would get a new one if I were you. Long term steroid use is very damaging, and the fact that it's not working is another sign to look for a new doc.
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@Snip
Killing wall-to-wall carpets WILL help a lot but not to be undertaken without being stable allergy yourself if plan on doing it.
Or have someone else do it.
I learned by observation to do long slices and roll up like sod.
After saw prof do my Mom's. Immediate relief!
Did my rental myself. Immediate relief!
I put in wood floors, hers were already underneath.
The tremendous dust, dust mite poop (major allergen), and pollen and mold and mildew is a huge portion of weight of wall-to-wall.
Area rugs, small wool, can be washed. Only my place, Mom too old for smaller rugs.
Just had a baseline bone density test, and have to say the test results need some work. Nearly impossible to interpret the language used, the negative scores that compare my bone health to healthy younger women and then to my peers. I had to waste my drs time re-interpreting what the radiologist wrote to get an English-to-English translation.
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@mm
Common. just had a allergy test for a antibiotic . When completed and I saw the Doctor in charge, she started out explaining the results in English, and graduated into Dr. Jargon, and gave me a note only a Physician could understand. I wasn't allergic is all I walked away knowing.
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@mm You could have Googled it and read any number of plain language explanations on layperson's medical sites such as Mayo Clinic, WebMD, etc., or you could have taken a course in statistics - which involves torture - to understand what T-scores mean.
Besides. Google can turn up a lot more useful and varied information on treatment than your doctor will give you in a 10 minute visit.
I never go to the doctor without visiting my friend Google as well.
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I'm 68 and I've had 2 dexa-scans, years ago, ordered by 2 different doctors, but I haven't gone for a third because neither doctor was either able or bothered to explain the results to me, and they aren't exactly written for laymen!
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@Judith, get another doctor.
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@Judith--you need to ask for explanations. Be your own best advocate. Tests such as these will do no good if you don't. As a former cancer patient (cured), I learned right away to ask and ask some more.
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I'm 68 years old and have been declining bone scans each time they are offered. I am highly skeptical and resistant to taking any sort of medication on an ongoing "preventative" basis. Any medication has side effects and unless I the reasons to take something are compelling, I'd rather do all I can to stay healthy in general, avoid the side effects and take my chances. Readers might be interested in some alternative approaches to bone health: https://www.betterbones.com/
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@Julia, thank you for the link - great information!
It's interesting that one of the signifiers that bone density could be a problem is thinness. But I thought thinness was the ultimate secret to all health! (sarcasm)
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@rockstarkate - as a thin person, I definitely find it frustrating that this is one of the health problems that comes along with my otherwise healthy weight. The thing is that bones strengthen in response to weight load, and they don't care what KIND of weight. So a person who has fifty pounds more fat than I do is constantly taxing their bones in a way that I can't unless I physically drag around a 50-pound weight. I've been lifting my whole life, but as I age, I've had to go lighter because my joints can't take the heavier weights. I've been focusing more on core strength and balance as I've gotten older because falling and breaking a bone is a real fear for me.
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@rockstarkate
That's what Gym Rats believe and the Diet scams that rack in billions. Ask Oprah.
So these are the reasons and benefits for getting a bone density test, and it was briefly mentioned there are few risks to the tests.
So then what? What happens with regard to treatment if the tests indicate bone density loss, such as:
1. What are the options for treating reduced/reducing bone density due to aging and/or treatments for cancer (which I had)?
How effective and expensive are these treatments for osteoporosis?
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@PB Great question.
The Drs wring their hands. The major drugs have lovely side effects such as spiral fractures of the femur and death of jawbone. Forteo, which has to be injected daily, helps build new bone at the cost of around $3000 a month.
I am going with ReClast, which is a yearly infusion to avoid possible problems with the esophagus.
Pick your poison...
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@Meems, Reclast IS a bisphosphonate--it's also called Zometa, given 2x/yr to ER+ breast cancer patients who are on an aromatase inhibitor and can't tolerate oral bisphosphonates. AIs cause further estrogen deprivation (after menopause, tissues other than ovaries still make estrogen), which lowers bone density.
Before starting radiation, my DEXA showed moderate but advancing osteopenia. Because I also have GERD, I must take a PPI (Dexilant)--that thins bones too, but nothing else works and without it I'm anemic. Can't tolerate oral or IV bisph's either, so I take Prolia 2x/yr. along with Calcium citrate, D3, Mg and K2 and walk as much as I can (no running due to knee prostheses). My osteopenia has improved, per latest DEXA...but still broke my scaphoid and elbow falling on a stone floor. (Radiology reports said "normal bone density for age"--I'm 67). There goes the weight training.
Due to chronic overbite, I have a loosening front tooth, and I fear it might be ONJ from the Prolia.
But dear friend broke her hip (due to osteoporosis) and died 18 mos. later.
There comes a time in life when we can't fix one thing without breaking another...and so on & so forth. We really do have to roll the dice. because we can't keep our bodies perfectly intact forever.
1
I bet nobody is advertising the fact that a mammogram has 50 times the radiation of a bone scan...yet women are expected to have them 20 to 40 times in their lives, depending on who they are listening to.
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I’m one of those who question the value of bone density screening for most people over 65. For one thing, based on a bone density scan, most women over 65 and almost all women over 75 would have a greater than 20% 10-year risk of major bone fracture. So why take a test to tell you what you know? Of course, the medical establishment and pharmaceutical industry would advocate for testing and drug treatment because that’s how they make money. For another, the treatments, bisphosphonates, have side effects and don’t work very well. There are no proven clinically meaningful benefits for bisphosphonates in postmenopausal women without a prior fracture or vertebral compression. And even in women with those prior problems the benefit of drug treatment is minor. Bone mineral density increase (with bisphosphonate treatment) is poorly correlated with fracture risk reduction. So forget the tests and drugs and take care of yourself by having a healthy diet and by exercising. Something we all should do at any age.
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@Marie
My SIL had part of her jawbone rot from this drug treatment. It was very hard on her, particularly as she's a naturally thin woman and she lost too much weight (not my judgment, hers and her doctor's judgment) and had a terrible time regaining it later.
3
I experienced my first vertebral compression fracture at age 56. At the time, I was a distance cyclist and runner and had no risk factors for osteoporosis. The fracture was attributed to "overdoing" on a training ride. Osteoporosis wasn't considered or even mentioned as a possibility. Eight years later when I suffered a second unprovoked vertebral fracture, the diagnosis was made, and treatment was begun. Although my bone density has increased, I am an inch shorter, and have chronic back pain.
Any fractured bone which is not adequately explained by an identified traumatic injury should lead to an evaluation for osteoporosis, whether the patient is male or female, over 65 years of age or not. With regard to the Task Force's statement regarding men, I would reply that "the absence of evidence is not the same as evidence of absence".
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In my earlier post, I should have mentioned that I am a man, with premature osteoporosis.
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The problem may seem semantic but it is the difference between "screening" and "diagnosis". Anyone with fractures needs a diagnostic test, not a screening test. (A DEXA in this case.) For example, when a woman has a lump in her breast we do a diagnostic ultrasound, but we don't screen all women with breast ultrasounds. There are multiple reasons to suspect osteoporosis which are not covered by the task force recommendations for screening.
By the way, long distance cyclists have an increased risk of osteoporotic fractures.
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@ssamueljI had a stress fracture in my hip in the 90s, but my ortho doctor had a dexa scan done before he diagnosed too much jogging with inappropriate shoes. I have good bones, but I'm glad he took the time to check it.
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Another risk factor - many chemotherapy treatments.
Also, folks with osteoporosis should consider another preventive method - exercise. Exercise *may or may not* help with the actual disease (results are mixed), but it will help with strengthening the core and with balance, thus decreasing the chances of a bone-breaking fall.
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@HN--agree HN because of our de facto criminal health care system, you have to be your own doctor.
I don't mean to imply, you become a faith healer with all your problems but carefully evaluate anything a doctor tells you to do to see if it makes any sense.
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