I am 55, disabled with a spine fracture. Bone density tests show I have osteoporosis. The risks of spine surgery out weigh the benefits.I am a former marathon runner & did strength training 2x/ week. I would benefit greatly from Forteo (lily) but it costs $2,700/ month. lily says I cannot get co-pay assistance because I have Medicare, a federally funded program, according to lily. I can get it for free, but your income has to be les than $35k. I can take generic fossmax but it takes a year to work vs. Forteo which can work in 3-6 months. can anyone offer advice?
This article and all responses avoid the important role of plant-based nutrition in halting the progression of bone loss. Numerous studies cited by The Physicians Committee for Responsible Medicine and many life-style physicians (McDougall, Klaper, Greger, Davis) demonstrate the creation of an acid environment in the body from the consumption of animal protein (meat, dairy, eggs, poultry, fish). When animal protein is replaced by a diet of vegetables, fruit, whole grains and legumes, bone health is restored and many other health issues are resolved even for mature adults like my husband 86 and myself 76, just back from our 5 mile daily walk.
PCRM is primarily a vegan and anti-animal research group (with reported ties to PETA), so I would suggest proceeding with caution. For starters that "acid environment in the body" business is nonsense. While eating meat (and various other foods) can temporarily lower the pH of your *urine* (make it more acidic), if you are healthy, your blood pH is tightly regulated by the body, and isn't affected much by your diet. Furthermore, there is no evidence that calcium from your bones plays any role in the regulation of blood pH (again if your are normally healthy).
Of course, there are convenient test strips being peddled here and there so you can check the pH of your urine. Unless you have kidney problems, or certain other diseases, save your money.
Of course, there are convenient test strips being peddled here and there so you can check the pH of your urine. Unless you have kidney problems, or certain other diseases, save your money.
1
Didn't the Times recently publish the results of a study that found no benefit to bone density from resistance training? It was just this year, and it was the most depressing thing - and yet here we are optimistically praising weight-bearing exercise as having a salubrious effect on bone health. Exercise is good, and surely strong muscles and good balance protect against falls, which in turn protects against fractures - but if it's true that we CAN rebuild bone density, I'd like to hear about it.
2
I recall that piece as well, and if you read books like "Dr. Lani's No-Nonsense Bone Health Guide: The Truth About Density Testing, Osteoporosis Drugs, and Building Bone Quality at Any Age" you get a much better understanding of all of the factors involved than you do in this article which promotes the very drugs that have caused many serious issues for people. In fact, many doctors are advising their patients that these drugs are a very last resort.
While I really appreciate these NYT health articles, they should be presented in the context of other recent NYT articles. This article recommends weight-bearing exercise to reduce osteoporosis risks, but within the past six months there have been at least two other NYT health articles explaining that the notion of using weight-bearing/resistance exercise to benefit bone density and bone strength is nothing more than conventional wisdom that turned out to be false when subjected to scientific measurement. Should I trust this article, or the others? If articles are in conflict, that should at least be discussed.
11
As usual, the cannabinoids are neglected. There are cannabinoid receptors in the bones and cannabinoids are known to increase the density of bone-building cells. Animal studies at the Hebrew University in Jerusalem show the cannabinoids enhance bone healing after fractures. Mice deficient in natural cannabinoid receptors show age-accelerated bone loss similar to osteoporosis. The current thinking is that cannabis is probably good for older people losing bone density. But as always, we run up against the drug war barriers to marijuana clinical trials. When we finish demolishing those barriers, we'll know more.
5
My experience was with the eyes of a great internist / rheumatologist who treated an inflammatory condition with prednisone. Them bone density tests showing bone loss. Then weekly Fosamax with no gain. Then Forteo for the prescribed smugness of time. The result was improvement. Next Prolia which I am still on. Yes further improvement. I trusted my Dr. more than fears of worst case reactions. I am in my 60s strong and lean. Fit. Happy. Grateful for the guiding light of caring Drs. I not worried about my osteopenia. I am taking extra D3 and an algae based calcium with D3. The Drs felt that's better than the "ground rock" brand calcium which has other potential negatives. I am now moderate risk. That's my story.
3
Sorry about iPhone typos
If you research drugs like Fosamax, you will discover that they do not help build bones, they merely stop bone loss or bone breakdown. So, something else you are doing is helping build your bone density, not the drugs you have referenced.
Vitamin K2! And the vitamin D recommendation is way too low; be sure to have your vitamin D levels checked.
4
A bit obsessive, I tracked down a couple of the SSRI/ Bone Mineral Density/ Fracture studies. I don't think there should be a blanket statement about these antidepressants "causing bone loss of fractures ( two separate measurements) - which could frighten some users unnecessarily. I found a 2013 report using the Study of Women's Health Across the Nation [it's about the only area where women have been the subject more often], which found no evidence of a decrease in BMD in users of SSRIs or tricyclic antidepressants over a 6 yr period in women with a mean age of 50. In one of the other studies, there was an increase in the rate of falls in those taking SSRIs. Not necessarily fractures or BMD. I think the point is to take in information and calmly sort it out; and to assess what medications you need to stay as healthy and active as possible.
3
Well done! I am a 65 year old male physician with premature osteoporosis who has had 2 vertebral compression fractures. So when I was diagnosed, and read about the issue of SSRI antidepressants and osteoporosis, I researched with more than a little interest, since I had taken one for several years. I agree that the evidence against these medications is not clearly "causal", but more an association based on the increased risk of falling. The osteoporosis specialist I see is of the same opinion. So it would seem misleading at this point to suggest that SSRI's weaken bones, although they might increase the risk of fractures.
I'm continuing to be active, hiking (with a LIGHT pack) and cycling; and I'm optimistically looking forward to my first on-treatment DEXA scan.
I'm continuing to be active, hiking (with a LIGHT pack) and cycling; and I'm optimistically looking forward to my first on-treatment DEXA scan.
4
I addition to running, walking or cycling, regular resistance training or exercise is very important for your muscle and bone health. You'e never too old to practice this in some form, even simple resistance bands for use at home are helpful.
3
I have a significant history of osteoporosis in my family, both my mother and grandmother had the classic dowager hump. My father never recovered from a bad fall and complications from a hip fracture. I hope that I am on a solid path to improve my own bone health. When I go back in a couple years for my next bone density scan I will be happy if some of the simple exercises my specialist gave me http://ways-to-stay.com/?s=no+bones+about+it, are helping. I have four brothers who need to have this on their health radar. Thanks for a great article to share.
Mary at http://ways-to-stay.com
Mary at http://ways-to-stay.com
3
Men definitely do get osteoporosis. My father was never officially diagnosed, but he shattered his heel when he missed a step and broke a hip in a minor fall in his 50's. My brother (based on family history) asked for a bone scan, and after (reluctantly) agreeing his doctor was shocked by the results: my brother's years of Tagamet use had contributed to full-blown osteoporosis at age 50.
There's a lot of research that heartburn medications may lead to decreased calcium/Vitamin D absorption -- not ideal for bone health.
There's a lot of research that heartburn medications may lead to decreased calcium/Vitamin D absorption -- not ideal for bone health.
5
It's good to alert men to the dangers of osteoporosis.
This is one area where coming up with a short evidence-based list of what "works" to prevent bone loss or to try to rebuild bone is challenging, because when you look at research, you find a lot of maybe's.
One thing I feel strongly about -that most of the general public does not know - is how dangerous PPIs are. They should carry a "black box" warning, or simply be restricted to prescription only use.
This is one area where coming up with a short evidence-based list of what "works" to prevent bone loss or to try to rebuild bone is challenging, because when you look at research, you find a lot of maybe's.
One thing I feel strongly about -that most of the general public does not know - is how dangerous PPIs are. They should carry a "black box" warning, or simply be restricted to prescription only use.
5
My mother was treated for osteoporosis, but never broke a bone. My father, however, fell while in rehab for a stroke and broke his femur (hip). He never recovered his ability to walk, as his stroke left him unwilling to do the PT necessary to regain ambulatory status. He lived another five years, to 92, using a wheelchair.
My husband's grandfather also broke a hip about a year after his wife did. Both were very slight, as my dad had been, but otherwise had few of the characteristics listed.
My husband's grandfather also broke a hip about a year after his wife did. Both were very slight, as my dad had been, but otherwise had few of the characteristics listed.
2
In 2011 at the age of 56, having been diagnosed with osteoporosis shortly after my eighth bone fracture (my 3rd lumbar vertebra from merely heavy coughing), of course my well-intended doctor prescribed a bisphosphonate.
I thought it best that I first consult with a naturopath. The first thing I remember him telling me was that he'd actually reversed osteoporosis in at least two of his patients, something that conventional medicine believes either unlikely or impossible. In any event, with the results of my most recent bone density scan this past summer, I was both relieved and impressed as the results showed that apparently I'd become my naturopath's third reversal: I was no longer suffering from osteoporosis, having found my way back to osteopenia, a less threatening precursor to osteoporosis. And I'd managed to do so without bisphosphonates.
Your readers might benefit from an excellent source of information on more healthy ways of managing and recovering from osteoporosis: http://saveourbones.com It's a doctor-approved webpage that features endless information on this issue and, in my opinion, an essential resource.
I thought it best that I first consult with a naturopath. The first thing I remember him telling me was that he'd actually reversed osteoporosis in at least two of his patients, something that conventional medicine believes either unlikely or impossible. In any event, with the results of my most recent bone density scan this past summer, I was both relieved and impressed as the results showed that apparently I'd become my naturopath's third reversal: I was no longer suffering from osteoporosis, having found my way back to osteopenia, a less threatening precursor to osteoporosis. And I'd managed to do so without bisphosphonates.
Your readers might benefit from an excellent source of information on more healthy ways of managing and recovering from osteoporosis: http://saveourbones.com It's a doctor-approved webpage that features endless information on this issue and, in my opinion, an essential resource.
7
My bone density also improved when I was undergoing cancer treatment, despite the fact that I lost way too much weight, but I still have osteopenia, and despite taking a PPI and a SSRI. My only therapy was Evista. My doctor says it does not have the track record the meds mentioned in the article do, but I had radiation to my mandible, and am already at risk for osteonecrosis of that bone due to the radiation it received. The more common drugs for osteoporosis would increase this risk.
1
I was treated with bisphosphonates for about a decade, after contracting osteoporosis due to long term steroid treatment. As of 2012, I no longer have osteoporosis, still getting screened by my rheumatologist on occasion. I don't mean to blow your bubble, but your experience reads to me like they just sold you a different name for your osteoporosis. And yes, I do work out every day, take calcium, drink milk, stuff. But the report has nice percentage readings, and I can compare a decade of scans.
4
Not mentioned in this article is another group of people at high risk for bone disorders. I'm in my 60's and have been living with HIV for nearly 30 years. Whether from the virus or the many medications this puts me, statistically, at great risk for many serious bone disorders. So far no problem, but often with these disorders people don't know there is a problem until something snaps. It would be helpful and give great peace of mind to at least have base line tests done, but I can't pay for it and, as G.S. pointed out in his earlier comment Medicare has a rather narrow list of criteria for paying for the test.
https://aidsinfo.nih.gov/education-materials/fact-sheets/22/62/hiv-and-o...
https://www.poz.com/basics/hiv-basics/hiv-bones
https://aidsinfo.nih.gov/education-materials/fact-sheets/22/62/hiv-and-o...
https://www.poz.com/basics/hiv-basics/hiv-bones
9
When I told my doctor that both my mother and my sister had osteoporosis and perhaps a bone scan was in order for me, he talked me out of it by saying "Let's wait until you've finished menopause, Dave" with a chuckle.
A year later my pharmacy was offering a rudimentary bone scan for $20. I took it and the results were positive, as was the followup dexa scan. My doctor apologized, and retired a few months later.
A year later my pharmacy was offering a rudimentary bone scan for $20. I took it and the results were positive, as was the followup dexa scan. My doctor apologized, and retired a few months later.
24
Yes, my dad has osteoporosis, along with a badly healed broken back, it caused him more worry and more pain than his cancer, heart disease, and type 2 diabetes. He once told his doctor he was considering shooting himself, because of the excruciating pain. He spent the last 2 years of his life on morphine.
10
Dad HAD osteoporosis. My brother might have it, too.
4
Though just anecdotal, I have come across some osteoporosis, and some suspect bone fractures, among men in the bicycle racing community. This may be due to hours and hours of cycling being the sole exercise of these men as, while it is great aerobic work, it is not weight bearing. I would be curious what a bone density scan of Tour de France entrants turned up.
13
Weight lifting is important. I use 3# weights to work my upper body, and do my PT exercises 4 times a week, for the lower body. Then, as much walking as possible.
6
I need to take Prilosec to keep down acid reflux at night. I've regularly run a mile or two (3/4 mile in my late 70s) most of my adult life, and my endocrinologist indicates I have dancer's legs with minor bone loss. Lost good bit of bone mass in my back. I have a small farmlet that gives my back good stress gardening, shoveling, and repairing stone walls. Based on this article, I'm going to be sure to add to that back muscle strengthening work. Thanks for the info and the various responses.
2
While it is indeed anecdotal, my first vertebral fracture was probably related to "overdoing it" cycling. At the time, cycling was my main source of exercise.
1
My understanding is that bone density accounts for only about 1/6 of the total risk for fractures; the other 5/6 include factors such as poor vision, poor lighting, slip hazards, lack of railings, poor muscle tone. All of these can be improved, resulting in decreased risk. It's also not clear that bone density is a good measure of bone strength. Finally, it's not clear how much drug treatments help: how much is the risk for a fracture decreased? But much more importantly to me is: What is the effect of drug treatment on overall mortality? And overall quality of life? None of these issues are addressed in Ms. Brody's article.
31
Thank you for this article. I have had quite a few older male patients with osteoporosis. It is definitely on my radar and should be on the radar of any clinician who treats older men.
11
This article mentions that "a low-trauma fracture" increases the chance of osteoporosis but does not mention how much effect the breaking of different bones --a small bone in the foot or hand, for example, in contrast to a serious break of a femur-- has on later in life osteoporotic fractures of weight-bearing bones. Also, how much does the age at which breaks and fractures happen affect the subsequent development of osteoporosis? If such details are really not known, that should be said.
In any case, the article is alarmist and does not give nearly enough statistical data.
In any case, the article is alarmist and does not give nearly enough statistical data.
4
A low-trauma fracture does not increase the chance of developing osteoporosis. It is a "risk factor" because it *indicates* undetected bone fragility.
7
While the article says that age (women over 60 and men over 70) is a risk factor, and there are a lot of other risk factors as well, Medicare covers the bone density scan only if the following conditions are met:
A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings
A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures
A person taking prednisone or steroid-type drugs or is planning to begin this treatment
A person who has been diagnosed with primary hyperparathyroidism
A person who is being monitored to see if their osteoporosis drug therapy is working
https://www.medicare.gov/coverage/bone-density.html
A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings
A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures
A person taking prednisone or steroid-type drugs or is planning to begin this treatment
A person who has been diagnosed with primary hyperparathyroidism
A person who is being monitored to see if their osteoporosis drug therapy is working
https://www.medicare.gov/coverage/bone-density.html
7
Yes.
More than a decade ago the UK National Health study of some 13,000 patients found that taking proton pump inhibitors increased chances of fractures by 25% to 50%.
The 50% levels involve drugs like Prilosec, now available in the US as an over-the-counter drug. Of course patients taking PPIs long term should be followed -- but often are not until a fracture occurs.
More than a decade ago the UK National Health study of some 13,000 patients found that taking proton pump inhibitors increased chances of fractures by 25% to 50%.
The 50% levels involve drugs like Prilosec, now available in the US as an over-the-counter drug. Of course patients taking PPIs long term should be followed -- but often are not until a fracture occurs.
6
The PPI data preceeds the recommendation that anyone taking those medications add a magnesium supplement. Hopefully that is routinely discussed by MDs.
1
Find an old X-ray showing bone structure (in my case, one taken in the 1970s after a vehicle accident), find one of the same body parts that is recent, or have one taken, have a doctor compare the two, and if there is a bone mass difference, you're covered with any kind of insurance. Interestingly, my rheumatologist told me, the other day, that there is significant difference between Dexa scans taken with different machines, and it is preferable to, as much as possible, to stick to one for comparative purposes. So don't move coasts in between scans, like I did ;)
1