Should I Take Medicine for Osteoporosis?

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Unless you break a bone, you may not be paying attention to your bone health. Bone loss is a silent process.

The National Osteoporosis Foundation (NOF) estimates that a total of 54 million U.S. adults age 50 and older are affected by osteoporosis and low bone mass.

I have received numerous emails from readers who have recently been diagnosed with Osteoporosis. As our estrogen levels decline, bone loss may accelerate.   Many women suddenly find themselves in a quandary as to whether to go on medication or not.

I thought I would share one women’s story with you.  For the purpose of this blog, we shall call her Jeanne.  Jeanne has avoided any pharmaceutical use because her mother took DES while she was pregnant with her.  Recently, Jeanne was diagnosed with Osteoporosis. Her doctor says her case is severe and he recommends she go on a drug called, Forteo.

To help support Jeanne, I  turned to osteoporosis expert Diane L. Schneider, MDa geriatrician, epidemiologist, co-founder of 4BoneHealth.org, and author of The Complete Bone Book.  

According to Dr. Schneider, “Osteoporosis is the result of bone loss that occurs silently and progressively creating a fragile skeleton that puts one at risk of breaking a bone or having a fracture.”

Dr. Schneider graciously shared her review and thoughts on Jeanne’s options:

Jeanne, age 60, was diagnosed with osteoporosis by bone density scan. Her lowest skeletal site was the lumbar spine (low back) with T-score of -3.7 and her total hip was -3.2. The T-score is comparison of your bone density measurement with young women at peak bone mass. The T-score along with assessing risk factors for breaking a bone provides a fracture risk assessment.


Risk Factors and Lifestyle

In discussing her risk factors, Jeanne had never broken a bone, she considers herself in excellent health with no chronic illnesses, and she is taking no medicines. She has been diligent in taking calcium supplements, getting regular exercise, and followed a vegan diet for the past six years. She felt that she was doing “everything right” to lower her risk of osteoporosis that debilitated her mother. Her family history is her major risk factor.

The results of her bone density plus her family history of osteoporosis puts Jeanne at high risk for breaking a bone. One concern is the level of her bone density at her age. A thorough investigation should look to uncover any additional problems that may be contributing to her low bone density. For example, screening for celiac disease, overactive thyroid, calcium loss in the urine and multiple myeloma to name a few.

Before discussing medicines, other general measures of calcium, vitamin D, nutrition, and exercise should be addressed as well. I find discussion of these areas are often left out of one’s interaction with their healthcare professional. So be sure to bring these up with yours.


Calcium

On review of her diet, Jeanne was consuming 700 milligrams of calcium a day from various foods and drinks. She took a calcium supplement that contained 600 milligrams twice a day. Her once-a-day multivitamin contained 500 milligrams of calcium.  All together her diet and supplements totaled 2400 milligrams of calcium.

For women over age 50 and men over age 70, the latest recommendation from the Institute of Medicine is 1200 milligrams a day of calcium from all sources. At 2400 milligrams a day, Jeanne was taking double what she needed. Excess calcium ends up in your urine putting you at risk for kidney stones.

Keeping in mind that Jeanne should only consume 1200 milligrams of calcium, her calcium supplement was stopped entirely. With an average of 700 milligrams in her diet and 500 milligrams more from her multivitamin, she met the 1200 milligram recommended target. Taking the separate calcium supplement put her way over and is not needed; but that’s what her primary care doctor had recommended without asking what else she was taking or obtaining a dietary history.


Vitamin D

Jeanne had 400 IU of vitamin D in her multivitamin and 500 IU in each tablet of calcium. Since I suggested to stop her calcium supplement, she would need to take a separate vitamin D supplement. The best guide to determine whether she needed more or less than 1000 IU she was getting in the calcium supplement is using a vitamin D blood level.


Nutrition

Jeanne considers herself a lifelong healthy eater. She strictly follows a vegan diet and prior to that was ovo-lacto vegetarian. However, in review of her usual foods for meals, she was not consuming enough protein.  The recommended daily amount of protein for an average adult women is 46 grams or 0.8 grams per kilogram per day. Remember protein is needed to support your bone, it’s not just made up of minerals.


Exercise and Fall Prevention

Jeanne walks regularly and practices yoga. Stressing your bone through weight-bearing and weight-resistive exercises are key. The exercise must be of high enough intensity to produce mechanical strain. I recommend walkers change up their speed and intensity intermittently. Try walking up steps or a hill, or walking faster for a block then repeat every couple of walks.

Yoga is good for improving balance and core strength. Yoga poses may need to be modified to avoid loading the spine in bending forward postures.

Over 90% of wrist, shoulder, and hip fractures are a result of a fall. The key is not to fall. Improving core strength and balance will help lower the risk of falling.


Osteoporosis Treatment

Fortunately, we now have choices for women and older men who have been diagnosed with osteoporosis or are at high risk for fractures. Jeanne had avoided any medicines but she was basically doing well in following healthy lifestyle. My comments above are just small modifications. Unfortunately, these general measures are not enough to lower her risk of fracture and improve her bone density.

I recommended that she consider starting therapy with Forteo (teriparatide) for the following reasons. Her spine skeletal site was lower than her hip. Forteo has a good response at the spine with an average increase of almost 10% in two years of use. It is the only medicine that stimulates the bone-building cells, called osteoblasts.  Connections are made in the bone microstructure that had broken, new bone is formed, and bone volume is increased. As a result, fracture risk is reduced. Forteo is “natural”-it is the first portion of parathyroid hormone. It produces a short burst of parathyroid hormone action that achieves these effects.

The medicine is a daily injection using a click pen-like device. This route of delivery dissuades some people from starting the medicine but it is simple and is practically painless. In addition, its use is limited to two years then followed by one of the other medicines to maintain the gains achieved on Forteo.

According to Dr. Schneider, if you are at high-risk for fracture, general lifestyle measures are limited in decreasing fracture risk. Medicines play an important role in the treatment of postmenopausal women and men with osteoporosis. Consult your healthcare practitioner to discuss the best options for you.

Remember: Suffering in silence is OUT! Reaching out in IN!

Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide To Surviving and Thriving During Perimenopause and Menopause.

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Cathy Chester

    The statistics about bone loss and osteoporosis are scary and I’m glad you helped Jeanne get solid advice. I have a scripp now to get my 2nd bone density test. I’ll be 57 next month and I want to stay on top of things. Because of kidney stones calcium supplements are not advised. I’ll see what the test shows and take it from there. I’ll lean on your advice if there’s a negative result. Hope not! Great post (again) Ellen!

    • Def circle back with me if you need any more support! I am happy to connect you with Dr. Schneider. Good Luck!

  • Generation Above Me

    Thanks for the great overview. There is now a “yellow alert” stage called osteopenia that flags weakening bones before they get all the way into the “red danger” stage of osteoperosis. I am in the yellow (partly because I am tiny, and I don’t get enough high-impact exercise because I have heal spurs that get aggravated by high impact exercise), so this information is timely for me. Thanks!

  • I am very wary of taking any medication at all. My SIL took an osteo drug and was rushed to the hospital three different times with horrible pain until finally SHE figured out it was the osteo drug she had been taking. She went off it and no more pains. I think osteo is a serious issue today, but I also think that we rush to drugs as solutions far more than we should. I am not completely against meds, but I think that we should be very very careful. Not all doctors know
    WTH they are doing, I’m sad to say. In the interests of full disclosure, my father was a physician so I’m not anti-doc.

    • I agree, not all doctors are created equal! Nor are all drugs. However, there are times we all need drugs and then there are times we don’t. I reached out to Dr. Schneider as she is up on the latest information. on bone health. She is making it her life’s mission to educate our youth on how to make sure that they are proactive about their bone health. Unfortunately,like in Jeanne’s case…..all of the proactive measures she has taken haven’t prevented her from this disease.

  • Haralee

    It is a tough subject Ellen and you presented it well with the case scenario. In my past life as a drug rep I did not hear good long term effects of some of the drugs. That said it was 8 years ago and new drugs are out with hopefully a better side effect profile.Small fair skinned slim women have a better chance of osteoporosis. It can be a genetic predisposition too. I do think women should have a bone density test as a baseline.

    • Yes, it is important to be proactive about your bone health. The drugs for osteo are not all fantastic. I have heard many stories. Most women are scared to take them. Jeanne is in a serious situation…so I reached out to Dr. Schneider as she is up on the latest information. I am so happy she shared her expertise with us.

  • I know it is a major issue as we get older. I have great bone density, at least so far, and I am hoping to continue it. I really don’t need another physical issue (as if any of us do).

    • That is wonderful, Tam! Happy to hear your bone density is good! Keep on being proactive about checking it!

  • Lisa_GrandmasBriefs

    Great information, as always. I’ll be talking to my doctor about this. I take so many other medications that I’m wary to add even more. But, ya never know… I just may need it (and be thankful you brought it up!).

    • Be sure to have a bone density test done and then sit down with your doctor for an honest evaluation of your scores. Tuck this information away, in case you need it. If at anytime, it would be helpful to chat with Dr. Schneider….just LMK. She is fantastic and on top of the latest everything about bone health.

  • Helene Cohen Bludman

    Interesting — I wonder if I might be taking too much calcium too? Definitely going to discuss with my doctor next visit.

    • Yes….too much – is not good either. It is like the Three Bears………find what is just right!

  • Linda

    Thankyou Ellen! I was very close to osteoporosis after my first bone density at 51. I started on a strict regiment of plant base calcium, strontium boost, plus vitimen D3 liquid. So thankful to report new bone growth! Now at almost 55, my spine is osteoporosis free with slight osteopenia in my left hip! Every year got better and better! If this didn’t work, I would have tried something else. Forteo sounds like a positive choice for bone loss!

    • It is fabulous that you are so proactive about your bone health, Linda. I wanted to post this story, as many post-menopausal women suffer from this issue. Glad it was helpful information to tuck away. Hopefully, you will never need it. Sounds like you are on a great program.

  • Lois Alter Mark

    Well, this is a good reminder to make an appointment for my bone density test! It’s been too many years since my last one, although my friends Ben and Jerry have been helping me out, I hope 🙂

    • Haha….def make that appointment asap, Lois!

  • Cheryl Nicholl

    An interesting subject. My mother and her mother both suffered from osteoporosis. I have made that clear with my MD from an early age and have been on 600mg Calcium + 800IU of Vit D since my 30s. This with an exercise regime that forces me to lift weight AGAINST my bone mass may have kept me from developing it. I test out at a much younger bone density. Good post.

    • So happy you are proactive about this, Cheryl. Especially with your family history. Go YOU!

  • This is such an important topic. Bone density tests are so important to get especially in your 50’s. You are always such a wealth of information that’s why I always spread the word about your blog! <3

    • Thanks, Carolann. This is such an important topic for women! You are so right about the importance of bone density tests. We all must be proactive about our health….instead of reactive.

  • M.A.

    Great post Ellen. I’m also curious about caffeine and how that comes into play with bone loss. Did Dr. Schneider consider if Jeanne drinks coffee and what does the research show? I really love my coffee but I’m wondering if it is doing more harm in the long run.

    • I am going to reach out to Dr. Schneider on this one! Be back soon!

  • Thank you M.A. for asking the question about how coffee drinking impacts our vone health. I reached out to Dr. Schneider and here is her answer:
    “Although caffeine is reported as harmful in the media on a regular basis, the data are conflicting. Some studies show an increased loss of calcium by the kidney from moderate coffee intake others showing no effect. The reason for the differing results is related to adequate calcium intake. If you have sufficient calcium, your cup of joe will not cause excessive losses of calcium. The solution is to provide adequate intakes of calcium rather than decreasing your caffeine intake. As with any thing else don’t over indulge. You might want to have a latte with milk, soy milk, or almond milk just to sure!”