<p>Lemaitre1:</p>
<p>Since my osteoporosis is in my wrist (T-2.7) and not the “central sites” you mention (I assume hip and spine) in your post, is there less concern? Should this be treated in any way?</p>
<p>@marthrap</p>
<p>Osteoporosis is usually a systemic disease. When we perform a DEXA study on a patient we measure bone mineral density (BMD) at three central sites, the lumbar spine and the left and right hips and consider those measurements as samples that we can extrapolate to the whole skeleton. If the hips and spine show low BMD we can be fairly certain that all bones are low in BMD. Osteoporosis is often seen earlier in the spine than in the hips because the type of bone found in the spine is somewhat spongey and is called trabecular bone while the bone in the hips is somewhat harder and is called cancellous bone. BMD changes tend to occur earlier and progress more rapidly in trabecular bone than cancellous bone. Therefore the pattern of finding the spine to have an osteoporotic T-score while the hips are still just osteopenic is a common one. Also, when we treat patients with medications like Boniva or Fosamax we tend to see increases in BMD in the spine before they occur in the hips.</p>
<p>While we use a DEXA scanner, a massive peice of equipment, that measures the bone density at seperate central sites, and is also capable of measuring BMD in the wrist and forearm, using low dose x-rays while the patient is lying on their backs on a table, some doctors have small portable devices in their offices that measure peripheral sites such as the wrist, hand or foot using either ultra-sound or x-rays. The position of the National Osteoporosis Foundation (NOF) is that a formal diagnosis of osteopenia or osteoporosis can only be made by measuring at least one central site with a DEXA scanner, these peripheral devices are useful screening tools that primary care physicians can use to determine which patients should be referred for a full DEXA study. I am guessing that a peripheral device that can only scan the wrist was used to determine your T-score of -2.7 in the wrist. If that is the case you should probably also have a full DEXA study done for a definitive diagnosis of osteoporosis to be made. If BMD measurements at one or more central sites confirms the findings in the wrists, the NOF reccomends treatment with prescription medication such as Boniva, Fosamax, Actonel or Evista. However the final decision on what, if any, treatment should be used is something that you have to discuss with your doctor.</p>
<p>An interesting article on this topic (the links to related stories at the bottom of the article look very interesting as well[How</a> A Bone Disease Grew To Fit The Prescription : NPR](<a href=“http://www.npr.org/templates/story/story.php?storyId=121609815]How”>How A Bone Disease Grew To Fit The Prescription : NPR)</p>
<p>Thank you so much, one and all. I’m both more alarmed, and more reassured, than I was – if that makes any sense. </p>
<p>I made an appointment with my primary, and you’ve given me lots more questions to ask her. But given what I’m reading, it upsets me that I got a treatment plan by mail; my T-scores weren’t even included. And especially based on your post, Lemaitre, it sounds like medication should at least be considered any time there’s an osteoporosis diagnosis. I want to have a conversation with her about my situation, not a one-size-fits-most treatment plan. If I don’t get that from her when I see her, I might be giving you a call!</p>
<p>I’m interested in martharap’s question:
I simply cannot choke down the horse pills; in fact, I gag on anything larger than a Tylenol tab. Are there reasonably-sized pills, or chewables?</p>
<p>There are chewables. You can also get chewable vitamin D.</p>
<p>What are those caramel-ly calcium chews called?? Starts with a “V.” I could eat those all day. :)</p>
<p>Lemaitre1:</p>
<p>Thanks for your response. I assumed the wrist measurement was DEXA, as it was done in the same room as my hips/spine and I think with the same machine. After they were done with the hip/spine DEXA, I sat on a chair adjacent to the platform and rested my wrist on the same table I laid on for the DEXA. But maybe there was a different machine there that I didn’t notice. The tech made sure my wrist was in the correct position and the test was done.</p>
<p>If I did indeed have a DEXA of the wrist should all the readings show osteoporosis, if indeed the problem would be in all of my bones? Why would there be a reading of -2.7 in my wrist (it was only the right wrist they checked), -1.1 in my hips, and normal in my spine?</p>
<p>Thanks so much for your willingness to share your expertise with us.</p>
<p>VeryHappy, those are Viactiv however, Caltrates are a better choice (my daughter loves the vanilla). Viactiv has 500mg calcium/chew, Caltrate 600mg/chew</p>
<p>I don’t do well with large pills either. My doctor told me about Adora calcium supplements which are a little harder to find but well worth the effort. They are like a mini hershey’s bar and come in milk or dark chocolate. I no longer forget to take my calcium because I want it for dessert. For vitamin D3, I get the liquid form at the health food store and add a few drops to my morning smoothie.</p>
<p>LeMaitre, what place does Vit D and Calcium have for post menopausal women? Is the 600 dose so often mentioned a good place to start? In what forms are these supplement best absorbed?</p>
<p>
huh
my Dr never even checked.
[Celiac</a> Disease and Osteoporosis Tied in Treatment | Bastyr Center for Natural Health](<a href=“http://bastyrcenter.org/content/view/841/]Celiac”>http://bastyrcenter.org/content/view/841/)</p>
<p>cptofthehouse - </p>
<p>According to my test results from last week, my value on Vitamin D is 27 (pathetic) where the standard range is between 32-100. With these results, my gyne recommended a couple of options for me. One is to take 1,000 I.U. twice a day, or two, to take 5,000 I.U once a day. I think the reason she threw out the 5,000 I.U./day option is because she knows of a place where it’s cheaper to order the 5,000 I.U. and take it once a day, than it is to order 1,000 I.U./ and take two a day. </p>
<p>Both of these recommendations are for Vitamin D3.</p>
<p>I had two bone scans the past few years that were in the low normal range. One year post menopause I was suddenly in the mid osteopenia range! My doctor even repeated the bone scan to make sure it was correct. I have taken calcium 600 mg + D twice a day for years and she added Evista daily just this past week. She explained that you don’t really see improvement in the bone density from the Evista, the hope is that I won’t experience further bone loss. I really don’t like the idea of taking any prescription medication, but don’t want to see my skeleton disintegrate either!</p>
<p>Has anyone had problems with taking Evista?</p>
<p>MomCat2 - very, very interesting article. Thanks for sharing.</p>
<p>
The first time DW got tested she was under 15. :eek:</p>
<p>There’s a big difference between 2000 and 5000 IU/day, but 5000 is probably better, the optimal range appears to be 50-80 ng/ml.</p>
<p>Check out this handy chart:</p>
<p>[Vitamin</a> D Wiki | Vitamin D dose-response is not linear ? Feb 2011](<a href=“Overview Vitamin D Dose-Response | VitaminDWiki”>Overview Vitamin D Dose-Response | VitaminDWiki)</p>
<p>re: taking large pills - I found this to be mostly a matter of practice. When you eat food you are swallowing amounts much larger than a pill with every bite. I take a lot of supps, and I can now take 4 or 5 large capsules at once. It goes a lot quicker that way.</p>
<p>Many of the good bone supps like the AOR Bone Basics I mentioned before are a powder in a capsule, if you really have a problem you can open the capsule and empty them into a bit of juice.</p>
<p>My Vit D level was 7, then 11. Took prescription D (50,000 IU weekly) for 6 weeks and it went way up to 13! I’ve been on the weekly dose for over a year and my range is at the low end of normal. I also take 4 Citracal Plus Bone Density Builder tablets daily with meals. </p>
<p>I’ve had osteopenia for 3 years and have been dealing with a non-healing tibial stress fracture for 6 months. It’s finally starting to show signs of healing, but I’m still non-weight bearing. I’ve been tested for Paget’s and parathyroid problems and both were normal. I have osteoarthritis and fibromyalgia.</p>
<p>I decided not to take a bisphosonate (recommended by gyn and ortho), but my rheumatologist and new orthopaedist have both suggested Forteo. I’m considering it, but am concerned about the side effects, and about having to take a bisphosonate after I stop the Forteo. There’s a new drug similar to Forteo (but apparently without the black box warning) that’s in testing, but I will need something before it’s on the market.</p>
<p>Any suggestions? (Sorry for hijacking the thread)</p>
<p>I can’t believe no one has mentioned this yet (perhaps it’s the big white elephant sitting in the middle of the living room that no one wants to admit to being there), but I assume you all know how bad cola-based sodas are for you if you have low bone density. Just sayin’.</p>
<p>Good advice teriwtt; stopped my daily soda when the osteopenia was diagnosed. Smoking is also horrible for your bones.</p>
<p>I probably have 2-3 sodas per month and I don’t smoke, so no issue there. However, I’m reading that I need to give up coffee :eek: – now THAT is a problem!</p>
<p>Does anyone take Tums for their calcium?</p>
<p>I am guilty of diet colas. Average one a day. I’ve tried to quit, but I just don’t like the alternatives very much. Even though I read about how bad they are, I have trouble believing my level of consumption is that bad. I know I should quit. I do better in the summer when iced tea is more appealing.</p>