Sometimes, patients on their sixties don't think on their wellbeing in their eighties. Other times, patients on their twenties do care about their health at eighty!
I know a female patient who is their late twenties and has a spinal disc herniation. She was recommended basically to only practice swimming as sport.
What would you recommend someone like her can do now to prevent Osteoporosis later on her life?
This is very relatable. I am 79, and have been diagnosed with osteopenia for the last few years. I also have arthritis that gets complicated at times. I take supplements supposedly containing the ingredients that I need as well as following a diet rich in protein and minerals. But my doctor apparently felt I was aging into a higher risk category, and set me up for my first Reclast infusion, which I will need annually.
Thank you so much for the factual and descriptive explanations you shared in your two posts on this topic. I have read many articles about osteoporosis and osteopenia on reputable medical websites over the years and have never read anything as specific, visual and practical. You shared what it looks like and what it feels like. Please keep writing! What you are providing is unique and will resonate with the older women I know.
Thank you so much for your encouragement and kind words. I’ve been doing this doctor gig a while and my patients make it very clear what they do and don’t understand of what I say. I’m so glad you found it valuable and hope you read the rest of my catalog and subscribe! Coming soon: what kinds of subtle things happen in the clinic that make me concerned about cognitive decline.
"Vitamin K2 (Yamaguchi, et al., 2003) blocks the removal of calcium from bone caused by parathyroid hormone and prostaglandin E2, by completely blocking their stimulation of lactic acid production by bone tissues. Aspirin, which, like vitamin K, supports cell respiration and inhibits lactic acid formation, also favors bone calcification. Vitamin K2 stimulates the formation of two important bone proteins, osteocalcin and osteonectin (Bunyaratavej, et al., 2009), and reduces the activity of estrogen by oxidizing estradiol (Otsuka, et al, 2005)."
But you don’t mention anything about how combining a good calcium supplement with magnesium, and there’s a fairly specific ratio the right kind of magnesium can counter the constipating effects of the calcium. My understanding has always been that for good bone health, calcium, magnesium, and vitamin D need to be taken.
You are correct. My readers alerted me to this and further reading convinced me that magnesium was an important thing to add to the slurry. I have not updated the article yet.
Slurry? Do you really want to go with that? I believe that it’s a chelated combination of vitamins and minerals in a specific ratio to accomplish bone health
I have osteopenia and scoliosis & have shrunk about 2 inches. I also have osteoarthritis. I’m 65, doing physical therapy, dog walks (he’s small so I have to be mindful about falling, tripping on him) & bike rides.
I was taking calcium but there’s heart attacks in my family & the constipation so I stopped—I’m hoping I’m getting enough through diet.
I’d seen the prune research! I started eating them & will continue.
Thank you so much! I had an interesting appointment with a spine specialist-I’ve got lots of degenerative discs & it freaked me out but he said not to worry because it’s just aging. My mom, her mom & her sister all passed away when they were 63 so I don’t have family experience with this—your information is so valuable!
Thank you! I'm so glad to hear this was helpful. I am also older than my mother and grandmother ever were and it makes one think a little bit, doesn't it?
I truly appreciate this, Dr. Bates. I was diagnosed with osteopenia a few years ago even though I had taken calcium with vitamin D and magnesium supplements for over a decade. I have been working ever sense to try to take care of my own internal "scaffolding" so that it will last as long as I do. I was prescribed the Ibandronate weekly formula, but it caused me such pain in my back for about a day after taking it that my doctor switched to the monthly formulation. I now have that nuisance pain for just a few hours every month.
I guess the way to think about it is that the pain is demonstration that the medicine is getting where it needs to go. I hope it gets better with time; it does for most of my patients. Thank you for commenting.
I ended up with 5 vertebral compression fractures d/t osteoporosis. My former MD (after this debacle found a good dr), although only seen by the PA, decided all I needed was Prednisone, Flexeril, Hydrocodone, and Lidocaine patches without doing any labs, x-rays, or ortho consult. Then, when it was ordered and was diagnosed with osteoporosis, it was too late to have a kyphoplasty. Now, I have kyphosis, scoliosis and live pretty much in misery all the time. Used to be very active, now most things are an effort .
Now take weekly Fosamax and daily Vit D, calcium and exercise as much as I can. Mostly kidding I tell my Dr. I want a rod put all the way up my spine so I can stand up straight again. He says no, no you don't want that.
Oh, no! What a horrible story. I am so sorry to hear this.
Prednisone, of course, is exactly the wrong thing!
This is exactly the kind of story I hate and am trying to push the needle towards preventing. I hope you are able to find something that works for you, even just a little bit. Talk to your doc, of course, but I have had patients in similar situations who do well with Bowen PT.
I gave up on conventional PT. It did not help much. A chiropractor was recommended by someone. Never been to one, but gave him a try. He did no manipulation (bone cracking d/t the severity of osteoporosis), but I go monthly now for a neuromuscular massage much like Bowen PT. It helps immensely at least for a while.
Isn’t this basically the result of low estrogen, progesterone,and testosterone? It seems the Women’s Health Study was really wonky in its conclusions. Why not low doses of these 3, unless progesterone isn’t needed due to hysterectomy, for women for the rest of their lives?
I am going to reserve comments on hormone therapy for after I've done more research. Elsewhere in the comments, Dr Amber Hull, who knows an order of magnitude more than me on this topic has commented.
I have read if I go off Prolia there is a rebound decline. I have been on it for about 7 years at age 67. I have gone from osteopenia in my spine to normal numbers and osteoporosis to osteopenia in my hip. I have ran, done weight lifting, and taken Calcium and Vitamin D for years. My mom had debilitating osteoporosis in her spine and I have done everything I can to prevent it. I did break my wrist after a fall 3 years ago.
Yes, there is a rebound decline when one goes off prolia, but there are things to do to mitigate it. Talk to your doc!
It sounds like you have been very diligent about your bone health and your family history is catching up with you. I think I'm funny. Next time you'll have to do a better job picking your parents.
I broke my wrist ice skating four years ago. It really put a crimp in our winter activities!
I know! I realized I will never try snow skiing again! I love the snow so we went very infrequently. I actually broke my wrist because I took weights with me when I went to stay with my grandchildren. I had a “station” set up in a walk in closet. I lifted, stepped over the weight and was running in place, slammed my foot down on the weight and fell backward. Actually also broke my 5th metatarsal which never actually showed healing, but they kept letting me increase activity to normal. That one perplexed me because I was off of it 6 weeks.
I'm the only brother to my 3 sisters, but we all share my father's twisting arthritic bones. My oldest sister is nearly 70 and suffers with scoliosis and has shrunk over 8". Next oldest has osteoporosis. I'm 65, and I've always been a heavy weightlifter. Even now my deadlifts are over 300#. Yet I too have scoliosis ( though no osteoporosis). I'm thankful for your articles, and hopefully they'll help many. I'm also hopeful that the genetic arthritis and all its associated pains and disabilities can be solved.
Dr. Mary, thank you for this. Wondering if you could share your thoughts on what are generally the best forms and amounts of D and calcium — that is, most bio-available, best absorbed?
You are welcome. Thank you for reading. I have learned today, thanks to a reader question, that the best way to get your calcium is in your diet. This makes sense as our bodies did not evolve, expecting supplements. The recommended amount of calcium is 600mg 2x/day, or 1200 mg. Dairy and leafy greens are probably the easiest food sources of calcium. People have opinions about which form of calcium is best in supplements, but I have not been convinced by any.
As for vitamin D, vitamin D3 is the recomended form, and in my experience, 2000 IU/day is required to get the levels up to ideal.
It's impossible for me to live independently without bending over and picking up things. My osteoporosis was caused by advanced hyperparathyroidism that 3 PCPs gaslit me about for over a decade. I have a “grabber” but it is limited in what it can lift. Do you have any posts describing ways to pick up objects that might minimize our risks of fractures? Youtube video advice on the subject is often at odds. Thank you for your dedication as a PCP working with older women. The ageism I've experienced from my 3 female PCPs has me in a hot despair.
You ask an interesting and important question that I know absolutely nothing about. If one of my patients asked me this question, I would encourage them to find the "bone builders" class in their town and to ask the teacher that question. Alternatively, I would encourage them to find a physical or occupational therapist who was interested in osteoporosis, perhaps through a local acute rehab hospital. There are probably some basic principles that you can apply to the problem of picking heavy things up off the floor.
As for taking care of older women, it is my pleasure and preference to take care of the older crowd. I have a few 30 and 40 year olds who have no medical issues and it's fun to see them for a change of pace, but I became a doctor to help sick people.
I personally have diagnosed hyperparathyroidism at least 4 times. I'm sorry you had such a hard time getting yours diagnosed.
A wonderful read!
Sometimes, patients on their sixties don't think on their wellbeing in their eighties. Other times, patients on their twenties do care about their health at eighty!
I know a female patient who is their late twenties and has a spinal disc herniation. She was recommended basically to only practice swimming as sport.
What would you recommend someone like her can do now to prevent Osteoporosis later on her life?
Thank you. It might be worth a conversation with her spine doctor to ask for recommendations.
This is very relatable. I am 79, and have been diagnosed with osteopenia for the last few years. I also have arthritis that gets complicated at times. I take supplements supposedly containing the ingredients that I need as well as following a diet rich in protein and minerals. But my doctor apparently felt I was aging into a higher risk category, and set me up for my first Reclast infusion, which I will need annually.
I hope it works well for you! That is one of the medications that I talk about. It is a good solution for a lot of patients.
Thank you so much for the factual and descriptive explanations you shared in your two posts on this topic. I have read many articles about osteoporosis and osteopenia on reputable medical websites over the years and have never read anything as specific, visual and practical. You shared what it looks like and what it feels like. Please keep writing! What you are providing is unique and will resonate with the older women I know.
Thank you so much for your encouragement and kind words. I’ve been doing this doctor gig a while and my patients make it very clear what they do and don’t understand of what I say. I’m so glad you found it valuable and hope you read the rest of my catalog and subscribe! Coming soon: what kinds of subtle things happen in the clinic that make me concerned about cognitive decline.
Still no mention of K2.
"Vitamin K2 (Yamaguchi, et al., 2003) blocks the removal of calcium from bone caused by parathyroid hormone and prostaglandin E2, by completely blocking their stimulation of lactic acid production by bone tissues. Aspirin, which, like vitamin K, supports cell respiration and inhibits lactic acid formation, also favors bone calcification. Vitamin K2 stimulates the formation of two important bone proteins, osteocalcin and osteonectin (Bunyaratavej, et al., 2009), and reduces the activity of estrogen by oxidizing estradiol (Otsuka, et al, 2005)."
https://raypeat.com/articles/articles/osteoporosis-aging.shtml
I'm not convinced by the K2 studies. Or maybe I just haven't read enough of them. :-)
But you don’t mention anything about how combining a good calcium supplement with magnesium, and there’s a fairly specific ratio the right kind of magnesium can counter the constipating effects of the calcium. My understanding has always been that for good bone health, calcium, magnesium, and vitamin D need to be taken.
You are correct. My readers alerted me to this and further reading convinced me that magnesium was an important thing to add to the slurry. I have not updated the article yet.
Slurry? Do you really want to go with that? I believe that it’s a chelated combination of vitamins and minerals in a specific ratio to accomplish bone health
Thank you for your two-part note about osteoporosis.
You are welcome! Glad you enjoyed it. Thanks for dropping me a note to let me know.
Thoughts on Tymlos? Thanks in advance.
I classify Tymlos as one of the meds I send people to the specialist to discuss. I cannot know everything. Sorry not to be more helpful.
Thank you for your posts.
I have osteopenia and scoliosis & have shrunk about 2 inches. I also have osteoarthritis. I’m 65, doing physical therapy, dog walks (he’s small so I have to be mindful about falling, tripping on him) & bike rides.
I was taking calcium but there’s heart attacks in my family & the constipation so I stopped—I’m hoping I’m getting enough through diet.
I’d seen the prune research! I started eating them & will continue.
Thank you so much! I had an interesting appointment with a spine specialist-I’ve got lots of degenerative discs & it freaked me out but he said not to worry because it’s just aging. My mom, her mom & her sister all passed away when they were 63 so I don’t have family experience with this—your information is so valuable!
Thank you! I'm so glad to hear this was helpful. I am also older than my mother and grandmother ever were and it makes one think a little bit, doesn't it?
I truly appreciate this, Dr. Bates. I was diagnosed with osteopenia a few years ago even though I had taken calcium with vitamin D and magnesium supplements for over a decade. I have been working ever sense to try to take care of my own internal "scaffolding" so that it will last as long as I do. I was prescribed the Ibandronate weekly formula, but it caused me such pain in my back for about a day after taking it that my doctor switched to the monthly formulation. I now have that nuisance pain for just a few hours every month.
I guess the way to think about it is that the pain is demonstration that the medicine is getting where it needs to go. I hope it gets better with time; it does for most of my patients. Thank you for commenting.
I just wanted to say thanks! I’m at high risk and do preventative things, but this inspired me to do more. All the jumping!
You are welcome! I appreciate your having let me know.
I ended up with 5 vertebral compression fractures d/t osteoporosis. My former MD (after this debacle found a good dr), although only seen by the PA, decided all I needed was Prednisone, Flexeril, Hydrocodone, and Lidocaine patches without doing any labs, x-rays, or ortho consult. Then, when it was ordered and was diagnosed with osteoporosis, it was too late to have a kyphoplasty. Now, I have kyphosis, scoliosis and live pretty much in misery all the time. Used to be very active, now most things are an effort .
Now take weekly Fosamax and daily Vit D, calcium and exercise as much as I can. Mostly kidding I tell my Dr. I want a rod put all the way up my spine so I can stand up straight again. He says no, no you don't want that.
Oh, no! What a horrible story. I am so sorry to hear this.
Prednisone, of course, is exactly the wrong thing!
This is exactly the kind of story I hate and am trying to push the needle towards preventing. I hope you are able to find something that works for you, even just a little bit. Talk to your doc, of course, but I have had patients in similar situations who do well with Bowen PT.
I gave up on conventional PT. It did not help much. A chiropractor was recommended by someone. Never been to one, but gave him a try. He did no manipulation (bone cracking d/t the severity of osteoporosis), but I go monthly now for a neuromuscular massage much like Bowen PT. It helps immensely at least for a while.
I'm glad you've found something that helps! I would agree that bone cracking would not be a good plan for you for sure.
Isn’t this basically the result of low estrogen, progesterone,and testosterone? It seems the Women’s Health Study was really wonky in its conclusions. Why not low doses of these 3, unless progesterone isn’t needed due to hysterectomy, for women for the rest of their lives?
I am going to reserve comments on hormone therapy for after I've done more research. Elsewhere in the comments, Dr Amber Hull, who knows an order of magnitude more than me on this topic has commented.
I have read if I go off Prolia there is a rebound decline. I have been on it for about 7 years at age 67. I have gone from osteopenia in my spine to normal numbers and osteoporosis to osteopenia in my hip. I have ran, done weight lifting, and taken Calcium and Vitamin D for years. My mom had debilitating osteoporosis in her spine and I have done everything I can to prevent it. I did break my wrist after a fall 3 years ago.
Yes, there is a rebound decline when one goes off prolia, but there are things to do to mitigate it. Talk to your doc!
It sounds like you have been very diligent about your bone health and your family history is catching up with you. I think I'm funny. Next time you'll have to do a better job picking your parents.
I broke my wrist ice skating four years ago. It really put a crimp in our winter activities!
I know! I realized I will never try snow skiing again! I love the snow so we went very infrequently. I actually broke my wrist because I took weights with me when I went to stay with my grandchildren. I had a “station” set up in a walk in closet. I lifted, stepped over the weight and was running in place, slammed my foot down on the weight and fell backward. Actually also broke my 5th metatarsal which never actually showed healing, but they kept letting me increase activity to normal. That one perplexed me because I was off of it 6 weeks.
I was first screened and scanned in my 40’s and took fosomax for a few years. I took strontium at the time and was in normal numbers til menopause.
I'm the only brother to my 3 sisters, but we all share my father's twisting arthritic bones. My oldest sister is nearly 70 and suffers with scoliosis and has shrunk over 8". Next oldest has osteoporosis. I'm 65, and I've always been a heavy weightlifter. Even now my deadlifts are over 300#. Yet I too have scoliosis ( though no osteoporosis). I'm thankful for your articles, and hopefully they'll help many. I'm also hopeful that the genetic arthritis and all its associated pains and disabilities can be solved.
Thank you. I agree; osteoarthritis is very common and there is not much great therapy for it.
Dr. Mary, thank you for this. Wondering if you could share your thoughts on what are generally the best forms and amounts of D and calcium — that is, most bio-available, best absorbed?
You are welcome. Thank you for reading. I have learned today, thanks to a reader question, that the best way to get your calcium is in your diet. This makes sense as our bodies did not evolve, expecting supplements. The recommended amount of calcium is 600mg 2x/day, or 1200 mg. Dairy and leafy greens are probably the easiest food sources of calcium. People have opinions about which form of calcium is best in supplements, but I have not been convinced by any.
As for vitamin D, vitamin D3 is the recomended form, and in my experience, 2000 IU/day is required to get the levels up to ideal.
It's impossible for me to live independently without bending over and picking up things. My osteoporosis was caused by advanced hyperparathyroidism that 3 PCPs gaslit me about for over a decade. I have a “grabber” but it is limited in what it can lift. Do you have any posts describing ways to pick up objects that might minimize our risks of fractures? Youtube video advice on the subject is often at odds. Thank you for your dedication as a PCP working with older women. The ageism I've experienced from my 3 female PCPs has me in a hot despair.
You ask an interesting and important question that I know absolutely nothing about. If one of my patients asked me this question, I would encourage them to find the "bone builders" class in their town and to ask the teacher that question. Alternatively, I would encourage them to find a physical or occupational therapist who was interested in osteoporosis, perhaps through a local acute rehab hospital. There are probably some basic principles that you can apply to the problem of picking heavy things up off the floor.
As for taking care of older women, it is my pleasure and preference to take care of the older crowd. I have a few 30 and 40 year olds who have no medical issues and it's fun to see them for a change of pace, but I became a doctor to help sick people.
I personally have diagnosed hyperparathyroidism at least 4 times. I'm sorry you had such a hard time getting yours diagnosed.
Mary, what is a PCP?
Primary Care Provider
The doc (or NP or PA) that you see for your regular care.