Osteopenia

[Cataboo]

Just read this article in NPR and it's pretty outrageous:

http://www.npr.org/templates/story/story.php?storyId=121609815&sc=fb&cc=fp

How A Bone Disease Grew To Fit The Prescription
www.npr.org
In 1990 the bone condition osteopenia - a slight thinning of the bones - didn't exist. Today women are diagnosed with osteopenia and given medication. This is the story of how Merck's marketing efforts changed the definition of a disease, creating a whole new category of people who saw themselves as...

[KnottedYet]

Great article, thanks for the link!

I love the docs who tell their osteopenia patients to get to work changing lifestyle: they go to the nutritionist to learn about dietary changes, and they get sent to me to learn about weightbearing exercise.

Lifetime habit changes vs. lifetime drug use. It's good to have the options and it's good to have a doctor who can help you figure out which is the better path to try first.

[Cataboo]

Great article, thanks for the link!

I love the docs who tell their osteopenia patients to get to work changing lifestyle: they go to the nutritionist to learn about dietary changes, and they get sent to me to learn about weightbearing exercise.

Lifetime habit changes vs. lifetime drug use. It's good to have the options and it's good to have a doctor who can help you figure out which is the better path to try first.

Lifetime drug use that may long term make your bones more brittle.

Sounds like a great thing to be encouraging lots of people to do.

[KnottedYet]

Lifetime drug use that may long term make your bones more brittle.

Sounds like a great thing to be encouraging lots of people to do.

Yup. "If it ain't broke yet, don't Fosamax it."
(send 'em to me instead... evil laughter from the physical therapy department... mooo-heh-heh...)

ETA: the osteopenia/disease/drug thing reminds me of when docs used to freak at healthy women who were "anemic" during pregnancy and throw iron pills and dire warnings at them. Until someone finally realized low blood iron was normal (and desirable) as the body sequestered iron. I was anemic earlier this year and it was horrible, I was miserable. Nothing like the "anemia" I <didn't> have while preggers. Thank goodness my OB had the same stance as these bone docs; if the patient is healthy and has no symptoms, don't treat a test result. "Treat patients, not test results" is something I hear a lot.

Osteoporosis, now... that s*cks. I've worked some desperately debilitated elderly ladies, and darn tootin' I want them to be taking Fosamax. Fragile bones are bad news.

[cylegoddess]

Yes Big pharma sucks, but since many more people now days drink soda, eat acidic foods, dont exercise( sedentary) - oesteo is rising and yes! I am a fitness instructor, so I work to change it without drugs.

[Grits]

Good article. A few years ago I had one of the bone density tests with a perepheral device, it measured the heel in my case, and was diagnosed with osteopenia. I followed it up with a full diagnostic scan of the spine and hips which confirmed it and was put on Fosomax.

I then read a book, The Myth of Osteoporosis by Gillian Sanson, (poor title, the author acknowledges that osteoporosis is not a myth, but is much, much rarer a disease than you would think given all the publicity). It, as does the article, puts into question the validity of calling osteopenia a disease needing treatment and comes to the same conclusions, but coming at it from a slightly different angle. That convinced me to go off the fosomax and up my calcium intake. I've always done weight bearing exercise and really had no risk factors other than the ones you can't help - race, sex, body build.

I've heard similar things about cholesterol and blood pressure meds. The cut off for what is "normal" is changed, and a doctor goes from having healthy patients one day to lots of patients who need prescriptions just based on a number that someone, somewhere came up with. This definitely makes you think. We tend to do what our doctors recommend without questioning, but really need to do our own research.

[sarahspins]

Yes Big pharma sucks, but since many more people now days drink soda, eat acidic foods, dont exercise( sedentary)

I agree with this so much.. because the same can be said for diabetes, high blood pressure, heart disease, etc. I've heard a lot of arguments that they're on the rise simply because doctors are more aggressive at looking for them.. and on one hand I can kind of see that (as diagnositc criteria change), but it doesn't address the underlying issue that Americans just plain sit around much more than we used to... the human body was designed to be used, not sit in a recliner watching TV. No one really puts much effort into taking care of themselves until there IS a problem.

Now, I say that, I don't mean to sound crass.. I am diabetic (type 1) and I also take an ACE inhibitor to protect my kidneys as a preventive measure (I do not have high BP, or rather, I did not before taking ACE inhibitors). I'm also hypothyroid and take synthroid for that, so I'm basically on 3 medications for the rest of my life. I'm only in my 20's.. so that sucks. I worry about long-term effects, but I also know that the immediate short term results of not taking them is so much worse :p

[Biciclista]

Thanks for the article. To add to the above information provided by Knott, I encourage you to work on balance exercises. (which includes cycling :cool::p ) because most fractures are caused by falls and most falls are caused by poor balance.

[tctrek]

So when they say do weight bearing exercise, is any exercise using weights ok? Like circuit training, squats, lunges? I have osteopenia in my hips -- what sort of exercise is good for that? I do drink milk, eat yogurt and take Calcium/Vit D supplements and I do a somewhat standard strength routine a few times a week. Is that enough?

[Crankin]

Well, I have a somewhat skeptical attitude that osteopeinia is not real. I found out I had it over ten years ago. I've been taking calcium for 25 years, been exercising for longer, mostly impact for the majority of the time. I couldn't take Fosomax and was on Evista on and off for 3 years. I stopped taking it because of the side effects. I've lost 10% of my bone density in my spine in the last 3 years; no amount of calcium has helped. Both my mom and grandmother had this. I am thin and Caucasian, both apparently risk factors.
Right now I am waiting to discuss the results of some tests to make sure I am an OK candidate for Reclast. I am praying I can take this treatment without problems, because I don't want to be on my way to becoming my grandmother, who lost 3-4 inches in height and never was the same after she fractured her hip. I'm extremely conscious of what could happen when I am riding, x country skiing, or even just walking on the icy snow. It's not going to stop me from doing this stuff, but it's making me even more cautious than usual.

[KnottedYet]

Crankin, you would be a prime example of where the doctor should be talking about drugs for the first option: as a patient you have risk factors and a family history, so your test results would just add to the data. (treating the patient)

As opposed to quite a few women who have no history and low/nil risk factors, and the only data is the test result. (treating the test) These are the women I want to see get set up with exercise programs and nutritional guidance. I really like working with these women, often they've not been very active and have poor kinesthetic awareness. We have fun, I love opening up the world of activity to someone.

Good luck with the Reclast, and stay active!

[Trek420]

Knott and all, aren't cyclists more at risk (unless we cross train) because of a lack of weight bearing?

[Cataboo]

Crankin, in addition to what Knot said - it sounds like they've actually tested your spine for bone loss, as opposed to testing your wrist or heel and inferring your spine must have issues like the article was talking about. I'm assuming your test is more accurate.

[Bike Chick]

Knott and all, aren't cyclists more at risk (unless we cross train) because of a lack of weight bearing?

That's what I was told by my doctor. She said it does nothing for bone density and that I needed to start walking and/or weight lifting in addition to cycling.

[Crankin]

I had the regular Dexa scan for bone density. I've had one every 2-3 years since about 1998. Any other test would be a "rip off" in my opinion.
I agree that for most people, getting them off of their *sses and moving, along with dietary changes is the best thing. Knott, if you can get anyone to do this, you are a saint. I am in the process of planning a beginning fitness class for my psychiatric clients; the level of unhealthy behaviors is astounding...

[indysteel]

That's what I was told by my doctor. She said it does nothing for bone density and that I needed to start walking and/or weight lifting in addition to cycling.

Your doctor is correct. Running, walking, weight lifting, kickboxing, step aerobics, and the like are "weight bearing." You're essentially bearing the weight of your own body to resist gravity. I'm not aware of exercises that you can do to target any specific area, but I'll defer to the PTs to answer that one. I would also suggest doing something like yoga that helps you with balance.

[Trek420]

Not a PT, no medical training, blah blah blah :rolleyes: but clarification on the kickboxing. It's a great aero workout but kickboxing itself has no impact.

Make sure your class includes work with the heavy bag. :cool:

[DebW]

I had a dexa scan a couple months ago that showed mild osteoporosis of my spine, hip area somewhat better. My friends couldn't believe the diagnosis because I backpack and do trailwork and lots of weight-bearing things, but of course I don't do those things 3 times per week. So I've been doing some reading on the subject. According to one book, walking is such mild weight-bearing exercise that it is unlikely by itself to increase bone density (at least in a one-year time frame). Jumping exercises were experimentally demonstrated to increase bone mass. I have a question maybe Knot or someone can answer (though it's likely no experiments have ever been done to determine this for sure). If I have a 2 mile commute to work and want to increase the bone density in the spine, which of these commuting methods would be best, or at least useful: walking, jogging, walking with a heavy backpack, cross-country skiing, snowshoeing, cycling. I'm not likely to jog due to knee issues, but the others are viable, depending on conditions - though lack of any sidewalks on the busy streets of my commute makes cycling feel safer. Any evidence that carrying a heavy pack increase bone density in the spine? Does it matter if the backpack weight hangs from the shoulders or sits more comfortably on the hips?

[Crankin]

I'd like to hear the answer, too. I started running just to counteract the trend, which ended up just starting some pretty awful back/hip issues. I am ignoring it so far, with the possibility that it is a disc issue (been to the doc once and first line of treatment didn't do a thing). I stopped running, even though I liked it, because a lot of the research I read said running might actually cause fractures. Oy, not sure what to believe. I had the passing thought my back/hip pain might be a fracture, but it comes and goes and when I described it to the doc, he pretty much confirmed my description by immediately stating, "it's a disc." Next step is MRI, but I am waiting to get the osteo stuff straightened out.
Like you, Deb, it's worse in my spine than hips and still at the mild stage. I had a slow speed crash last summer, with no ill effects.

[michelem]

I, too, was diagnosed years ago (in my mid-20's, via DEXA imaging). I'm one of those people who is up-front with my docs and say from the beginning that meds are a very last resort. They don't always like that attitude, but they can work with me on my terms or I'll go to someone else who will.

I, too, have the genetic pre-disposition for, plus family history of osteoporosis. Something I've added to the arsenal in just the past couple of years is LOTS of vitmain D supplementation. For whatever reason, I'd never had my d levels tested before, but this new doc ordered that right away. Turns out, that in all her years of practice, she'd never seen a patient with lower d levels than mine. I guess that's what hyper-vigilant sunsblock application will do to a gal! :eek:

Without going into too much detail (if you want it, ask, and I can give ya plenty!), this doc has taught me that nutitionally, there's more to it than calcium. In order for the calcium to be absorbed and utilized properly, there has to be an adequate amount of d. Also, not too much protein, especially animal protein. And, not too much sugar (that's a tough one for me! I've been known to eat straight, refined sugar by itself!).

And, the all-important weight-bearing exercise.

DEXA results have remained steady (no further bone loss) . . .

[newfsmith]

The annoying part of all this is accepting that we are all living in the middle of scientific research, NO ONE has the answers. Even the effect of weight bearing vs non-weight bearing exercise is called into question by some researchers. They claim that muscle strength is what matters in preventing fractures, and that cycling is just as good for preventing hip fractures as running.

Some of us will be lucky and that will be enough. Others will need drugs, some of us will get osteoporosis in spite of everything we try. It is no different than heart disease or cancer. Not everyone that gets a disease gets it because of lifestyle choices. I've a friend with advanced lung cancer that never smoked. Yes, people need to take responsibility for their lifestyle choices, but there is a tendency in today's society to believe that if you only did things the right way, nothing bad will happen to you. The last I checked, Scientists; physicians; Zen, Tai-chi and Yoga masters still all die just like the rest of us. So live the best quality of life you can right now and do it for as long as you can.

[salsabike]

The annoying part of all this is accepting that we are all living in the middle of scientific research, NO ONE has the answers. Even the effect of weight bearing vs non-weight bearing exercise is called into question by some researchers. They claim that muscle strength is what matters in preventing fractures, and that cycling is just as good for preventing hip fractures as running.

Some of us will be lucky and that will be enough. Others will need drugs, some of us will get osteoporosis in spite of everything we try. It is no different than heart disease or cancer. Not everyone that gets a disease gets it because of lifestyle choices. I've a friend with advanced lung cancer that never smoked. Yes, people need to take responsibility for their lifestyle choices, but there is a tendency in today's society to believe that if you only did things the right way, nothing bad will happen to you. The last I checked, Scientists; physicians; Zen, Tai-chi and Yoga masters still all die just like the rest of us. So live the best quality of life you can right now and do it for as long as you can.

Well said, newfsmith.

[KnottedYet]

Yup.

And if your quality of life will allow you to jump (both feet) in place 50 times a day so your bone deposition will follow impact force patterns at the hip, and allow you to do the "prone boat" or "superman" exercise for up to a minute 3 times a day to allow extensor muscles to strengthen and calcium to settle into the vertebrae along extension patterns; all the better!

(and don't forget all those great activities you do up to an hour a day on top of it)

[Zen]

And if your quality of life will allow you to jump (both feet) in place 50 times a day

Do those 50 jumps have to be consecutive or can I do them randomly throughout the day?

[solobiker]

I know weight bearing acitivies are great for the bones and for healing..I have said this to my patients many tmes. The one area where I am lacking significantly is my calcium in take. I am not a fan of milk or cheese and will sometimes eat yogurt. My question is do you think supplements really work. I know there should be a proper ratio with another mineral for absorption purposes I just don't remember what it is. Does anyone know what it might be.

[KnottedYet]

magnesium and zinc.
And vit D, of course.

If you have calcium going into your gut, the ultimate source doesn't matter as long as you are absorbing it. If you can't eat dairy (like so many folks) then go for other high calcium foods or supplements. Ca ions are Ca ions, regardless of whether they come in a pill or in a cheese sandwich.

The associated nutrients in the cheese sandwich are much more exciting than what generally comes in a calcium citrate/vit D/magnesium/zinc pill, which is why most labels I've seen say you are best off taking the pill with a meal. (better absorption)

Zen - just jump. whenever you want. There are some great force-line xrays of hip joints (the head of the femur) that show the different deposition patterns of bones subjected to impact vs bones that aren't. Jump, girl, jump! Get a jump rope, jog, whatever. Get those bones used to impact and depositing calcium where they need the extra buttressing, so that someday when you miss a curb your femur says, "No problem, I touch down like this at least 50 times a day" instead of "OMFG! Impact! I can't handle this! <snap!>" I've talked with lots of folks who swear their hip broke BEFORE they fell. The break caused the fall, not vice versa.

[Tuckervill]

My PT-friend/gym owner/fitness guru swears by jumping-jacks as the perfect exercise. I can do 200. :D

Karen

[Crankin]

You know, when I was teaching fitness classes, I eventually stopped doing regular jumping jacks. Why? Because all of a sudden, we started seeing lots of back and hip injuries from the repetitive stress of all of the jumping jacks and running. I always did alternating leg jacks after that. I think it was something like 7x your body weight for full impact jacks and 3x for alternate leg ones.
So, it's sort of like, what do I do? Deal with the pain of injury to my bones from the high impact stuff, or deal with the risk of fracture?
I'm thinking of restarting some easy running again, despite the fact my hip is still hurting. Yesterday I did 3 3 minute intervals of running at a 10:30 pace, with no ill effects. Already doing the superman exercise and lots of other weight bearing/core stuff.
Still waiting to get the final word from the doc about the meds.

[tulip]

I don't like jumping jacks because they hurt my knees. Perhaps I don't do them properly. However, I really like the idea of jumping rope. I'm also thinking of painting a hop-scotch grid on my driveway (behind the privacy fence!). That would do the trick, and be fun, too.

[Tuckervill]

I had to work up to 200 JJs. My knees couldn't take it either, and I baby my knees so I would stop as soon as they felt tired. But, eventually I just kept going and it's fine. I'm working up to 6 minutes on the jump rope. Cardio wise I can do it, but the knees and lower legs get tired and I start to make mistakes which lead to tweaks in this or that ligament or tendon, and soreness. So I'm working up slowly.

My knees are better off when I use them, even the jumping and etc. I just don't do too much.

Karen

[solobiker]

Thanks Knott!! I remembered once you responded to my post. I think it has to be a 2:1 ratio with the magnesium and calcium...but then again I could just be making that up. :p