At what loss does fracture usually occur?

Does anyone out there know at what point fractures (non-trauma) occur with low BMD readings along with not being able to take calcium and vitamin D supplements on a regular basis. Also, is there an increase in muscular/bone pain prior to a fracture with this disease? I understand that for every -1.0 reading, there is a 2.5% chance of a fracture. But, those numbers do not seem like any big deal to me. As of 2008, my lowest reading of -3.4 was in my spine, L-2 through L-5 areas, and osteopenia with borderline Osteoporosis in my hips and Osteoporosis in other parts of my spine with my numbers continuing to decrease slowly, but surely. I also have Osteoarthritis and fibromyalgia.
My numbers, to me, don’t seem to be low enough to be of concern for a simple fracture, but I’ve had increase of bone pain since October and it’s gotten pretty bad to where I’m unable to do much of anything, this past month. I cannot even tolerate walking on my treadmill right now. My doctor put me on Lyrica last week which I'm refusing to take, after taking it for 3 days, because of the "medicine head" feeling. No thanks! So, I'm just dealing with the pain till I see him in another month. I would rather find the culprit to the increased pain instead of masking it with more meds. I can't help but wonder if it's a precursor to a fracture or just low in vitamin D, or possibly both or the worsening of my disease. My doctor seems to think my pain is a fibromyalgia flare-up. I've had those many times and this is deeper, in my bones, so I'm hesitant to go with that.

I cannot take any forms of calcium and am vitamin D deficient and can only tolerate taking vitamin D irregularly, which doesn’t help my case. I am taking Reclast without any problems, thus far. This week was my second infusion. I’m 5 feet, 110 pounds, do not smoke, drink or take recreational drugs and try to stay fairly active, except as of late because of bone pain. Yes, I am on other meds that I've taken for years (tramadol) to help decrease muscular pain, but those do not seem to help lately.

Anyway, I was wondering how low the BMD readings have to be in order for fractures to start occurring from just silly things, like bending at the waist, etc., and if there is a correlation between sore bones and fractures with my reading of -3.4. I know everyone's body is different and this may be a tough question, but just a little insight and approximation would be helpful, if at all possible.

Thanks,

Cynthia

By Loods
Posted April 5, 2009 at 11:05 am
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Hi Cynthia,

I have to say I don't think BMD ratings have much relevance as to how often you are likely to fracture. I have severe osteoporosis and a rating of -6 in my spine, but my Specialist told me these are just figures and does not always indicate you are more likely to fracture than someone with, say -3. In fact she said for some reason people with a 'better' score often fracture more!

Although many people like to know what their scores are so they can keep an eye on their condition I don't think it is advisable to get too hung up on figures.

If I went around all day worrying about being -6, I wouldn't get out of bed!

It is difficult to say why you are experiencing an increase in pain because even with a poor reading I don't get pain. The only time I had very bad back pain was when I was on fosamax/actonel, so if I was you I would consider the possibility that it is Reclast that is causing the problem, not the osteoporosis itself? Many people experience side-effects with these drugs, you only have to read the discussions on this web-site to realise that.

Could you come off reclast for a while and see if you pain improves? Even though you have been taking it for a while with no effect it can suddenly start to affect you. I was on biphosphates for 18 months before I got really ill with them. Now I am off them I have slowly got my life back without pain!

By Birdrocker
Posted April 5, 2009 at 11:23 am
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Michael Turner from Mayo Clinic article in Pain Medicine Nov 2008 talks about patients may be diagnosed with fibromyalgia have vitamin D deficiency .

A Canadian product "ddrops" is now available in the US through Carlson laboratory. You can order online or find in your natural foods store. The drops are concentrated in 1000 or 2000 IU.

Good luck

By MamaMarks
Posted April 5, 2009 at 12:53 pm
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Hi Loods~

Thank you for the quick response and information. I too do not worry about the numbers and do what I feel like doing, within reason of course. When I was first diagnosed I was shocked, scared, angry, then defiant. I'm still defiant! I like planting and gardening and will dig a hole big enough for a 15-gallon tree then tug and pull and lift the tree into the hole then plant it. I'm told that's a 'no-no'. I refuse to 'not live' based on numbers and I hate being dependent on others to do the things I’ve always enjoyed doing, so I just do it and deal with the pain for a few days afterwards and figure that if I break, then they can fix me. I know….I know…stupid.

I was just curious though after reading some of the posts on this site if there is a correlation between an increase of bone pain prior to bone fracture and at what BMD levels do most fractures occur. I’ve noticed that some people on this site have had many fractures with just having osteopenia, which I find somewhat interesting to say the least. I understand, as you’ve explained it as well, that it’s hard to answer that question since each person’s body is different and handles this disease differently and not everyone feels pain. But this knowledge still doesn’t stop me from thinking that there may be some type of correlation.

I do have to say that after, a week of, suffering severe myalgia last year, after my first Reclast infusion, 3 weeks later I woke up wondering why I felt so different. I realized I was without pain! This lasted approx. 6-7 months and was greatly appreciated let me tell you! I wasn’t completely pain free, but my pain was reduced a good 85% and any reduction is appreciated! However, at the end of last September the pain started to come back with vengeance, feet first, and has increased in intensity since then.
I did not have the same side effects last week from my second Reclast infusion as I did a year ago.
I know not everyone has had satisfactory results from Reclast and some have had some pretty horrific experiences and my heart goes out to them.

In reference to your question about stopping Reclast for a while to see if my pain decreases: This year is only my second infusion of Reclast. If my bone pain does not ease up, even with this infusion, I will suggest to my Rheumatologist that maybe we need to try something else next year. I did take a hiatus of about 8 months from Boniva before starting the Reclast and had a DEXA done before the Reclast and my scores became worse so my doctor is absolutely against me stopping all meds and doing nothing since my T-scores tend to get worse rather quickly.

Thank you for your comment and suggestions. It’s always nice to get someone else’s perspective on this issue.

Here’s hoping you the very best!

Cynthia

By MamaMarks
Posted April 5, 2009 at 12:55 pm
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Birdwalker~

Thank you for your suggestion. Is this the same Carlson company that makes the fish oil? I take the lemon flavored fish oil everyday and so far, it's been a month now, I haven't had any problems with it. I'd be willing to try their D products if that's the case.

Take care,

Cynthia

By Gatekeeper
Posted April 5, 2009 at 4:30 pm
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Cynthia,

Everyone takes the Vit. D drops in this family, including my 20 something boys.

I too have a similar attitude about life, with the hope if something breaks they'll fix it. Last year I took a hard tumble from the porch and when I found out my dexa scores this year, am surprised I didn't break something. I wasn't even that sore, except for where my knee and top of my foot hit the ground first.

I've been doing my garden chores since the weather got decent on Thursday, boy do I feel it, but I notice it less working in my garden. ~ JJ

By nornd
Posted April 5, 2009 at 4:37 pm
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Hi mamamarks, I was interested reading your entries, especially the part about digging holes and planting big trees all by yourself. I too live on a small farm-type property and have spent years doing similar things. After diagnosed with osteoporosis I was forced to put a limit on my physical tasks. So I do feel I should caution you. Sometimes we energetic women do too much for our poor bones to handle. Exercise is good, but not if we constantly go over the limits. Remember that over-exercise is mentioned as a known cause of osteoporosis. I feel so much better now that I am not doing the 'silly' things I once did, while still being very active and exercising every day. Why is it that you can't take calcium? I wondered whether strontium would be a good answer for you? Have you read about it? Good luck.

By justosteopenia
Posted April 5, 2009 at 7:39 pm
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Hi mama et al.
I have fibromyalgia with OA as well.
My dexa is no where near anyone here. I should be doing the cha-cha compared to you guys. CS and LS well, that's another story with narrowing and herniated discs etc.

I would like to share R. hip is -1.4 and left is -1.0 the pain in the right hip was unbelievalbe last Oct. to date, as well.
I have trochanteric bursitis in the right hip diagnosed after an MRI.

Bone pain and fibro pain are two different things. I truly thought I had bone cancer on the right hip the pain was that severe.

I'm sorry but I would NOT take any of the bisphos. out there orally or by injection. If it can cause flu like symptoms...no thanks...that's what I've been living with since 1992.
I try any type of alternative medicine approach.
I bet U dollars to donuts it's the reclast or you could have bursitis like myself . Thus the need for an MRI. Xrays' show nothing.

It is unfortunate that you cannot take vit. and minerals but here's a suggestion.
Get an MRI. I also started PT for the hips 3 x's a week. You need a therapist that does at least 15 minutes HANDS ON, more if you can get it. I am doing more walking (treadmill walking 2.5 for increments of 10 minutes only); has given me exercises as well. I have increased my D, calcium and mag. (My bloodwork showed my D was low) a problem for fibro patients, so i've been reading. I've also heard about a Dr. Grossman, naturapathic MD (he's been on TV). I'm going to have him suggest bloodwork to see what vitamins I really need. It gets costly. He will do a phone interview, He's in Colorodo and I hope co-ordinate with my primary care.
I plan on finding an acupucturist next. It worked really well in 1997. I've not been able to find someone yet.
Can U tell my why U can't take vit. I've heard this from many peole and don't understand.
Can U tolerate liquid or IV vitamins. I take tramadol for pain (I had lyrica 1 1/2 years ago and only took it at nite for sleep. My fibro dr. got very angry. I live w/o it now. ) I just recently started celebrex which helps the hips esp. walking up stairs. I will take it till the inflamation of the bursitis goes down.
If after 30 days my hip still hurts I will get a steroid injection.
I thought you were my twin with fibro, oa, and hip problems beginning in Oct. who knows maybe it's the baromectric pressure affecting both of us. I wish everyone well. This is a great place to read and learn.
Blessings

By abbeyg
Posted April 5, 2009 at 8:43 pm
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I can add my numbers.

Hip -2.69
Spine -2.4

I fell on a step last August and had a burst fracture and a compression fracture to my spine.

I had an MRI in February and the test noted another compression fracture to my spine. I'm still not 100% certain how that one happened, as I have not fell or anything since August.

I would use caution to the "if I break it they will fix it"....after I had the CT scan in the ER I was not allowed to move till after surgery. The doctor later told me that I was very lucky to still have the ability to walk and have bladder/bowel control.

By Stu
Posted April 6, 2009 at 5:41 am
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Take a look at this site.
http://courses.washington.edu/bonephys/ophome.html

This is a great site and will give you the risk of a fracture based on your sex, age and t score. Its a good site with lots of information
Stu

By Loods
Posted April 6, 2009 at 8:37 am
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I think from all the 'posts' it shows that we all have different ways of dealing with our situation, there seems to be no definitive rule. I also believe a lot of it is down to luck. You can do everything possible with medication, vitamins, exercise and still unfortunately break a bone.

I don't feel the condition should rule your life but I do think you have to be sensible. Broken bones do of course mend but often not without a certain degree of limitation or continued disability. Avoiding a break will always be preferable but not to the point of restricting your life, it's getting the balance that you are happy with.

By BobWallace
Posted April 6, 2009 at 9:16 am
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I was told by the doctor that my T score of -2.5 in my femur neck but me at immediate risk for a atrumatic fracture, meaning it could break without falling or a blow, just walking around. It nearly made a cripple out me. No golf, no fishing alone, etc.
Thanks Stu for the reference fracture rating.
BMD does not always correlate with bone strenght that is indicated by the studies of those taking Fosamax, etc. whose BMD increased but they experienced fractures.
I no longer take Fosamax (bone glue).
My osteoporosis was caused by Celiac Disease the number one cause in men and it is not arrested.

By MamaMarks
Posted April 6, 2009 at 11:36 am
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Wow!

Thank you everyone for the wonderful input and advice, all will be taken to heart. Stu~ Thank you for the site. As soon as I'm done here I'll go check it out. I’m always looking for information on something I don’t understand. Loods~ You are so right on everything that you have said on your posts here and I greatly appreciate your insight. You are my guru! LOL! Bob~ What is "bone glue?" I think you should get back out there and go fishing Bob! That used to be one of my all-time favorite things to do. I don’t do it now because my son is 29 and lives in another state and my husband does not like to fish and I will not go alone. But, if that’s something you’ve always enjoyed doing, just do it! Abbeyg~ Holy cow sister! Take it easy and watch those steps. I have steps that lead to the bottom of my property where my garden and animals are and there have been numerous times that I've almost fallen backwards while walking up them. Backwards! Thank heavens for good balance! I often think that if hubby can't find me, that's where I'll be; at the bottom of the stairs doing one of those "I've fallen and I can't get up" routines. I know that may not be funny to some of you, but if you knew me, you’d laugh your butts off. I’m not accident prone nor clumsy and for something like that to happen would just be out of the norm for me.
Justosteopenia~ Where do you live? Thank you for all the information that you gave and the similarities between the two of us are pretty uncanny! I love the sharing! Nornd~ I have not tried strontium and will research that. My physician has not said anything to me about it. He has been my doctor for almost 20 years and is very good at his job. He is very quick to respond to any complaints or new ideas that I have, in regards to my health, and is very educated, although he has not mentioned strontium. How long has it been on the market?

To answer everyone’s question. I have the type of body that builds resistance to medications; antibiotics, pain meds, vitamins, etc. I can take things for a short while, then my body starts rejecting them by making me incredibly ill. I have to rotate antibiotics etc., but very rarely need them, thank heavens. For some reason my body does not assimilate ‘things’ properly. My doctor said this is a good thing (not sure what the good thing about it is) and potentially a very bad thing. If I ever got very ill requiring I.V. antibiotics I’d be in trouble. I have tried several different types of calcium, even liquid and the effects are still the same. I’m still looking for the ‘right type’ and am not opposed to trying something different. I do my best to eat healthy with lots of fresh veggies and fruits on a daily basis, but cannot tolerate dairy products, even soy, which is not dairy. Right now, I can take the vitamin D as long as it’s not too much or too often. My Rheumatologist draws blood every 3 months and checks my levels. We just take it one step at a time. It would be nice to be able to take something on a routine basis, tried it a million times, but my body has it’s own mind.

I thank everyone who has taken the time to post to my question and to share your own thoughts and feelings and even a little about yourself. It’s nice knowing I have a place to go to talk to others that are in the same boat as I. Everyone’s advice and insight are incredibly helpful.

Here’s to not breaking anything!

Cynthia

By SusanRae
Posted April 6, 2009 at 11:52 am
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Dear MamaMarks,

In 2003 my T score was -1.76. I started breaking bones in 2005 (smashed wrist--plate and 6 large screws). In 2006 I broke my elbow badly (2 bones, 3 screws). My T score after I broke my elbow the first time was -2.0. I broke my elbow again 6 months later. Sometime in this timeframe I also broke two bones in my feet. I had three falls from a standing position and broke 4 bones. I was not doing anything outrageous.

A recent scan shows I'm now at -2.9, in spite of taking calcium with vitamin D since 2003.

I never had any pain before breaking any bones. Something else is causing your pain. Please be careful in your activities.

As to the comment someone made about "If I break it, they can fix it." NOT NECESSARILY SO. Because of my wrist break, 30 years of violin playing have gone down the drain. My elbow breaks have limited my mobility so much that I cannot put the backs on my post earrings or French-braid my hair. If I want to wear a necklace with a short chain, I cannot fasten the clasp myself, and must ask for help. The elbow hurts ALL the time--24/7. So please, all of you, be careful!

The T score may not be all that relevant, because I see many of you have worse scores and no breaks. But don't take outrageous risks. Don't stop living, but use caution.

By Alli
Posted April 6, 2009 at 12:37 pm
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I would also caution your thinking on .. if you break they can fix them... i suffered a spinal fracture and it ain't no picnic and it took 6 months to heal and once you have one you will NEVER want another. I believe you need good flexibility and strength to your bones to prevent fractures if you have low scores. From my research just calcium won't do it you need a snergy of nutrients all working together. Dr Susan Brown offers great advice on bone health and I am trying to follow her natural directions and so far no more fractures. Yes get out and do what you like best but please be careful if you got low scores!!!

By MamaMarks
Posted April 6, 2009 at 12:48 pm
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Creakylady~

Holy cow! Did you break all of those bones from a standing position each and every time? I’m terribly sorry that you’re having to go through this and I wish you well. When I read stories like this it just amazes me that fractures can occur at higher readings than say someone with readings of -6 that has never had a fracture. Why is that? You seem to be handling it well and my hat goes off to you! I’m also glad that you do not have pain as a precursor to your fractures. I have been in chronic pain since my mid 20s due to a vehicle accident, but the pain has been much worse the past two years, especially in my feet, and my T-scores have also steadily dropped, even with meds. Of course that got me into questioning whether or not there is a correlation between pain and impending fractures. As I’m reading, that’s not always the case.

I was the one who made the comment, "If I break it, they can fix it." It wasn't meant to be disrespectful or non sympathetic to anyone in regards to this disease. I’m sorry if this comment has offended anyone on this site as it sure wasn’t meant that way. It’s just my way of trying not to live in fear of this disease and how I deal with my non ability, mentally, to do some of the things I used to do. I honestly do not take my comment to heart and am pretty darned careful to not break anything. My heart goes out to all of you who have had debilitating fractures or just fractures in general.

Take care everyone and thank you again for your wonderful comments and insight. They are greatly appreciated.

Stu~ I’ve been on the site that you recommended and I have to say that it is a wonderful site full of valuable information. Thank you again for sharing.

Cynthia

By SequoiaHealth
Posted April 10, 2009 at 7:25 pm
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Hi mamamarks:
Be careful with vitamin D from a fish oil source. Vitamin A toxicity is becoming a real problem.

Hope this helps.

Woody McMahon
Reston/Herndon Osteoporosis Support Group Leader

By MamaMarks
Posted April 10, 2009 at 7:49 pm
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Woody~

Hi there!

Please explain what you mean about getting vitamin D from fish oil. Also, vitamin A toxicity? I take Carlson's fish oil and do not see vitamin A or D listed as an ingredient, just the Omega 3 oils. Are these hidden ingredients? My doctor didn't say anything about the fish oil when I told him I was taking it. However, he did write it down in my chart. I take 1-2 tsp a day.

I have read many of your posts and value your opinion.

I hope you are doing well and thank you for responding.

Cynthia

By SequoiaHealth
Posted April 10, 2009 at 9:03 pm
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Hi Cynthia:
Cod liver oil is the most common form of fish oil. It contains high levels of Vitamin A. Your fish oils must be from the body and not the liver if D and A are not listed.

I prefer Udo's Blend which is a plant based oil. You can read more about Udo Erasmus at http://www.udoerasmus.com/firstscreen.htm. He gives dosing recommendations on his website. His book Fats that Heal Fats That Kill is worth reading as well.

Hope this helps.

Woody McMahon
Reston/Herndon Osteoporosis Support Group Leader

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