Bone Strength

• By jerryd3001
• Posted February 1, 2008 at 10:15 am
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Bone strength comes from the quality of the bone and its quantity. Quality can only be determined by biopsy and histology or bone fracture that records the strength. Neither of these is very desirable so DXA is used as a pretty good, not perfect, substitute.

Fracture also results from what you are doing: falls, near falls, incorrect exercise, excessive bending, etc. If you have lowered bone density and do nothing about it, you aren't guaranteed to have a fracture. It is just that, if you compare your risk with people with normal bone density, your risk goes up about two-fold for every standard deviation (which corresponds with about 10% loss of bone density) reduction from the norm. So, for instance, if you have -3 S.D. DXA score, you are about six times more likely to fracture than someone with normal BMD. Once again, you are not guaranteed to have a fracture, just more likely than someone with normal BMD.

You have two choices: take something to reduce the fracture risk, something that also has some side effects, or do nothing and accept the increased risk of a fracture. There is no road you can take that has no risk, it is that simple. You must weigh the risks and decide which road has the fewest risks. For me it is a no-brainer. To my knowledge no one has died from properly taking osteoporosis medications, whereas something like 25% of people who have a hip fracture die within one year of that. So my goal is to reduce the risk of fracture with Fosamax while using my knowledge of its side effects to keep those potential problems to a minimum.

Fosamax has been on the market since 1996, if I remember correctly, and I have been on it that long myself, with a return to normal BMD a few years ago. It was also in clinical trials before then so we are certainly at the fourteen-year time frame for its use. It is not without side effects, as almost nothing is, but, considering the benefits for millions of users, those side effects are bearable. As we learn more about osteonecrosis of the jaws, that problem will also decrease if people will follow the guidelines to be sure their bone turnover isn't overly depressed by the bisphosphonate they take when they have invasive dental procedures done. Having a morning fasting serum CTX test done appears to be the proper test for this.

My fear for you would come from your deciding to be your own physician and not taking your medications. You are putting yourself at increased risk unnecessarily IMHO. If you prefer not taking so much Fosamax, or other medication, speak to your physician about it and perhaps take a reduced dose. At the same time ask for biochemical markers of bone formation/resorption to be done occasionally to determine if you are resorbing excess bone on the lower dose. Of course, you should also continue to have DXA done occasionally which will also tell you if you are again losing BMD. The the key thing is that you work with your physician to get therapy that will satisfy your needs and reduce your risks simultaneously.

When you think about it, living is scary. What we have to do is put the fearful things in their proper perspective. Any of us could be killed the next time we get in a car or go out in a lightning storm, or fall in the bathroom. The key is to keep the fear where it doesn't rule your life and go on living. Personally I place the fear of something happening because I'm taking osteoporosis medications right up there with getting hit by lightning, or even less. For one thing I have knowledge and science giving me objective ways to deal with any problems that might result from the osteoporosis medication, whereas a hit by lightning is purely random. I guess you have to try to put things in perspective, too. Good luck.

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• By sdivas
• Posted February 1, 2008 at 12:30 pm
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There is a test, QCT bone density test that gives a difference between cortical bone (outside of bone) and trabecular bone (inside of bone). It is my understand tht QCT gives a better indication of the possibility of fracture. The test is available in So Ca;, but I don't think QCT bone density test is readily available through-out the US. As for your fear, I sincerely believe that what we fear we often create. We do the best we can for ourselves with the knowledge that we have at the time. We take a leap of faith every morning when we get out of bed; not knowing what is ahead of us. I would suggest that you do not worry about the "what if"s". Worry, and emotional distress is not good for overall health, and certainly not good for the bones. Sandi

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• By bgillis
• Posted February 1, 2008 at 1:53 pm
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Jerry, thank you for your comments. You didn't mention your age or your DEXA numbers. I took Fosamax for a number of years & had improvement the first 2; then all went back to original diagnosis. My numbers have been the same for 10 yrs which means I am better!. I am 67...in great shape....hit a very long golf ball (much longer than most women my age) as am strong due to working with weights, exercise, etc.

I have read that Fosamax can weaken your bones after many years of taking the med. Who knows. The medical field has made many errors concerning medications.

I have taken every blood test for Osteo & all have come back normal including bone turnover (Fosamax slows turnover which is crucial!) There is a book called "The Falacy of Osteoporosis" which is very interesting.

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• By Tinkerr
• Posted June 27, 2008 at 2:14 pm
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Hello,

I am writing an article for a major newspaper in Boston and I'm looking for comments on the usefulness of the FRAX tool. I have lots of doctors and few patients in my story.

If you are interested or need more information, please contact me at tinkerr@bu.edu or check out my work at www.tinkerready.com

Thanks so much.

Tinker Ready
www.tinkerready.com
Freelance journalist
Cambridge, MA

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• By Toot
• Posted June 27, 2008 at 4:51 pm
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I agree with you on this. They tell me I have severe Osteoporosis. I have tossed around and read everything I can on this stuff. These meds are dangerous. I am active, healthy, and in full motion. I exercise with weights. I bend twist and can move better then most 20 yr olds I know. I think a lot of this is a racket to make $$$$$$. Those with broken bones need to do something. I think these dexa scans are scaring the hell out of everyone and it is all a money making scam in most cases.

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• By bgillis
• Posted June 27, 2008 at 4:53 pm
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Hi Jerry ...thx for responding. I never have talked to a man with Osteo which I realize occurs.

I don't know what the future holds, but right now I feel great with 5 mi. of walking daily; golf 3-4 times wk; free weights & daily exercises at home. I have not lost any heighth (am age 68, 108 lbs. w/same body I have had for yrs). I had a boating accident a few yrs ago (flat bottom boat in Alaska that hit a sand bar hard). I was in front & 4 people landed on me (2 very big men!) I somehow didn't break a rib (am very small in that area) so I have to be in good shape!

I probably shouldn't writing to you until after July 8th when I have my DEXA (last one 2 yrs ago). My numbers have been the same for 11 yrs which means I am better! Fosamax showed good numbers for 2 yrs only & than I went back to my original numbers.

I'm sorry but I am not trusting of the medical field; can't go into everything here! But let me say...yrs ago I was given a metabolism test during every physical (who does that any more?) I was on thyroid pills over 25 yrs & went off & my gland was totally normal (I was a runner then). How lucky I was since the gland was turned off for all those yrs. Good luck to all of us with the Osteoporsis problem. bgillis

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• By bgillis
• Posted June 27, 2008 at 7:16 pm
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Toot...thx for the note & agreement! Medical field makes errors so that is why we must do our own research & make decisions. Look at the Thalidomide drug way back when...Merck drugs recently. Even Forteo.. Not everyone gets cancer, but some do. There is no long term info on this drug which I am not gong to take. If I ever fracture, I will then consider my options. I hit a golf ball longer than most women my age so I know I am strong & am not going to worry about this problem right now. I am having a Dexa on 7/8 & will probably report on my findings at that point....bgillis

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• By Toot
• Posted June 28, 2008 at 10:45 am
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bgillis,

Thanks for agreeing. I have seento much stuff prescribed for people they really did not need. Your right they make a lot of errors. Thaey are people just like you and I. We each have to make our own decisions as we have to live with them. Wish you well!

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• By dawner82002
• Posted June 29, 2008 at 8:24 am
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Well said!

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