medical professionals in my area- Sacramento, CA

I am having trouble finding a doctor in my area, greater Sacramento area of California that specializes in, or is very familiar with osteoporosis. I have talked to my 3 physicians over the 2.5 years I have been diagnosed with it but they have very little to contribute to give me guidance as to diet and exercise and prevention from it getting worse. I was referred to an endocrinologist after my DEXA scan last year, where it showed additional bone loss. He told me I excreted more of my calcium in my urine and gave me a pill to help stop that. He is not available for phone conversations and when I went back to ask questions he was very quick, matter of fact and not very helpful about my hypercalcemia condition. In addition, my GYN is so busy that I saw her assistant last time and she was not helpful with my questions. I would like to be able to consult a health professional that has some knowledge and is willing to talk to me. Does anyone have the same problems?
I look forward to hearing from anyone in this area.
Cher

By jerryd3001
Posted February 8, 2008 at 9:35 am
Report post

Cher,

Here is the link to find an endocrinologist: http://www.aace.com/resources/memsearch.php and here is the one to find a rheumatologist: http://www.rheumatology.org/directory/geo.asp.

What you are probably going to have to do is locate the physicians in your area that treat osteoporosis, then make calls to them to find the one who seems interested in giving you quality care. Basically call the receptionist and explain exactly what you said above, that you want someone you have confidence in who will work with you to properly treat your medical problems. Good luck.

And I just want to make one slight correction, if your are spilling calcium in the urine, that is hypercalciuria, not hypercalcemia, which means excess calcium in the serum. Hypercalcemia is a potentially much more serious condition since the body allows little leeway from high to low in serum calcium levels.

Hypercalciuria is often misunderstood, even by physicians, so you might want to do some serious research on that topic. Basically the excess calcium can stem from two sources: 1) too much calcium absorption from the gut which is then spilled out the urine or 2) excess resorption of calcium from the bones that is then spilled through the urine. The way to tell which type you have is to be sure you have a fasting 24-hour urine test. What that shows is that the excess calcium isn't from diet because you aren't ingesting any, thus it has to be from the bones, which means it needs treatment to stop the bone resorption. Or, if the fasting 24-hour urine calcium test is normal, then your aren't spilling calcium from bone resorption. You might be able to check your medical records to see if your 24-hour urine calcium test last year was fasting or not. If it wasn't fasting, it needs to be repeated under fasting conditions.

I hope this helps and that you can report back with success in finding someone to help you.

By marion2
Posted February 8, 2008 at 4:55 pm
Report post

Could you clarify what you mean by a fasting 24 hour urine? Are you implying that you need to fast for the full 24 hours? I have had several 24 hr urine tests done under the care of very reputable endocrinologists and have never been told to fast for a day.
Marion

By jerryd3001
Posted February 8, 2008 at 7:10 pm
Report post

Marion,

Now you have me questioning too. I'm heading out the door and will try to get more details by tomorrow. The studies I've seen, at least some of them, use the word "fasting." I do believe, however, that applies to calcium intake only. That is, the diet is calcium-restricted prior to the urine calcium testing. I don't believe the person is fasting in terms of other food intake. But I'll try to provide some references and more details as soon as I can. Here is one from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/1482031?ordinalpos=5&itool=EntrezSy stem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.

Here is another PubMed article using the term: http://www.ncbi.nlm.nih.gov/pubmed/10215562?ordinalpos=2&itool=EntrezS ystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Now for some detective work to be sure exactly what "fasting" means in this case.

Thanks for asking on this. More later.

By jerryd3001
Posted February 9, 2008 at 2:12 pm
Report post

First a suggestion to anyone who might want to write a long response on this BB: Write it in a word processor and transfer it over later. I spent hours, with interruptions here and there, writing this and found that I had been automatically signed out in the mean time with my text gone and absolutely no way to get back to it.

This topic is as esoteric as any you'll ever want to discuss, and not nearly as neat as I described it in my previous post. For some ideas in general see this online article that is mainly directed toward kidney stones, but that also includes osteoporosis issues: http://www.emedicine.com/med/topic1069.htm. Skim down to Brief Outline of Specific Hypercalciuria Disorders to get some idea of the complexity.

As regards the fasting issue, I believe that concept stems from an article by Charles C. Y. Pak and others in NEMJ 1975, Vol 292 No. 10, p. 497-500, A simple test for the diagnosis of absorptive, resorptive and renal hypercalciurias. PMID: 163960. Enter the numeric portion of the PMID here http://www.ncbi.nlm.nih.gov/sites/entrez.

What fasting entailed in this study was nothing after 9:00 P.M. but distilled water three times during the night/morning. This had been preceded by a low-calcium diet for at least seven days before the test, mainly no dairy. Then the urinalysis was for a specimen collected for two hours only, not 24-hours. A calcium load of 1 gm was then given within a special diet which was followed by another 4-hour urine specimen collection.

The authors noted, "The first [assumption] was that, during a fast, when intestinal calcium absorption is excluded, calcium appearing in urine must come from body stores, presumably from bone; it should therefore be elevated in states of excessive bone resorption, as in primary hyperparathyroidism, and in renal hypercalciuria. Secondly, after an oral load of calcium, the urinary calcium should be abnormally high in the presence of an intestinal hyperabsorption of calcium as in absorptive hypercalciuria."

As you will see if you read many of these articles on hypercalciuria, they are directed toward diagnosing and treating kidney stones in patients. Yet physicians will sometimes include 24-hour urine calcium testing for osteoporosis patients. That was done in my case when I was first diagnosed. So the question becomes one of when and if osteoporosis patients actually need urine calcium testing done.
Here is an article that gives some guidelines that seem logical: http://findarticles.com/p/articles/mi_m0BJI/is_22_30/ai_67716887. In short, if standard FDA-approved osteoporosis therapy is not having the desired effect, then other tests might be warranted to try to find a secondary cause that is not being effectively treated by the medications.

It appears to me that correct urine calcium testing could be a multi-step procedure. For example, if a person was not responding to an FDA-approved medication with increasing bone mineral density as detected by DXA, then a standard 24-hour urine calcium test might be done. If this comes back normal, then no further testing for hypercalciuria appears to be needed, and other tests should be done in an effort to find the source of the problem. If it comes back elevated, then additional tests might be needed. This could include the fasting urine calcium level, similar to or as described by Pak and others, to be sure that the elevated calcium is from bone resorption and not from excess gut absorption. Another option could also be to perform one or more of the various biochemical markers of bone resorption tests, such as NTx. See: http://www.maleosteoporosis.org/maleosteo/biochemical_markers.htm for more details on these. It doesn't seem logical to do the 24-hour urine calcium as a routine for newly diagnosed osteoporosis. For one thing, it should be elevated before therapy because we know the bones are losing calcium, that's why you have osteoporosis. That resorption should cease once you commence effective therapy. Thus the logic of waiting until the desired results of therapy are not occurring before doing the 24-hour urine calcium testing. Please be aware that is my logical conclusion, and may not conform to the real world. Ask your physician to be sure.

I welcome the input of medical experts if they can further elucidate the issues discussed above or correct my interpretation of the literature on this topic if needed.

Disclaimer: This entire issue of hypercalciuria as related to osteoporosis is complex and should be discussed with your physician if you feel it applies to you.

By zeta
Posted February 10, 2008 at 8:18 pm
Report post

Hi Cher,

You might want to consult with endocrinologist Kulkarni-Data. She is with UCDavis Medical Group and her number is 916 734-3730. I saw her once and found her quite knowledgeable, easy to talk to, and fairly open minded. However, it took a couple months to get an apt with her as she is busy and popular. My PCP who I like alot too recommended her. Best of luck--zeta

By windblown
Posted February 17, 2008 at 4:39 pm
Report post

Dear Cher: I would agree that your best bet for a specialist is looking for one at a Univ Med Center. The Dr that I have for osteoporosis is a Mineral Metabolism Dr, and she is great in so many ways. To bad you aren't closer to her area of location. She is the vice chief of a Univ Med Osteo Center and Research Facility, so looking for someone like that in your area would be ideal.

Good luck finding someone.

By KMFDallas
Posted March 6, 2008 at 8:36 am
Report post

Great info Jerry. Dr Pak has a clinic at UT Southwestern University in Dallas, TX. I have an appointment there next week. Dr. Pak is no longer seeing any patients. Answers - Hopefully.

Welcome to Inspire!

Explore topics in this discussion:

9 replies

Add to the discussion

NOF on Twitter

Group leaders

You