I'm new to this site and I'm not quite sure how to ask my question, but here it goes. My primary care doctor had the bone density scan done. She went over the results with me and she said I have osteopenia and osteoporosis. She gave me Actonel to take. She also did a Vitamin D test and it came back 29 which she said is a little low but she wasn't worried about it. I saw my rheumatologist yesterday and she said my bone density scan was ok. She said I had osteopenia and no osteoporosis. She went over the test with me also and she said I just had osteopenia and I didn't need to take anything. She looked at the Vitamin D test and said 29 was way to low and she gave me a prescription for Vitamin D. I guess I'm confused as to which Doctor's diagnosis do I follow my primary or my rheumatologist? Is it okay for me to take Actonel if I only have osteopenia?
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Which Doctor?
- By AGL
- Posted October 3, 2009 at 12:27 pm · 9 replies
- In Osteoporosis/Osteopenia treatment
- Shared with the public
- Edited October 3, 2009 at 12:31 pm
Explore topics in this discussion:
Osteopenia Exercise Actonel Hysterectomy Menopause Boniva Osteoporosis Fosamax
9 replies
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- By Mrs_Thistlebottom
- Posted October 3, 2009 at 3:01 pm
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Hi, AGL -- Let me preface my remarks by saying that I'm not a medical professional and am not qualified to give advice. All I can tell you is my story, which is lot like yours, and what I decided to do about my situation.
I was diagnosed with osteoporosis earlier this year. At the time, my primary care provider was a physician's assistant (PA). Her lab report summary stated that I had osteoporosis of the right hip and spine. She strongly recommended that I get on Fosamax right away, and her tone was urgent and alarming.
The lab report suggested a secondary cause for the osteoporosis, since my lowest Z-score was below normal for my age. After taking a second look at the lab report, she backtracked and said it would be OK to postpone medication, increase calcium to 1,500 mg, and be more diligent about weight-bearing exercise and strength training.
I decided to seek a second opinion with a specialist in internal medicine. She looked at my T-scores and said I did NOT have osteoporosis in either hip. She said that all T-scores were "fine" except for the lumbar spine area (even the lowest score of -2.5 puts me on the borderline between osteopenia and osteoporosis). She also ordered metabolic testing (hormone levels, vitamin D, etc.) and a more detailed urinalysis to see how much calcium I'm excreting.
It turned out that my vitamin D level was low (28), and she put me on a once-weekly megadose for three months. I plan to follow up with an endocrinologist to monitor my vitamin D level, especially during the winter months. According to the recommendations of the Vitamin D Council (vitamindcouncil.org), optimum levels are 50-80 ng/ml year-round. Evidence indicates that vitamin D may play a strong role in bone remodeling.
Personally, I would be more inclined to follow the recommendations of a specialist. Berfore you take medication for osteopenia, I would suggest that you do some more research on bisphosphonates (Actonel, Fosamax, and Boniva are all in this class of drugs). My humble opinion is that a diagnosis of osteopenia calls for some lifestyle changes--diet, exercise, supplements, and the like. Good luck!
- By sdivas
- Posted October 3, 2009 at 5:04 pm
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AGL, hello and welcome to the community. I would suggest asking the doctors office for copy of the dexa. You will be able to see the scores and know whether you actually have osteopenia or osteoporosis. Please use Search for my discussion post "Ask The Professionals". Check SequoiaHealth's post on lifestyle changes. I am fracture free and my osteo care has been with my primary care physician, but some people feel more comfortable with a specialist; although there isn't any osteoporosis specialists. There are some clinicians that focus on osteopenia/osteoporosis, but few and far between. If you are on the borderline (-2.5), you may find that lifestyle changes and Vitamin D will make a difference. There are people that have osteopenia that do fracture, which is why it seems some doctors are handing out prescriptions as a preventive. I don't feel any person can make the decision for you. There is more than enough information on the community about the different medications both pro and con. (Please use Search). This is your life; your bones and your health responsibility. Educate yourself and make what you feel is the best decison. Once you are confident that you have made the best decison for your lifestyle, you can move forward and not second guess yourself. Although you can always revisit your decision if any changes with your bones indicate. Ask your doctor for a referral to work with a physical therapist for exercise specific to your bone loss, but please be sure the PT has knowlege on osteopenia/osteoporosis. (Search Sara Meeks/MotherGoose posts; both PT's). Please don't become overwhelmed with all the information. You had bone loss before you were given the diagnosis, so you have wiggle room to take time, make decisions and put an osteoporosis plan in place. Sandi
- By millie123
- Posted October 4, 2009 at 10:31 am
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You've gotten some good advice here. I would try doing some life-style changes and the D supplementation for a year. You might look up some of my previous posts and see what that did for me.
- By vflorence
- Posted October 4, 2009 at 10:42 am
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The medical doctors STILL need to be educated about the difference between osteopenia and osteoporosis and the role of Vitamin D as a percurser to Calcium uptake.
You are lucky that your specialist knew what to do since your primary care physician SADLY appears to be in the dark.
Yes -- you must increase your low Vitamin D levels and as far as low bone mass or osteopenia---- the first line of defense is exercise and nutrition. READ ON MY FRIEND.
Medications are only to be used for frank osteoporosis. Your primary care physician must be reminded that ACTONEL is a very potent medicine and should be used only as a last resort !
- By lilrayosun
- Posted October 4, 2009 at 12:37 pm
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I second Mrs. Thistlebottom. And I also love her moniker.
- By bettyrenshaw
- Posted October 7, 2009 at 6:12 pm
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AGL
Read more here and online 'side effects' on boniva, actonal etc. ======before you do any of them!!!!
AND LEARN WHY TO
'DON'T DO THEM'.
- By SusanRae
- Posted October 7, 2009 at 7:58 pm
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Hi AGL ~
Don't become too complacent because you "just" have osteopenia. I guess by reading this website, you're not being complacent. Good for you! But don't feel pressured to jump right in and start taking all the osteoporosis drugs, either. Like Sandi/sdivas said, you have wiggle room to take time, educate yourself, and make your plan. These folks have given you lots of good advice and feedback.
I was diagnosed with osteopenia in 2003 and my nurse practitioner just had me take a calcium supplement. No one said anything about vitamin D. By luck I found a calcium supplement that had vitamins and minerals, including D3. No one ever checked my D levels. I then had a hysterectomy in 2005 and went through menopause. In 2005 and 2006 I broke four bones in 14 months. Still, no one ever checked my D levels, or calcium, or anything. I didn't think I had osteoporosis--I just thought I had bad luck. Then in 2007 I was diagnosed with a disease known to cause osteoporosis, and my endrocrinologist told me not to worry about it now. We would take care of one thing at a time. So for another year and a half we did nothing about my bones. Then last December he ordered a DXA scan and said you've got osteoporosis--now take this Fosamax. No one said anything about diet at any time. My endocrinologist said the acid-alkaline balance hasn't been proven, and about exercise he said to exercise but don't go crazy. Huh?
That's about when I found this website. After reading posts here, I went to an independent lab a few weeks ago to have my D tested (paid for it myself) and found out my D is 28, too. I'm taking about 3,000 iu of D now. I've learned some exercising do's and don'ts here on the NOF site, plus diet and lifestyle recommendations. I'VE GOT TO EAT MORE VEGETABLES! Personally, I'm going to give these things some time to work before I will consider taking the bisphosphanates. My spine's only -2.9, so I'm not too worried yet. But I am being really careful not to break any more bones.
I have an appointment next week with a naturopath to see if she can help me with nutrition and lifestyle changes. I need someone to hold me a little bit accountable.
And I love Mrs. Thistlebottom's moniker, too!
Good luck to you all!
- By bettyrenshaw
- Posted October 7, 2009 at 11:35 pm
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AGL
OSTEOPENIA AND OSTEOPOROSIS ARE NOT DISEASE==THEY ARE STATES OF YOUR BONES. THE TESTS ARE MERELY INDICATION THAT YOUR MAINTENANCE IS TO0 LOW.....TOO DEFICIENT.
SO BEFORE YOU GO ANY FURTHER TAKE THESE NUTRIENTS AND BEGIN NOW TO RESTORE THE DEFICIENCY!!!
YOU DO NOT HAVE TO WAIT FOR 'TESTS' TO PROVE A DISEASED STATE===GET THE NUTRIENTS FOR NATURAL BONE HEALTH... THEY ARE THE SAME AS THE ENDOC WILL TELL YOU TO TAKE==AND SHE WILL BE TRYING TO RESTORE BONES WITH IMPLEMENTING --WHAT YOUR BODY NEEDS NOW AND NOT GETTING==CALCIUM, MAGNESIUM, SUNSHINE [VIT D] ETC PARTNER--
NOT EXCLUDING ALL NUTRIENTS NEEDED, AS IN ALL VITAMIN MINERALS THAT YOU GET FROM FOOD AND THEIR SUPPLEMENTS.
READ ALL DISCUSSIONS===STUDY PREVENTION==KEEP AWARE OF YOUR BODY AND LEARN MAINTENANCE OF IT.
DON'T WAIT FOR TESTS AND DOCTORS AND HAVE TO 'REPAIR'.. I AM HERE TO TELL YOU -LIKE SO MANY MEMBERS.
IT IS LIKE RUNNING YOUR CAR WITH OUT OIL. YOU WILL THROW A ROD!!!!
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