Bone density scans and prednisone use

I have an appt next week w/an endocrinologist to discuss a bone density scan I had a bit over a year ago (right after that was when my health got awful, and I am just getting back to it now).

My gi and pcp didn't know how to read the scan because it was inconsistent and I'm pre menopausal -- the hip and femoral neck scores weren't bad, but there were two spine measurements, one in the osteoporosis range (t =-2.7) and one in the osteopenia range (t=-1.9).

I am not sure that this discrepancy is so weird, as I don't have a car and walk a lot, usually even when I'm sick....

I had another scan four years earlier, and the hip and fem neck measures were identical, but that one only had one spine measurement, which was t=-1.4 -- not sure how to compare, but that's clearly gotten worse.

Of course, since that last bone density scan, I've had more pred, and had the 3 months of bed rest, so it's probably even worse now.

I just wondered if anyone has any insight to offer about these readings or what to expect at the appt. It would take a whole lot to convince me to take fosamax etc..... my take is give me a few years w/out drugs and good nutrition and lots of exercise, and then let's see.....but of course, don't want to be stupid either.

Thanks.

I know what you mean about the fosamax. Hubby took it for about 3 years along with chewable calcium (Vivactin caramel) and the last bone scan showed him now out of the osteopena range. He has stopped the fosamax as he feels 3 years is more than enough and trying to stick with calcium and more exercise. Hopefully the next one will be even better.

     I have something to contribute to this topic.  I went through an early menopause (periods were over by the time I was 45).  My family doctor recommended a bone scan when I was in my early 50's and I was diagnosed with osteopenia.  This was prior to my developing UP.  I tried Fosamax and it gave me terrible indigestion, so I just quit taking it after only about three months.  When I was diagnosed with UP, at age 52 in 1998, my GI doctor never mentioned taking calcium when on prednisone.  I knew nothing about prednisone back then or the harm it can do.  I only took calcium sporadically.   My GI doctor finally told me to be sure to take calcium daily in 2000, during my second flare.   In 2004, I took a terrible fall right on my tush and suffered a compressed fracture of my lumbar spine.  That is when they told me I had full blown osteoporosis.  My bone scan read -3.7 in the spine shortly after my operation.  A few years before it was -3.5.  My hips were -1.5.

     I am not due for another bone scan until late this year.  I take calcium daily but will not take any med for osteoporosis.  My friend wound up in the hospital after a Boniva injection and almost died.  I take 2 chewable Caltrate's daily.  I have a lot of problems with my teeth.   I know a woman who works for a dentist and he will not pull a tooth or do invasive procedures if the patient is on any med for osteoporosis until that person is off the drug for three months.  That sends a warning signal to me.  My colorectal surgeon thinks my bones will improve by taking the calcium and doing some weight training, which I should do more often. 

Riddle me this:

You have been through the grinder haven't you?! Sorry to hear about the teeth! I asked one of my dentists if I should worry about prednisone "breaking" my teeth and he said "..prednisone doesn't work like that.." LOL!

blueglass:

I can't help you with the scan numbers either..my last DEXA they said I had osteoporosis..that was almost two years ago....my next scan is scheduled for May 2012...

The best advice I've been given is to do weight bearing exercise (as has been said by others on this post). It doesn't have to be a "Arnold" workout either...twice a week exercise all muscle groups with weights...can start with low weights and low reps/sets....I'm starting in two weeks as I didn't feel my body was ready for that kind of workout...as my 1 year anniversary is approaching, I figured that was a reason to celebrate - start working out!

Hope your tests go well blueglass....your continued story and overcoming challenges has been an inspiration to me (a long with most of the other folks on here...summerstorm, suebear, nascarron, villager, 80'schick, esoR, blueheron, and on and on...and with all the folks that just had surgery - can't remember all the names!)

God Bless you with another recovery!

jimmy

I saw the endocrinologist today, though I'd post a report -- some info that might be useful to others.

Good news! She's not recommending that I take any drugs (so no tension there, as I was probably going to to decline ....). She took a really thorough history, and then examined me in various ways (touch the floor, reflex hammer, look for fat deposits that pred can leave, move arms and legs in various ways). Basically, my hip readings are normal. My lateral spine (lying on my side -- they didn't do that the first time I had a scan) is the one that tested osteoporosis, but she said that one is really volatile, and it was likely so high because I was very sick and very skinny when I had it -- it actually changes w/weight. My other spine measurement is the one that's in the osteopenia range. She said nonetheless, my fracture risk is very low.

The spine is the first to get worse measurement wise and also the first to get better. If the problem stays only in my spine, there's a more mild drug that i could go on. During my scan they checked and I had no compression fractures (that's why older people can get stooped over -- lots of little spinal fractures)

Advice was mostly what you'd expect -- get 1200 mg calcium a day from food and supplement (I've been taking the liquid calcium citrate, and she said that's the best if you might have an absorption issue), walk every day, eat healthy, do weight bearing exercise, get lots of Vit D (I need to get another test for that soon, as mine was low last time.... she said it should be well into the 30's).

Some general things about prednisone: she said the damage is done from it. It's not hurting me anymore as long as I'm not taking it, but it will be hard to catch up. The biggest amount of bone loss comes two years before periods cease to five years after, and since mine are still regular, it's very likely that that hasn't started for me yet. She says it will be hard to catch up, and it's pretty clear that she expects to be recommending drugs after menopause. But it is good that I'm not there yet (keeping that in mind, because for one or two days each month, my periods are just awful now.... trying to remember it's good for my bones).

Besides the pred, having gut issues for so long meant that I wasn't absorbing nutrients as well, and that affects bones too, and I think she said that some of my other drugs could have interfered too.

One funny thing: I told her all about my surgery, and then two minutes later she asked me how many bowel movements I had a day..... I said none, I have a bag, and she laughed.... I know this comes up here in lots of contexts, but it's such a funny thing how people hear information but it just doesn't sink in.

Editorial -- sometimes here I feel bad for people who had surgery after only having one or two flares.... but at the moment, I'm thinking it's an excellent thing..... get the offending organs out and don't mess up other parts of your body with not only pred and other drugs but also with being sick for so long that you don't get properly nourished.

In any case, isn't it nice to go to the doc and find out things are better than you thought?