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Hello and welcome to the board,

Both the hip and spine have various scores for different areas, but the number you want to pay attention to is the "total" score. When you are scored, the norm you are being compared to is a healthy 30 year old who is at peak bone mass. A score of -2.5 places you in the osteoporosis catagory. One important piece of information is that bone density tests give no information on bone quality, which is a critical piece of information when it comes to fracture risk. However, since there is currently no way of measuring bone quality, many doctors push to treat anyone with low density with bone medications.

Some things you can do is take calcium with D, take a good multi-vitamin, eat plenty of fruits and vegetables, particularly green vegetables, walk, get sunlight, limit acid-producing foods, such as meat, sugar, processed foods. It's very possible that calcium with D will take care of your pain. But in the final analysis you will almost certainly be faced with making a decision whether to go on bone medicine (usually biphosphonate drugs) or go the natural route (strontium is the big gun of the natural treatments). There's lots of info on the board about both routes, and I encourage you to do plenty of research about this whole subject as well as the treatments. ani

How old are you and have you gone through menopause? The reason this is important is the Z-score factor. Z-scores are only used on premenopausal women and men younger than 50. There is no diagnosis with a Z-score. It just gives you an idea of where you stand compared with people your own age. If you've gone through menopause (been a full year without periods or had your ovaries removed) you disregard the Z-score and look at the T-score. Based on that, you have osteoporosis. The fact that the spine is osteopenic doesn't factor in any treatment. You treat according to the lowest score. You can't say you have osteoporos in the hip and not the spine. If you have it, you have it.

Regarding the neck region - that is referring to the femoral neck - the narrowest section between the pelvis and trochanter. It commonly is weakest simply because there's less bone there. That's also the area that fractures when you break your hip.

So...treatment. Everybody needs 1200 mg of calcium each day. The body can only absorb 500-600 mg at a time, so don't load up on it at breakfast and figure you're good for the day. If your diet isn't high in calcium, take a supplement. They're all equal because calcium is a mineral and calcium is calcium. We steer our patients away from oyster shell calcium because of the possible lead content. Cost doesn't matter in calcium. Take with meals for maximum absorption. If you have a problem with constipation and/or gas, a calcium citrate would be better (like Citracal) Also look for a calcium with magnesium. Also read your food labels. Many foods have calcium added. If you see a %, simply add a zero for the calcium content (25% = 250 mg)

The recommendations for Vit D have been increased to 1000 IU a day. Vit D sends the calcium to the bones. Without it, the calcium won't work. After age 50, our ability to process it from the sunlight decreases, so take a calcium with D or a D supplement. You can't get enough from foods on a daily basis.

Spend 4 hours a day on your feet. Weight bearing exercise (anything done while standing) is good. No bending forward from the waist - like toe touches - pivot from the hips. No twisting, Pilates, crunches or jogging (jams the spine) Walking is good.

Meds? Are you on Hormone therapy? If not, I wouldn't necessarily advise starting it, but if you are, it does protect the bones and another med (if you decide) can be used in conjunction. There are a lot of choices out there. Talk with your doctor. If you're nervous about Fosamax/Actonel/Boniva, Evista is a good alternative. It's a synthetic hormone that has no effect on breast or uterine tissue. A new drug that's getting good results, especially for hips, is Reclast. It's given once a year by a 15 minute IV. A lot of hospitals are now giving it routinely during hip surgery following an osteoporotic hip fracture. It's important to know that with all medicines, calcium is needed. Without it, the medicine can't do its job.

I don't understand the pain. Normally with osteoporosis, there is no pain until you fracture. That's why it's called the silent disease. Have you had any nontraumatic fractures? That puts you at a high risk for fracture. If you pain is in the joints, it's probably arthritis. Are you on any medications? Do you have a family history of osteoporosis/hip fracture/height loss? That increases your fracture risk also - as does having > 2 alcoholic drinks a day and having a hearing/vision impairment.

This is a lot of info for you to absorb. I'll be glad to answer any followup questions.

Hi!

This is a late (re?) reply because it seems my prior reply didn't work...sorry!

Nandina,

Thanks for your welcome and your information!!

Bonebabe, thanks for your reply. Here are my answers:

I am nearly 49 and have not yet reached menopause.

You mention absorption being better when D is taken with a meal...I am bad about that. I heard(from my health food store), that absorption of calcium even with D is low (less than 50%...I may be wrong). They have a 'plant-based' calcium (?!) they claim has over 50% absorption, but it's quite expensive. Have you heard anything about that? I've only found D in 400 doses, and I'm hesitant to take 3. Can I 'overdose' on it?

I am finding that being on my feet at least 4 hours a day is painful I my degenerative discs. I am thinking I need to see a specialist regarding this.

No, I'm not on hormone therapy.

What you say about pain being unusual makes me concerned. The pain is not constant or terrible. My hip occasionally 'catches' when I walk and hurts a bit. The back does bother me quite a bit, which my be more the discs than bones. No fractures (other than tailbone a decade or so ago). The only other med I'm on is Zocor. My (10 year older) sister has some osteoporosis. I don't consume even a daily alcoholic drink....maybe 1 or 2 a week.

Please let me know what else I can answer for you and THANKS SO MUCH FOR YOUR TIME AND EXPERTISE!!!

O.K., now I have some more info that is very insightful.

Are your periods regular and the same cosistency as when you were 30? If they're getting spotty or skipping then your ovaries are producing less estrogen. This will have a definite impact on your bones and can account for your low scores, although not completely.

If your periods are still the same, you're fortunate to have huge red flag here. You will look at the Z-scores until you've been a year without periods. To be a regularly menstruating woman, these scores are quite low. You need to take action now to improve your bone density. You have way too many years ahead of you to have low bone density now.

Are you on birth control pills? They will actually help your bone density. The Depo shot will do the opposite.

Since no drugs are approved for premenopausal women, you need to do whatever you can. Strontium may be an avenue you want to explore even though there's no approved one here - only strontium citrate. Do some research on it and listen to others on this board who use it. The patients we're currently following on strontium are postmenopausal women and one man. So far, there's been no measurable improvement. Your situation is entirely different.

Now calcium and D. It's your calcium that's better absorbed when taken with a meal. And STAY AWAY from that plant based calcium scam. Scam is what it is. Calcium is a mineral and there is no good or bad. Expense doesn't matter with calcium. Yes, calcium is not maximally absorbed. That's why I continue to inform people not to cram a bunch in at one time. You will only get 500-600 mg at a time. It's best taken with meals a few times a day. The Vitamin D sends the calcium to the bones. You need 1000 IU a day. D3 is what you need. Go to WalMart or some other pharmacy and get the generic brand of 1000 IU D3 (most of them are D3 - it's more easily converted in the body into what you need) Take one pill a day. Anytime with any food or alone. Doesn't matter. Take it. You need to be very proactive now. You will still, most likely, need medication when you reach menopause.

Your back pain is probably coming from the DDD. The hip catching (which I have) is common when we alter our posture and gait to compensate for back/hip pain. Arthritis can cause lots of pain and discomfort. I'd suggest you make an appt with a rheumatologist. It should give you some relief.

Walking, painful in the beginning, actually can help with the pain. I know, it's hard to do when you're hurting, but the more sedentary you are the more pain you'll have and the more your bones will deteriorate. Try 10 minutes at a time, 3 times a day. It can make a world of difference.

Since your sister has osteoporosis, you've got a family history thing going on that is out of your control. This is the time for you to really get serious and get moving; otherwise your life is going to be a series of doctor visits and lifestyle limitations.

Good luck to you and keep us informed.

Beth

Hi Beth!

I did not realize you'd posted this until today!! I am *SO THANKFUL* for you!!! What a generous and caring heart you have! You are benefiting so many lives!!

I have more answers for you and would LOVE to hear from you!

I am desperately searching for a good bone doc. I am so hesitant because of the experience I am having with my current internist, who has prescribed Boniva for me. I have taken it for 2 months now. The first 3 or 4 days are quite miserable. I feel I need to do something quite aggressive and quickly! Can you tell me the reasons these meds are not prescribed for premenopausal women?

About my periods...they are probably even more regular now than when I was 30. I did not marry until 32, then had fertility treatments (Pergonal, etc) at 34, 35 when we couldn't get pregnant. So...I am not seeing spotty or less regular periods at this point (soon to be 49).

No, I am not on birth control pills at the moment..may be something good to consider.

I am noticing a slight improvement in the 'catch' in my hips when walking. It happens less now. Maybe due to the diligence about pumping myself full of calcium and D? My question about D is...can it be overdone? The calcium I take has 400 D in it and I take it twice daily. I have some 1000 D, but wouldn't that put me way over? I am SO GLAD you told me about the plant based calcium! Do you have articles you can point me to about that? I can NOT afford to sit around and do nothing about this! I'll ask for calcium and D to be screened in my next blood test.

I am hearing what you're saying about the exercising and the urgency...these are things I need to hear!

Again...thank you and I look forward to hearing from you!

I'm very glad to share my knowledge with you and appreciate your kind words. This is what we try to do in our center at a local level.

Now, your questions. Bisphosphanates, at this time, are not approved for use in premenopausal women because they have not been studied in premenopausal women. Osteoporosis is mainly a disease attributed to postmenopausal women, due to the loss of estrogen, and is not diagnosed in younger women. It may come in time, but the risks too of birth defects is unknown - should one become pregnant while on the drugs. I think I'd get another opinion about the Boniva for you. BCP sound like your best option at this time.

The current hoopla about the plant based calcium is similar to that of Coral Calcium a few years ago. It's interesting that like the Coral Calcium, if you try to find any info on it, all you come up with is advertising for the product - no info on the product itself. Coral Calcium (which is essentially Tums and a multi vitamin) eventually was pulled off the market when the FDA got into it because it didn't live up to its claims. Calcium is a mineral, and as such, cannot be broken down. That's why it's one of the easiest supplements to get. You can't go wrong. Look for the USP symbol on the packaging and feel secure in getting a good product.

Your vitamin D - if you're getting 800 IU in a calcium supplement and get 200-400 in a Multi vitamin, you don't need an individual D supplement. It's difficult to overdose on D, so don't worry about that. The medical field is doing more studies of D and are now calling it the super vitamin. They are finding the people are more deficient in it than thought,so testing is going to be the norm before long.

I don't think the calcium and D have anything to do with your hip not catching. It probably has more to do with those muscles being exercised and stretched. A good thing. Calcium, though, does help with muscle strength and is often taken at bedtime by people with leg cramps to alleviate that. So, maybe.....

It's entirely possible that your years of spotty periods played a big factor in your bone density. We are beginning to see younger girls in our center with shin stress fractures. They are usually track athletes whose periods are abnormal due to their athletics - or girls with amenorrhea. All impacts the bone density.

So sounds like you're motivated and now you're getting educated. You can look at the ISCD website (iscd.org) for an osteoporosis specialist. I don't know where you live, but you should be able to locate somebody nearby.