bone loss
Ok Ya'll...this scares me. I had a bone scan 3 yrs ago everything was fine. My OB GYN sent me for a DXA bone scan last week and din't waste any time calling me saying I need to come in an discuss what we need to do. All of a sudden I am in Osteoporsis. I take my calcium daily and I eat dairy, drink milk, eat my veggies... I am 58 and I do not want any more pills. I was wondering if anyone has had the IV meds on the once a year thingy?
Kajun
My mom had RNY 6 years ago and was diagnosed with osteoporosis nealry 2 years ago now. She had an 18.1% bone density loss in her spine. She was 53 when she was diagnosed. Her diagnosis is what spurred a lot of my post-op research into vitamins and nutrition after WLS.
So a few things you need to know and keep on top of. (I'd recommend lab draw every 6 months on these things from now on). These 3 things play together when it comes to bone loss .... or better put, "bone building."
Vitamin D --- you want your numbers to be between 80-100.
PTH Intact -- you want this number to be on the low end of the normal range
Serum Calcium -- this number should be perfect at all times, if it's low you're in very big trouble
VITAMIN D -- I suspect that your Vitamin D levels are low... and that they have probably been low for a long long time. If your Vitamin D is chronically low (less than 50) your body is not fully able to process the calcium you take. No matter how much calcium you take as a supplemement, your body is simply not able to use it if your Vitamin D is in the toilet. Go visit the website for the Vitamin D Council and ready every morsel of information there. You'll see why I want your D up over 80. Any D result below 50 and your body is turning over Vitamin D as fast as you're taking it in. It's not until your level remains over 50 that your body is able to store Vitamin D and use it for the future. Once our Vitamin D is over 80 is when we start to see the benefits that D gives us -- lower cancer risk (including breast cancer), lower risk for MS, etc. BTW -- if your D is low and you're put on the Rx of 50,000IU once per week... don't get the Rx (that's Vitamin D2 in oil) instead get the same dose from www.vitalady.com which is in a water soluble form that is better absorbed by RNY folks.
PTH Intact -- this is the test that tells us if your body is leeching calcium from your bones. If you have high PTH and low Vitamin D, that's the classic indicator of resorption (leeching calcium from bone). The only way to get your PTH is down is to get your D up.
SERUM CALCIUM -- when we get labs drawn and they check calcium, they are only testing 1% (or less) of our total calcium content. 99% of our calcium is in bones, teeth and our organs. So when people say "I had labs tested and my calcium is fine." -- that really means nothing. The calcium in our blood is needed to keep your heart beating and keep your nervous system working ... so your body will do everything possible to keep your serum calcium levels perfect. To keep it perfect, your body leeches calcium from your bones and teeth to keep it perfect. If your serum calcium is low, you're in deep doo-doo because that means you don't have any bone left to leech from. (Or in rare cases you have some other disorder that also requires serious treatment.) So they check it in case there's something drastically wrong, but really the only way to know your calcium content is with a DEXA scan. Just something to keep in mind.
DAIRY, MILK, VEGGIES --- Unfortunately, we can't count those things toward our calcium count. Look at this diagram. Notice that in our digestive tract there are 2 spots in our intestines that are responsible for absorbing calcium from food. Both of those spots are bypassed after RNY. So the only way we can get our calcium is from supplement that is already in a form that our body is able to use. So drink all the milk you want, but don't count the calcium you get from it as being used at all.
CALCIUM CITRATE -- The ASMBS recommends that we get 1500-2000mg calcium citrate per day in addition to any calcium we might get from food. Our body can only deal with 500mg at a time and those 3-4 doses need to be taken at least 2 hours apart. So at age 58, you should already be at the top end of that recommendation -- so 2000mg/day. But with osteoporosis, you may need to be even high - more like 2500mg/day. Remember, we malabsorb stuff, so higher than RDA levels are generally OK for RNY folks, so keep that in mind when you're talking to your OBGYN about dosing.
OSTEOPOROSIS -- Read this article about Medication Considerations after RNY. There's a short mention of drugs for osteoporosis that is of importance to you... check the middle column, about the middle of page 4 where it talks about bisphosphonates (drugs like fosomax and boniva): Here's the quote:
The oral bisphosphonates are another class of medications that could present problems due to a reduced pouch size, which may increase the risk of gastrointestinal ulceration.26 Since these patients can be at risk for osteoporosis because of decreased calcium absorption, other treatment options (e.g., calcitonin salmon nasal spray, synthetic parathyroid hormone [teriparatide], raloxifene [for women]) should be considered.
RESOURCES -- those two links I just sent you, print them. Read them. Take copies of them with you to your appointment and give them to your doctor. Before your OBGYN decides on a treatment for you, she needs to know and completely understand what risks we have and what special requirements we have after WLS. I'd also recommend you buy the book "Osteoporsis for Dummies" -- I bought it for my mom and I also read it, very good information.
I go into bit more detail on vitamins -- lots about calcium and Vitamin D - in my "protein book". The first part of the book is a compilation of a bunch of my research, the second half is recipes. Here's the link: http://pamtremble.blogspot.com/2008/09/my-protein-book.html
Keep us posted on your appointment and what treatment you end up with.
Pam
So a few things you need to know and keep on top of. (I'd recommend lab draw every 6 months on these things from now on). These 3 things play together when it comes to bone loss .... or better put, "bone building."
Vitamin D --- you want your numbers to be between 80-100.
PTH Intact -- you want this number to be on the low end of the normal range
Serum Calcium -- this number should be perfect at all times, if it's low you're in very big trouble
VITAMIN D -- I suspect that your Vitamin D levels are low... and that they have probably been low for a long long time. If your Vitamin D is chronically low (less than 50) your body is not fully able to process the calcium you take. No matter how much calcium you take as a supplemement, your body is simply not able to use it if your Vitamin D is in the toilet. Go visit the website for the Vitamin D Council and ready every morsel of information there. You'll see why I want your D up over 80. Any D result below 50 and your body is turning over Vitamin D as fast as you're taking it in. It's not until your level remains over 50 that your body is able to store Vitamin D and use it for the future. Once our Vitamin D is over 80 is when we start to see the benefits that D gives us -- lower cancer risk (including breast cancer), lower risk for MS, etc. BTW -- if your D is low and you're put on the Rx of 50,000IU once per week... don't get the Rx (that's Vitamin D2 in oil) instead get the same dose from www.vitalady.com which is in a water soluble form that is better absorbed by RNY folks.
PTH Intact -- this is the test that tells us if your body is leeching calcium from your bones. If you have high PTH and low Vitamin D, that's the classic indicator of resorption (leeching calcium from bone). The only way to get your PTH is down is to get your D up.
SERUM CALCIUM -- when we get labs drawn and they check calcium, they are only testing 1% (or less) of our total calcium content. 99% of our calcium is in bones, teeth and our organs. So when people say "I had labs tested and my calcium is fine." -- that really means nothing. The calcium in our blood is needed to keep your heart beating and keep your nervous system working ... so your body will do everything possible to keep your serum calcium levels perfect. To keep it perfect, your body leeches calcium from your bones and teeth to keep it perfect. If your serum calcium is low, you're in deep doo-doo because that means you don't have any bone left to leech from. (Or in rare cases you have some other disorder that also requires serious treatment.) So they check it in case there's something drastically wrong, but really the only way to know your calcium content is with a DEXA scan. Just something to keep in mind.
DAIRY, MILK, VEGGIES --- Unfortunately, we can't count those things toward our calcium count. Look at this diagram. Notice that in our digestive tract there are 2 spots in our intestines that are responsible for absorbing calcium from food. Both of those spots are bypassed after RNY. So the only way we can get our calcium is from supplement that is already in a form that our body is able to use. So drink all the milk you want, but don't count the calcium you get from it as being used at all.
CALCIUM CITRATE -- The ASMBS recommends that we get 1500-2000mg calcium citrate per day in addition to any calcium we might get from food. Our body can only deal with 500mg at a time and those 3-4 doses need to be taken at least 2 hours apart. So at age 58, you should already be at the top end of that recommendation -- so 2000mg/day. But with osteoporosis, you may need to be even high - more like 2500mg/day. Remember, we malabsorb stuff, so higher than RDA levels are generally OK for RNY folks, so keep that in mind when you're talking to your OBGYN about dosing.
OSTEOPOROSIS -- Read this article about Medication Considerations after RNY. There's a short mention of drugs for osteoporosis that is of importance to you... check the middle column, about the middle of page 4 where it talks about bisphosphonates (drugs like fosomax and boniva): Here's the quote:
The oral bisphosphonates are another class of medications that could present problems due to a reduced pouch size, which may increase the risk of gastrointestinal ulceration.26 Since these patients can be at risk for osteoporosis because of decreased calcium absorption, other treatment options (e.g., calcitonin salmon nasal spray, synthetic parathyroid hormone [teriparatide], raloxifene [for women]) should be considered.
RESOURCES -- those two links I just sent you, print them. Read them. Take copies of them with you to your appointment and give them to your doctor. Before your OBGYN decides on a treatment for you, she needs to know and completely understand what risks we have and what special requirements we have after WLS. I'd also recommend you buy the book "Osteoporsis for Dummies" -- I bought it for my mom and I also read it, very good information.
I go into bit more detail on vitamins -- lots about calcium and Vitamin D - in my "protein book". The first part of the book is a compilation of a bunch of my research, the second half is recipes. Here's the link: http://pamtremble.blogspot.com/2008/09/my-protein-book.html
Keep us posted on your appointment and what treatment you end up with.
Pam
My Recipe Index is packed full of yumminess!
Visit my blog: Journey to a Healthier Me ...or my Website
The scale can measure the weight of my body but never my worth as a woman. ~Lysa TerKeurst author of Made to Crave
I am scheduled to have my first Bonivva IV next week . I have a very similar situation as you. However my problems are compounded by taking prednisone for my rhuematoid arthritis. The endocrinologist has decided my best treatment is an IV too. However instead of once a year I am going to receive it every 3 months. His concern about doing it only anually is "what if the medication becomes 'black boxed?'.'Three months in your system as opposed to a year makes me more comfortable. "
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