Another 10% bone loss - so talk to me about osteoporosis treatments

I, too, had DEXA yesterday and I'll let you know how I'm doing and how I'll deal with it when I know.  But I'm interested in the responses you receive.

Julie,

Do you have risk factors other than the DS?  From the nice folks at Mayo Clinic.  The factors I have are in this color.

Risk factors you can change

• Low calcium intake.   A hx here.
• Tobacco use. Not any more and only for three and a half decades or so.
• Sedentary lifestyle. My MOST physical jobs allowed me to wander around in a small area...most jobs required my sitting still in one place.
• Excessive alcohol consumption. There was at time when I hung with a crowd where we had nightly "debriefing" at a local bar.
• Corticosteroid medications.  Months and months on prednisone...many short bursts of other steroids.
• Other medications. Long-term use of aromatase inhibitors to treat breast cancer, the antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton pump inhibitors and aluminum-containing antacids are all associated with an increased risk of osteoporosis.

Risk factors you can't change

• Being a woman. Fractures from osteoporosis are almost twice as common in women as they are in men.
• Getting older. The older you get, the greater your risk of osteoporosis.
• Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.  (Edited to half-risk because I remember that my Italian granmother was, genetically, of the "northern European" variety of Italians with blonde hair and blue eyes and she was "always" all hunched over. 
• Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
• Frame size. Men and women who are exceptionally thin (with a body mass index of 19 or less) or have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.
• Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
• Medical conditions and procedures that affect bone health. Stomach surgery (gastrectomy) and weight-loss surgery can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, hyperparathyroidism and Cushing's disease — a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.

In my case, it would appear that I didn't have a lot of alternatives.  And this list doesn't even mention estrogen...and I guess that's good since I haven't had any since 1978 or so.

I want to make sure that I don't focus only on the current malabsorption other than as one of many factors that may have contributed to the current situation.  Doing something to reverse that malabsorption may improve the condition, but so many other things are involved, I *MAY* be at the place I was going to be whether or not I had had a malabsorptive surgery...ifkwim.

Well, I'm white.   I don't smoke and I drink hardly at all.   I have taken steroids many times, but never for more than three months' duration - like you, short bursts, due to adult onset asthma (which quite interestingly, has completely resolved since I move to the western side of the state and away from a coal powered electric plant)    I am relatively small framed, and my mom has mild osteoporosis.   She is very large framed (and overweight) but has been on long-term steroid treamtents in the past and has horrible spinal stenosis due to spondylolisthesis.    

Sue, do you take strontium?

No...but I'm going to.

(I'm melting down right now because I took an almost 91-year-old to a luncheon honoring women vets and she had more fun than people hanging with a bunch of other 90+ year-old women WW II Vets...then I took her to see her 88-year-old cousin, who happens to be my grumpy mother.

Then it was another 50+ miles to take her home and get my ass home---I drafted Mr. Sue for that part--and now I'm trying to get caught up on the important things...diuretics, coffee, reading my body scan results and answering YOU!!)

 By all means, be proactive and do what you can.  BUT let's look at this in what I believe MAY be the right perspective.  Or a least one that should be examined.

It's about a 10 year cycle to replace all the bone in your body.  For anyone.  DS or not.  You had the bone you needed to support an individual weighing  300lbs.  You lost the weight and no longer need that much bone to support your smaller body.

It makes sense to me that if you started at X 2 years ago, you would be at X -20% today.  Would it not be normal for all of us to lose some bone?  That's comparing you to you.

What I would like to know is how you fare against the general population of women your age?  Do you have any information on this?  Your bone density compared to theirs.  It's easy to diagnose bone loss because it is real.  But are you losing bone you NEED is the question.

I think this is at least worth bringing up in your discussion with the doc.

That is a good point.

Also, important to know T vs Z score, Z being more useful.( Some Z scores include race as well as sex and age, some don't. Certainly is some room for improvement. Also, different heavy metals should require recalibration---such as strontium) Then, compare  yearly scans against the your baseline.

 Patty - that IS a good perspective.   I don't have my "official" T and Z scores yet, as they'll go to my doctor, but just basing my scores as to what the tech told me.   I've apparently lost 10% since my last DEXA, about 1.5 years ago.    So, I can see initial bone loss - from let's say surgery date to two years out, but anything beyond that, if I'm looking at this correctly, is due to my calcium malabsorption.    I know I had both sets of scores last time.....so I'll await those results.

I'm still reading thru all this and absorbing...and won't have time until after a major project is finished in a week to elabotate much...
But Julie, fyi, this is all very ironic. We are both around 5 yrs out. I had a baseline Dexa done at 1 yr - and one done last month. In 4 yrs I developed osteoporosis and now have a dose of Boniva on my desk...staring at me while I debate taking it.
I have a lot more ?s for my doc b4 I take it.
Risks-smoking -yes, I just quit for 2 months after 28 years
Mother has it (she is small boned, I am large)
Post menopausal for 15 yrs (hysto)
I've never lost down as far as you, never had any calcium, D, iron or other issues-
already have an artificial disk in c-5/c-6 from stenosis (last year)
now dexa shows L1 & L-2 not good at all. I don't have the numbers and my internist just left the practice. Hopefully I'll be able to get in there & get hard data in a few weeks.
Oy

Weren't you at one time examining the possibility of an enlarged parathyroid or something?  Or do you think this is 100% related to the vitamin D?

no enlarged parathyroid here.....I have an enlarged nonmotile descending colon, sm segment Hersprung's, that makes all this calcium one clay mess to evacuate.