Osteoporosis treatments after DS

Here's my issue and I'm scared! Revised to a DS in 2013 from a rny. Rough recovery but I healed and have maintained my weight loss with in a 10lb range 10 years out. (400 down to 175) I've taking vits and over the years had few labs with lower calcium. In 2016 they had me do thyroid biopsy but they were fine. Had elevated blood calcium but 24hr urine test showed to be normal. In 2020 I had a scan and it showed osteopenia. My PCP didn't really seem concerned and just said we will monitor. I kick myself for not pressing for more info. This last year I noticed some aches and pains and my stomach area was more pronounced. I chalked this up to being older or post menopausal. . Then my family noticed bad posture and my leaning to one side when I first get up in the am. I then started reading and realized it's probably progressing. I can't put my head against the wall when standing against it Rounded shoulders. I made an appointment with a rheumatologist, is this correct? I'm sure they will do testing and go from there. As far as the meds I'm assuming DS patients can't tolerate meds in the stomach, should I insist on a bone building med first? I want to go in as informed as possible. My mom had osteoporosis, I'm guessing my hunching over some is due to fractures. I'm 53 with teenagers at home. I want to try to treat this the best I can. I want to keep the "widows hump" from getting worse. I do walk for exercise but looks like I might need to add strength training too. I take k1 but guess k2 should be added. I take A, d3, e, and a multi. 1200 mg calcium 2x a day. Lasix for edema. Sorry this is long, there's not a lot of info out there.

I have osteoporosis. I also hunch over - but I have no spinal fractures. I think it's just a symptom of the disease.

I did Reclast for three years (an IV infusion that you get once a year), then a two-year break, and if all goes well, I'll start Forteo in the fall (also an injectable - but one I'll be doing myself). Evidently it's a stronger bone-builder than Reclast.

K2 is the one that's good for bones.

I see an endocrinologist for my osteoporosis (I was referred to her by my PCP). I don't know about rheumotologists - but I'm sure they'll refer you elsewhere if he/she doesn't deal with osteoporosis (I honestly don't know if they deal with osteo or not - they very well might).

as far as exercise, anything where you're putting pressure on your bones helps to build them - even just walking.

EDITED to add: just checked - yes, rheumotologists also deal with osteoporosis.

Thank you for the reply! Did you tolerate the meds ok? From what I can gather from reading many suggest taking a bone building drug first then follow up with one to shore up gains if any. I'm not sure what my insurance might require but seems like the newest drug Evenity has good results for some. Just when you think your doing all you can it just comes back at you! I guess first thing first is appointment. I'm going to see and endo since I think my malobdorption may have contributed to this. Again thank you for the reply, any advice or help, I'm all ears.

Reclast was the only drug I've had so far because my endocrinologist didn't want to give me an oral drug (like Fosamax) because of my RNY. It's been awhile since I've had it (Reclast), but I think I may have had flu-like symptoms for a day or two after the infusion, but that's it. It stabilized my bones (i.e., no loss since), but the endo wants to try to build them up. I'm 63 now and she wants me to enter my final decades with my bones as strong as possible. Evidently Forteo is a little stronger - or else just better at building them. Plus she told me to do a lot of walking as that strengthens them too (and weight training, like the person below said - but weight training is one of those things I have to force myself to do since I'm not a fan!!)

btw - I was diagnosed at age 58. Since we never did a baseline before my RNY, I'm not sure if it was the malabsorption from the RNY, or just genetic - osteoporosis runs rampant in my family. I think every female relative - on both sides - dealt (or deals) with it. But that's neither here nor there, I suppose. At any rate, they supposedly have some really good bone-building drugs out now. Haven't heard of Evenity, but then, I haven't done a lot of research on all the options in awhile...

Thank you again for the info. The more I know going in to my appointment the better. I'm guessing I would not tolerate pill form either. Can't risk any issues with the lining of my stomach. Of all the info online it's been tough trying to find an endo, I've read way to many reviews. Using my ins as a guide most concentrate on diabetes and thyroid. I have found a few to make calls to tomorrow. I'm ready to get started on a plan but know it can't happen over night .

I did read, after I saw your original post, that rheumatologists deal with osteoporosis, too, so you should be fine (although yes - endos deal with diabetes and thyroid issues, too. Mine works in the "osteoporosis clinic" at my health network, so that is her specialty, but I think she deals with those other things as well)

I also have Osteopenia (62 yrs old male, SADi DS in 2014) which I think is very common in both WLS patients and in many people as they get older. I could eat a horse every day and not gain weight, but I also can't add much muscle and worry about osteoporosis and certain cancers I think WLS patients are more vulnerable to.

If you haven't already had a bone scan, you should do it every 2 years at a min. It shows progression very clearly, which for me is primarily is my wrists.

A couple of points to combat it:

1) I doubled my calcium (600 units x 2 times daily), 2) Dr said it's the vit D that needs upgrading with Osteopenia, so I now take 10k units x 2 each day (20k units total). 3) I get a lot of exercise for an old guy, and resistance training is really important for everyone as they age. You should focus on weight lifting while standing (e.g. curls, presses, pushups). The load-bearing component is how you help keep bones strong.

This is an important topic impacting many wls patients, so pls keep us updated and good luck!

Thanks for the advice. I've never been a big weight/strength person, should have! I do walk and have over the last 10 years. I'll try to start this obviously low at first. I need to see if I can find info on line on where to start. Again thanks!

I was never big on weight training either. I started by walking a block or so, then jog a 100 feet, then walking a little more. I then started lifting with 3-pound weights in each hand. It took 4 years to get to a simple basic workout mostly because I focus more on consistency but not weight amounts. After about 6 years I started a little more advanced workout but nothing special. My goal is to get in simple steps each day plus 20 min of arm and shoulder exercises plus the gut. Everything is pretty basic and can be done at home. I go to the gym just for a change of scene.

It sounds like it's working great for you. I've had to switch to walking in the mornings, Tx heat is rough. I walk in my neighborhood. I can certainly try to add strength/weights to my activities. I need to review form and how to videos and start small.