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Questions answered by Harvey Marchbein, MD
I am a 45 year old white female that was just diagnosed with osteoporsis. (-3.9 below the mean, which I'm told is severe). I had a hysterectomy at age 28 with no estrogen supplements. Because of cancer in my immediate family, estrogens are out of the question now. I am currently take Evista along with 1500 mg calicum w/vitiman D.
Depending upon the cancer and who in the family had the cancer (in addition to what year this information was imparted) this may or may not still be true. Unfortunately, Evista is not approved for osteoporosis and is no better than low dose estrogen or low dose Fosamax, so many experts would consider this insufficient therapy for your osteoporosis.
I have a t-5 compression that is 10yr old but is giving me alot of pain in the form of spasms. My doctor wants to do a nerve block but I insisted on therapy, hot packs , ultra sound and stim. My therapist wants me to do upper back exercises on the machines. Two doctors have told me to do nothing but walk. I'm confused and scared to even pick up my grandchild in case I should break a bone. How careful do I have to be? I'm afraid to do anything. Please help. Thank you, debbie
Many therapies can have similar, positive effects. Keeping that in mind, we always try to do the least invasive treatments fo a particular situation. Your questions might be best answered by a rheumatologist with a special interest in osteoporosis or an Osteoporosis Clinic at a University Hospital. they are somewhat too specific for this forum.
Does having twins at age 39 predispose the mother to osteoporosis? (I had my first child at age 25).
If appropriate calcium intake was observed and the patient has no other predisposing factors, the answer is *no more than any other 39 year old*.
Your case has too many variables and too little specific information for exact therapeutic recommendations, but some comments should be made.
I am a 45 year old who consumes little to no dietary calcium, and I have a strong family history of osteoporosis.
That is one thing that you can easily do and needs to be corrected immediately. Vitamin D is also needed in adequate amount.
My gynecologist did an osteoscan at my request this past August. I was diagnosed with osteopenia.
There is a great range of difference between osteopenia just over the cutoff for normal and osteopenia just below the cutoff for osteoporosis. In that we don't know what you were 2 or 5 or 15 years ago, a urinary NTX might be helpful to delineate the amount of bone loss you are currently experiencing.
All I have been able to find out in relation to the results is the bone loss is "moderate". I am having no menopausal symptoms and do not know whether I should begin hormone replacement therapy.
If you get regular periods and have no menopausal symptoms, then your aren't menopausal. Perimenopausal might be a better term. Birth control pills, recently shown to have no increased risk of breast cancer, may be a viable option.
When I consulted with my doctor, I expressed concern about breast cancer because I have cystic breasts.
No relationship has conclusivley been shown between cystic breasts (a subjective diagnosis in many) and breast cancer.
He told me that if I got cancer I would either live or die, but I did not want to get osteoporosis. He gave me a bag full of Premarin and told me to come back in a year.
If you get regular periods and are not menopausal, I'm not sure why one would be taking Premarin. If hormones are indicated, oral contraceptives, as noted above, might be more appropriate.
I did not start taking the hormones because I don't know what to do. How fast do the bones lose bone mass?
Depends upon the person. There are many medical conditions that may accelerate it as well as certain drug therapies that can predispose to it.
Would I possibly be a candidate for an osteoporosis drug since I am premenopausal and still have regular periods? If so, what drugs are available.
It appears that with certain inconsistencies in the history and treatment recommendations, a visit to an osteoporosis expert might be a good idea to delineate your possiblities as a perimenopausal patient.
Although I am 52 yrs old and pre-menopausal, a Dexa scan revealed osteopenia in my hip and low density in my spine. I've been placed on 5 mg. Fosamax and Arthrotec for occasional back pain in my hip and leg. My gyn. says that although my periods are irregular, I'm still producing more estrogen than could be gotten from HRT. My question is, at what point would HRT benefit me more than Fosamax , if at all?
Approximately 82% of women will be able to build bone with ERT/HRT but it is difficult to quantify how much good your estrogen is doing. A urinary NTX can be done to evaluate current bone loss to see if these changes may be, in part, due to recent bone loss as opposed to long term lower levels.
How bad is a reading of -.83 (spine) and -1.23 (hip) compared with women in my age group?
The interpretation is as follows: 0 to -1.00 is normal; -1.01 to -2.5 is osteopenia; less than -2.5 is osteoporosis of varying degrees. The spine is normal and the "hip" is "early" osteopenia. This may have been present for many years and may not, as noted above, represent recent loss. By the way, did you mean "in your age group" to mean that this is what the bone density result said? If so, the interpretation is different. The standard deviations noted above are for comparisons to 20-30 year olds (this is standard).
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York
**Note: Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician patient relationship. This information is not intended to supplant
the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.
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