Advice after hip replacement with osteopenia

What did the physical therapist say? If it were me I’d want an exercise plan that was personally designed for me as there are so many factors that affect outcomes. A therapist would assess current strength, balance, and range of motion along with the type of surgery so the exercises are the best fit for you.

I have such wimpy muscles that a recommendation for me might be to only lift 10 lbs whereas someone with more muscle mass might need 15-20 lb. That’s the problem with a generalized exercise program. It doesn’t work so well when it involves rehab along with something like osteopenia. I’d probably damage the bone remodeling with a 15 lb weight and the next woman might never make progress.

I had total hip replacement (left, anterior) this past March at age 61 after going airborne off an icy step and landing on solid ice precisely on my side (nothing breaking my fall but my left hip--no elbows, feet, shoulders, etc. helped to break my fall). I broke my left femur neck right in two. I went straight to the ER and had surgery 2 days later.

I am fit and active and somewhat slight (5'7" and 135 lbs); I guess because of the momentum of my fall and it being from a step (?) it was not charted as a fragility fracture (although it turns out it should have been). I healed well and was back to normal with no pain at all within 7 weeks. I totally forget that I have an artificial hip/femur neck. My surgeon constantly says it's healed and adhered and settled "beautifully," but I wish I'd known I had OP when I'd met with him (!) (that information came later after I wouldn't take "don't worry about it" for an answer).

I had asked for a Dexa scan a couple of times in the previous 3 years but was told both times "not something we do till you're 65." (I now coach all of my friends to allude to their mother's OP, etc., to get their Dexas EARLY.) I had had 4 follow-ups with my ortho surgeon before there was any mention of getting a Dexa and it took another 6 weeks after that to get one. It came back
Spine -1.6
Right femur neck -2.2
Right total hip -2.6
I had repeatedly expressed concern about OP and it had kind of been pooh-poohed (!). Anyway, the surgeon handed me an rx for Fosamax and said he was required to do that because I had fallen, but to do my own research, which I did.

I handled my own PA and got myself Tymlos which I just got last week and have taken 3 doses of so far (3, 3, and last night 4 clicks). I'm trying to get orders for bone remodeling markers (CTX and PNP1) because I FINALLY got my PCP to refer me to an Endo.

Sorry this is jumbled. I wanted to pipe up that I'm interested in all that you've queried, too, and wanted to explain how/why I happened to be ignorant of having OP until WELL after my new hip was healed and forgotten (by me).

Thank you. Your numbers similar to mine. I’m not getting near any medication as strength training should hopefully work in time - I’ve seen it successfully increase my numbers in the past. It was a year not putting full weight on surgery leg that plummeted my numbers. You might be interested in Dr. kevin McCormick, author Great Bones, who offers many remedies separate to meds. I can’t post links so google him: Osteonaturals

Also Dr Attia’s podcast featured Australian Belinda Beck, Ph.D., founder of The Bone Clinic and a leading authority on exercise physiology and bone health. Her Onero Academy site provides online strength traing program as well links to USA PTs she has certified.

Also, curious if your t-scores were measured before or after the surgery? Have you heard that the prosthesis will hurt numbers?

I have a titanium left hip. It doesn’t hurt numbers, you just don’t have a score there.

I had a left hip replacement in June 2023. At the same time, I was on Evenity.
All went well. Evenity improved my scores in right hip and spine.

annie208,
I believe that all women need a dexa around the time of menopause. To get a baseline .
I know that not everyone can take some of the meds. I finished a year of Evenity and then had an infusion of Reclast in june 2024.
I didn’t have any side effects and had significant gains.
So, I’m happy. Two and a half weeks ago, I had a bad fall. My entire left side was bruised including my face which I landed on. I just found out yesterday (after two weeks of headaches) that I have a brain bleed.
But, no fractures!
The brain bleed will resolve itself they tell me.

My first DEXA was 6 months after I broke my hip on ice (at 61) and had my emergency total hip replacement. I definitely fell through cracks where no one raised the OP flag while I was inpatient for that (kind of crazy in retrospect). My vitamin D levels have come back at 49 or 50 for years now and did so when I was inpatient for surgery as well, so maybe that steered them away from flagging me...(?)). I was told my DEXA would skip my left (surgery side) hip area and that my right forearm would always be included as a substitute for that missing data.

Thank you for the reminder that there are natural options to explore (especially when first dx'd if it is not severe OP). I believe under most circumstances I would try natural first, but I am an "old" mom and had 3 kids in my 40's. I'm eager to get back to skiing and hiking with them (we live in the mountain west) and while I immediately ordered GREAT BONES and am loving all the info, I decided to see if I could tolerate one of the anabolic meds (Forteo or Tymlos) as a first step because I'm finding I'm spooked (justifiably or not) that I'm fragile like a teacup now... I'm also super $ pragmatic and currently have great insurance that gave me a 2 year prior authorization for Tymlos without hassles. I would hate to try natural first, not get the desired results, and then be faced with paying for an anabolic right when I start Medicare (it being way harder to avoid high co-pays because the co-pay assistance programs can't be coupled with government sponsored insurance).

I'm so grateful to "meet" you. Do you still have 2-3 follow-ups looming with your surgeon? I'm eager to hear what they say about navigating OP with a total hip replacement (THR). (As I said, my first DEXA and OP dx came right at the END of all my surgery follow-ups, which is annoying, but it's water under the bridge at this point.)

Thank you! I am disappointed, shocked, at my surgeons lack of interest in OP. He said to consult my PCP/ lifted all restrictions, which I’ve heard from Dr. Mccormic is not wise so I’m very gradually increasing activity as low density bones may take longer to remodel. Will they knit into titanium solidly? Tthere’s no great data on this. Dr. Mccormic has referred to a holistic MD. I hope to talk to her soon and am considering estrogen as I don’t think it has the side effects of the other med‘s provided you have no History of Gyn or breast cancer. I’m open to talking offline if you ever care to…

My Dexa score was in the osteopenia stage prior to having both hips replaced. Now they just measure my back and left forearm. I have been going to a weight training class for 6 months now 2x/week and my recent Dexa score has improved 2 points so I’m out of the osteopenia range. I highly recommend a weight training class with a trainer who knows how to deal with older women and their issues.