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High CAC after bisphosphonates (no other cardiac risks)
Has anyone else who was treated for osteoporosis with bisphosphonates had a surprise very high CAC score? My lipids have always been good. I have always had low normal blood pressure, no kidney disease, no diabetes, normal weight, good diet, moderate exercise, low lp(a) and Apolipoprotein B, no angina, no symptoms of cardiac issues.
I do have osteoporosis, and more than 10 years of bisphosphonates did not work for me. After a long break, I requested hormone replacement therapy as an alternate treatment for osteoporosis. Out of an abundance of caution, my primary care doctor asked me to do a coronary calcium scan even though my cardiovascular health has always been exceptionally good. The result was a shock—over 1000! I consulted a local cardiologist and was advised to start rosuvastatin 5mg. She also told me that I am already doing all the right things and that I should just forget about the calcium score, which she says should not have been ordered in the first place. That’s nice to hear, but it leaves me feeling rather helpless as well as at risk!
Four years ago, in another town, after a dentist thought he might have seen carotid calcium on a routine dental x-ray, I consulted a cardiologist. Carotid ultrasound and echocardiogram stress treadmill indicated no blockages and normal heart function and strength.
I understand that high calcium scores most often indicate long-term plaque build-up and calcification; however, logic tells me that there CAN be other causes. I am seeking better understanding so that I have a better chance to make changes to improve my situation—or at least to not make it worse.
I have seen studies that conclude that Covid 19 can cause coronary calcium. I have also seen several studies that show a possible correlation between long-term bisphosphonates use and high CAC.
Whatever the cause, I have high CAC, and it’s not likely to go anywhere. I am very grateful for my good cardiovascular health (other than this CAC). I just want to better understand my risks and what I can do to improve them. I will be grateful for insights from others who have had a similar experience.
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@notmaggie Thanks for the information. I looked into it a little bit after seeing your post. My mother suffered a fractured femur that she always attributed to her osteoporosis medication. It was especially unfortunate because she never walked normally again and it affected her ability to exercise (which was especially needed after a triple bypass). I'll definitely look into it before taking them if the osteopenia progresses.
@notmaggie , who were you intending to get HRT from? I’m considering it.
@bitsygirl
Yes, do your research so that you can make the best decisions you can. It’s a complex issue with a lot of contradictory information available, and the research continues, so the available data changes.
I suspect (and hope) that new and better treatments and much better understanding will soon become standard. For now, my advice (just as a fellow human being—not a doctor) is to start now to do what might help and doesn’t hurt—fit weight and resistance and balance exercises into your life. They might not build bone, but they will help you prevent falls, and they just might build bone, too. Eat prunes if you can. Google “prunes and osteoporosis.” It appears that they can, at least, help preserve bone mass. Talk to your doc about HRT. The prejudice against it has changed and better versions are available than was used in the old WHI study that scared everyone off. Michael Lavacot, who is a participant on the Osteoporosis group here, has a YouTube channel. HE is great at explaining the current medication options. Dr. Doug Lucas also has a YouTube channel. I find him a little off-putting, but he is clearly intelligent, and he provides lots of information with links to resources.
Don’t wait for osteopenia to become osteoporosis. Take charge now and act now. Look at exercise and nutrition and supplementation. You might not ever progress to osteoporosis.
Best of luck!
@celia16
I had asked my primary care doctor to prescribe HRT. That’s why she sent me for the calcium scan. I haven’t given up yet. Just taking a break. I will discuss it further with my cardiologist. I also have an appointment with a local osteoporosis clinic in October. They should have more experience with the coronary calcium/osteoporosis combination.
I wonder if a gynecologist or an endocrinologist might be more willing and able to prescribe the right combination and type of HRT. It’s hard to know just where to start, isn’t it?
Good luck!
@notmaggie I asked several gynecologists and endocrinologists without success. One of them referred me to a group of menopause consultants, one of whom was willing to precribe Menostar after CAC and ultrasound imaging studies.
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