Is Osteoporosis reversible in post menopausal women?

I was saying the same thing to my husband last week. No where in my early childhood and beyond (school, home, doctors) did anyone emphasize the potential of osteoporosis.

Fearfracture. Thank you so much of all the info. The BTM table is very helpful.

I went through menopause 13 years ago and I did not do HRT. Eight years ago I was put on Alendronate for 4 years by my first PCP. No secondary cause tests were considered. I ended up switching to my mother's PCP in a state wide medical group. I was caring for my mother at the time and I wanted to get both of us into a larger medical group. Only test he used was DXA results. He left the medical group and my mother and I moved to the same PCP again. She was very good and put me on a medication holiday (off Alendronate). Six months later she started looking at secondary cause tests at my request (CBC, CMP, Vit D, 24 hr urine, thyroid, NTX, Celiac). Unfortunately, she left on medical leave right before the pandemic hit and never returned. Only the 24 hr urine came back with an issue. NTX was 24 in 2020 (range 26-124). So the results were never analyzed. Fast forward to today, 3.5 yrs later. Yet another PCP who read my 2022 DXA results showing decline from prior DXA 4 years earlier. In our follow up discussion, he immediately moved to meds. He felt no additional tests are going to change the need for meds at this time. I managed to convince him to follow up with Parathyroid test (based on 2020 24 hr urine results) and re-run the NTX test. He wants to put me on Prolia (denosumab) followed by Alendronate. What I don't understand is why my NTX # is now 22 (range 26-124). Isn't that telling me my bone resorption is way down? Yet my DXA results are worse. So I still need a bisphosphonate? I can't seem to get a clear answer here. Does this mean NTX is not a good measure? Should I be asking for CTX (& P1NP test) prior to new meds? I don't know how he is going to determine if Prolia is helping, other than DXA. Why do I want to wait two years for an answer? He's anticipating I could be on Prolia up to 10 years.

My gains on Alendronate were small e.g., spine 3.5 - 3.3. Interesting my spine has stablized at 3.3 (L2 & 3 are 3.7 & 3.9), hip 2.2, femoral neck 2.7, forearm 2.4.

I just feel like I'm on a runaway train and going down a rat hole of meds. Meds that will be used up and will not be able to help me in 10-15 yrs from now. That's why I've been researching and asking my PCP questions. His answer is the same. "No test is going to change the final outcome.. meds are needed now". I understand his point, however, there has to be a compromise somewhere. He's actually a very good doctor. I'm just not comfortable with that answer and it's creating such anxiety for me that I can't sleep or eat. Obviously, not good for me or my bones.

Is the attached picture the one you have mentioned? Just want to make sure I'm ordering the right one.

I don't see the attached picture. But if it says the following, I'm sure it's the same supplement formula:

"Nature's Way
Alive!
Bone Support
Calcium Max Absorption
1300 mg plant source calcium
per serving
with vitamin D3, vitamin K2,
magnesium"

The only supplement called 'Bone Support' that I can find in a web search is made by a UK company called Cytoplan. Is this the product you use? If so, where/how do you purchase it?

@fearfracture I disagree with this statement:
"Are you fracturing or have you had any fragility fractures? If you aren’t fracturing, there is no life-or-death situation."

Osteoporosis has no symptoms. We can feel strong and invulnerable and then fracture in one moment. That happened to me. I was doing sword tai chi. I fractured three spinal vertebrae in a few seconds, with one unwise movement.

If scores show serious osteoporosis, I don't think anyone should wait for fractures to go on meds.

The problem is less doctors and more insurance companies who want us on anti-resorptives first, when anabolics might be better to start.

As for guidelines protecting docs from liability, I totally agree. And many women have taken bone meds prematurely, even before they have osteoporosis. Each med is best taken for a limited amount of time and we can potentially run out of that time!

But I hope people will understand that you do not want to wait for fractures. Take it from someone who knows, every single day.

I hope your fractures have healed and I can understand how you would disagree with my comment "Are you fracturing or have you had any fragility fractures? If you aren’t fracturing, there is no life-or-death situation." But that was directed to one person, a person who already has an osteoporosis diagnosis, meaning she is aware of her condition, and who seems to be taking action to prevent fractures.

In your case, it sounds like you had not yet been diagnosed w/ osteoporosis, meaning when you fractured. Am I correct? Did you 1st discover you had bone loss when you fractured?

It wasn’t until approximately 2.5 yrs after my diagnosis and after discussing my osteoporosis with 2 different doctors that I learned what my t-scores actually meant. In 2019, my lumbar spine t-score was -3.9. Both my PCP and my endocrinologist discussed my BMD with me and never explained anything. In the fall of 2021, I had an appt with a random teledoc dr. and he explained that every standard deviation was 10%.

From July 2019 through November 2021, I made zero adjustments to my physical activities. When I was diagnosed, I was in the middle of moving—lifting boxes, moving furniture. Additionally, in the fall of 2021, prior to my teledoc appt. I spent a good deal of time digging up well established bushes—root ball and all. It was grueling work. I was bending over and jumping up and down on a shovel spade. Fortunately, I had no issues.

As soon as that teledoc dr. explained that my lumbar spine BMD was approximately 39% less than the average 30 y.o., I spent a good deal of time researching how to move to protect my bones.

Two basic things ppl with osteoporosis should avoid are forward flexion of the spine and twisting of the spine. I used to bend over and touch my forehead to my knees and place my palms on the floor—I don’t do that anymore.

I practiced doing hip hinges while holding a yard stick to my back to keep it in line and I watched videos about how to do everyday tasks when you have osteoporosis: laundry, getting in and out of the car, the dishes, etc.

The thing about osteoporosis is doctors take DEXA scan results and act like T-scores mean the same thing for everyone and the truth is they don’t.

I frequently read posts from ppl whose t-scores are better than mine but they are fracturing. Fragility fractures are a bigger indication of bone quality issues than DEXA scan results.

One DEXA scan tells us very little about our bones. It can’t even show bone loss. It only shows approximate areal density of one’s bones at one point in time. Without more info, there is no way to know what that really means. I would bet a million bucks that my t-scores, even between the ages of 25-30, were never 0, meaning I believe my bones were probably always below the mean.

I’m not against taking osteoporosis meds when necessary but I am against taking any medications without a good idea that what you are taking is right for your condition.

Bisphosphonates don’t work for everyone, and I have seen some info that seems to suggest that taking bisphosphonates before anabolics reduces the effectiveness of the anabolics. Additionally, since it seems that it’s not a good idea to take any osteoporosis meds for too long and since other osteoporosis meds need to be followed by bisphosphonates, it seems that taking a little time to make sure there are no other issues that need to be addressed (parathyroid, thyroid, Celiac, T2D, etc) and finding the best solution is better than just taking an osteoporosis med just because that is the only “answer” most doctors can come up with.

In my case, I also have hypothyroidism. It was diagnosed in 2017 and if doctors did their jobs, it would have been caught decades before—there is even a chance I could have prevented it.

I started taking levothyroxine in 2017 and because my endocrinologist failed to do proper testing before prescribing osteoporosis meds, I’m now left wondering if my bones had started to improve on their “own” once I had the hypothyroidism diagnosis and started treating it. My own experience is just another example of why proper testing is critical before just starting meds.

Leeosteo, believe me, I know how overwhelming it can be and you are not alone. There are millions of women trying to get help with their bone loss and, unfortunately, doctors really just don't have their acts together when it comes to treating osteoporosis. Recently, I was talking to a friend, who used to be a nurse, about my bones and what my doctor did and did not do and she said something that really just says it all, "As long as your doctor is following guidelines, he can't be held responsible."

I honestly think if someone's BMD falls into the osteoporosis range, all a doctor is really required to do is prescribe osteo-meds and I think that is all most of them are doing.

In my quest to figure out what exactly is going on with my bones and what is the best course of action and if there are any natural remedies I should incorporate, one thing I have learned is that a very small percentage of the people (women) diagnosed with osteopenia and osteoporosis are doing anything other than believing whatever their doctors are telling them.

Note, if you live in the US and are being treated for/have osteoporosis, your insurance will cover annual DEXA scans so ask about this and start getting annual DEXAs.

Regarding your doctor’s flippant reply, "No test is going to change the final outcome. meds are needed now" whoa!

Are you fracturing or have you had any fragility fractures? If you aren’t fracturing, there is no life-or-death situation. It's far more important to make sure the correct issue is being addressed than to just slap you on a medication, especially something that might not be correct for you.

If you are interested, https://www.medimapsgroup.com/find-centers-with-tbs-osteo/ complete the form to find where you can get a DEXA w/ TBS (trabecular bone score). Trabecular bone is a better indication of bone quality.

Since I am still trying to get help with my BTM scores, I can't really offer any help. I've asked a 2nd doctor who simple said she wasn't familiar with the tests so she could help me. Next I plan to ask my OB/GYN.

You said you didn't do HRT. Do a little research. I am considering it over 20 years after menopause. Note, your endocrinologist will never tell you HRT is an option. https://theros.org.uk/information-and-support/osteoporosis/treatment/hormone-replacement-therapy/

Fearfracture. Once again thank you for the additional info and your insight. My DXA results are pretty extensive and I believe they include TBS. I don't see a "TBS Score", however, they include xrays of individual vertebrates, hip, femoral neck, forearm with BMD and other info in great detail. None of it is good. I have not fractured yet but feel I may be close to fracturing if not careful. Everything I've read about HRT indicates it may be an option for postmenopausal women in 40-50's, but the risks are much greater for older post menopausal women. Between my previous PCP and current PCP we've assessed the usual secondary causes and my tests have been normal. I do think my diet and exercise is significantly lacking and has been for 15 or more years. I eat whole foods in general, however, I a very picky eater. I've been keeping a food log and was shocked that I was not getting the necessary nutrients for bone building. It's not just calcium and D. It's actually 20 essential vitamins and minerals. And you really need to ensure your eating the right combination of foods to allow your body to absorb and process the nutrients. You can't go overboard on any one nutrient because your body won't absorb them and you end up with bone loss. As example, a diet high in phytates (beans, nuts, seeds) leads to bone loss. Spinach is oxalic acid that doesn't allow calcium to be absorbed. Apple cider on dark green leafy veggies allows the nutrients to be easily absorbed. I could go on and on. My point is a balanced diet is key and with the right mix of nutrients (at each meal) that allow your body to take them in and support bone building. I think a nutritionist is key to my overcoming this challenge. Most probably with osteo meds for a while. I just want my doctor to work with me e.g., bone markers prior to meds, so we can monitor this is one more data point (other than just DXA) to we jointly can make the same call whether this is working or not. I'd be interested to hear how you make out with HRT. Like everyone else, I'm doing a lot of research trying to figure out why this is happening to me.