Severe osteoporosis plus severe lumbar spinal stenosis

Good evening @ingridbergman. Congratulations on selecting Evenity. It is the newest bone builder for those of us who encounter osteoporosis. In fact, it not only creates bone but also protects it. If I understand your inquiry, it is about a concern that you might have to face surgery. May I ask why you are unable to handle a surgical intervention? In order to cut to the chase, I am going to introduce you to @jenniferhunter. She is a walking encyclopedia about spinal stenosis and will understand your issues much better than I can. So.... give her some time and she will be here to respond to you.

May you be free of suffering and the causes of suffering.
Chris

Have you tried other drugs? . I take cymbalta and it helps some. But I am on a very low dose I also do testosterone pellets. The pellets help build bones and help a little with my pain.

Hello Chris,

I was wondering if you have also been on Evenity. I am trying to decide between that and one of the daily injectables.
Just curious as to what you have experienced. I have a jaw issue I am working out and then it’s on to some meds.

Good morning. Thanks for responding. Evenity was not available
I chose Tymlos. No side effects. Reasonable and positive results.
Chris

Thank you for your response Chris.
I am concerned that if I get steroid epidurals for lumbar stenosis my osteoporosis will get worse from the steroids. My osteoporosis is very bad. [T scores -3.8]. I think I am way too old for lumbar stenosis surgery. [almost 90].
The question is what to do if I don't get epidual steroids. I have been on osteoporosis meds about 9 years. PT never helped me much. I will look for Jennifer Hunter's notes. thanks again.

Thank you for the quick response. My doc prescribed tymlos due to my jaw issue. However if I can get that resolved I will take evenity instead. Still waiting to hear from insurance. It’s good to hear you had no side effects and some improvement. Did you have to go on another med after tymlos?
Thank you for sharing.
Candy

@ingridbergman Hello, this is your friendly encyclopedia, Jennifer, here who is also a spine surgery patient. I think that you are very much like my elderly mom who has severe osteoporosis. For her, that caused a spontaneous spinal compression fracture. She was not a candidate for a bone cement procedure to glue the bone back together, and I'm guessing the cement may be stronger than her weakened bone which could cause more problems. She wore a brace for a few months and did some rehab as the bone grew back together.

I think questioning if steroid injections could weaken your bones further is something to ask an endocrinologist who specializes in osteoporosis. In my mom's case, it was a parathyroid problem that was causing calcium to be removed from her bones. Eventually, one or two parathyroid glands were removed from her neck, but the damage had already been done. That was an easy surgery as the glands are right under the skin in the front of the neck. According to her endocrinologist, having that condition and being on Fosamax for 10 years doesn't really help so much. She still had severe osteoporosis which caused a foot fracture that in turn caused a fall and she broke her pelvis. The spine compression fracture came a few years later.

I think a chiropractor would be very risky for you, as it does not take much to break weakened bones or to herniate a disc anyway, so applying an additional force could do some damage. I had a bulging disc in my neck for years, and it herniated and popped one day when I turned my head. I will not allow a chiropractor to touch my neck knowing what I know now about spine injuries.

A simpler procedure for stenosis may be a laminectomy which is like raising the roof and adding a second story on a house. My 80-year-old cousin just had this done, and he did well and recovered quickly in a few weeks. More extensive spine surgery can take several months for recovery. In a laminectomy, they cut through some bone and remove it allowing more room for the spinal cord, but you need to have enough bone to be able to support the spine. I don't know if you would be a surgical candidate based on bone quality. For any kind of hardware that is screwed into the spine, you need good quality bone to hold it in place so the screws don't pull out. There are a lot of forces, and most of your body weight is acting on the lumbar spine.

My mom has just finished a year of Evenity injections for bone building, but I don't know how much improvement she has from that in her osteoporosis scores. For yourself, I would always ask a lot of questions about pros and cons and if any procedure may make you worse or weaken your bones.

How is your balance and mobility? Do you need assistive devices like a walker or a cane? Fall prevention is very important for you because so much can change in an instant if you fall and break bones. I think when my mom broke her pelvis, her fall was caused by just stepping on her foot and a bone snapped. I was there. She didn't trip and just fell over on her side on the floor. She had things in both hands so didn't try to break her fall. Take precautions to prevent that from happening. A bit of prevention goes a long way and holding onto a walker for stability is good. I have one of those too after breaking an ankle a few years ago and having to hobble around the house. I can walk again now, but I know how hard it is to be disabled.

Jennifer

hi jennifer,
thank you so much for your advice. i will ask an endocrinologist or my pcp. i had a laminectomy 18 years ago when i had a herniated disc. as you know back surgery is no fun and hard to recuperate from. having both osteoporosis and spinal stenosis is the pits. my gut feeling is that someone with OP should stay away from steroids. i have been on OP meds for 9 years and am currently on evenity. i don't have hyperparathyroidism like your mom. i was checked for it. i use a walking stick for ambulation. as you advised the trick is not to fall.

stay well and again thank you for your note.