New to osteoporosis and overwhelmed

@zingsong, so sorry to hear of your diagnosis. So many of us go through the same response as you; shock, dismay, confusion and overwhelm. I was diagnosed at 57 and like you, I was active, fit and ate a very healthy diet so it came as a devastating shock. It sounds like you are taking the bull by it's horns and learning all you can so that you can make informed decisions and move forward constructively.

One thing you might consider now is HRT. Since you are in the safest time window, it might be a good option for stemming the loss. We lose the most bone in the first years of menopause so it might buy you time and bone while considering all of your options. A transdermal estradiol patch is considered the safest method along with 100 mg of oral micronized progesterone (rather than synthetic progestin) to protect your uterus. No need to test your estrogen levels. If you are in menopause, they are low.

You mentioned that you were tested for autoimmune markers. Wondering if you might tell us a little bit more about that. Did you test thyroid antibodies, celiac, gluten sensitivity and were they all negative?

One thing I can tell you from personal experience is that it is unlikely you will regain your bone density with a natural approach. It's just not the way nature works. When I was first diagnosed I was determined not to take meds so I doubled down on my health protocol, increasing my exercise, got a standing desk, weighted vest, calculated calcium intake and all nutrients, daily prunes, etc. You name it, I did it. I took a full 2 years to see what I thought would be impressive results and to the contrary, they were devastating. I went from -2.8 in my spine to -3.2. At that point, I knew I had to embrace a medical approach so I went on Forteo. No side effects and a modest gain. After Forteo, I needed to do something to lock in the gains and I chose HRT. I was 62 at the time so not within that optimal safest window but I was about 10 years out of menopause. It felt like the most natural option to me since it's something the body produces, recognizes and uses to protect bone. I've been on them for about 5 years and have mostly stabilized. Banning any health issues, I plan on staying on them for the rest of my life as once you go off estrogen, you lose bone once again. If I end up in that situation, I'll make my decisions then on an appropriate medication to stabilize.

So, the good news is that you've discovered your osteoporosis early. Like you, if I had not insisted on a Dexa at 57, I shudder to think what my bones would have been like at 65, the standard age for recommending a bone density scan (ridiculous!). And like you, I look around at all of my sedentary friends who eat anything they want and their bones are just fine. Some of us are just faster losers than others.

Your questions and concerns about safe movement are appropriate and smart. It's a really good idea to learn how to move and exercise safely. It's a reeducation on what to do and what not to do and it seems you are already thinking very logically about that. I would highly recommend Melio Guide as a reference. Margaret Martin is a physical therapist specializing in osteoporosis (and she has osteoporosis and as an aside, she is on HRT). She clearly lays out a protocol for safe daily movement and exercise. Along with Dr McCormick's book, you'll have all the tools and information you need to make these important decisions and changes to keep yourself fit and safe.
https://melioguide.com/health-guides/
Wishing you the best of luck. Keep us posted!

Thx teb,
I got normal TSH but MD did not order antibodies test.
My tTG IgA and deaminated Gliadin peptide IGA both neg so MD ruled out Celiac and gluten sensitivities.
I am thinking about HRT but my OB/GYN doc said they would only initiate for postmenopausal symptoms and not for osteoporosis due to cancer and blood clotting risks. Teb - how concerned are you about these risks considering you plan to take HRT for the rest of your life? And is it b/c you don’t want to take bisphosphonates?

Personally, I’d ask to re-do the DEXA scan. Those are low numbers. Since you just went through menopause, I wouldn’t compare your numbers with others that are much farther post menopausal, or who have been on medication known to lower BMD.
There has always been a question about accuracy of DEXA scores for small and large frames. Here’s an article from Clinical Diabetes and Endocrinology:
https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-018-0062-7
I would probably investigate to see if in Asia they use a different DEXA score for cut off based on the majority of smaller boned females.

The DEXA machine can also give incorrect values if not calibrated correctly. DEXA scores cannot be compared accurately from year to year if the same equipment is not used - and actually the preference is that the same technician do the text but that is so impractical.
I have had DEXA scans every other year for 15 years (family history of osteoporosis) and only the last two done at MD Anderson were comparable. They have asked that I continue to do my DEXAs there so they can tell whether medication is working or not (I have to travel to get there, so it’s a bit inconvenient but worth it).
I tried oral alendronate but it bothered my stomach. I had a Reclast infusion in 2022, one year later my scores rose significantly!
My scores, I’m 69 this year:

AP Spine (L1-L4)
11/15/2023 69 0.789 -2.3
11/10/2022 68 0.744 -2.8

Femoral Neck(Left)
11/15/2023 69 0.566 -2.5
11/10/2022 68 0.525 -2.9

Femoral Neck(Right)
11/15/2023 69 0.592 -2.3
11/10/2022 68 0.557 -2.6

(hips were low, osteopenia only)

I am probably the loner in that I want my next DEXA done at a different facility. I do not recall any special attention being paid to positioning me. -It seems that I was just to lie on the table for my first and only scan. Being 4'11" and fine boned, I am hesitant to act on one scan.

The cancer risk was way over-hyped from the misrepresented results of the WHI study. The relative risk that was widely reported was a 26% increase. That sounded like a huge increase when in actuality, the absolute risk (which was not widely reported) was about 8 additional cases of breast cancer per 10,000 women. Risk of breast cancer went from 2.33% for those women not on hormones to 2.94% for those taking HRT. There was no difference in mortality rates. In addition, the study was conducted using oral estrogen derived from horse urine along with synthetic progestin. Risks are further reduced with the use of transdermal estradiol and bioidentical progesterone. If you have a history of breast cancer and/or CVD, perhaps there is some concern. I checked out my cardiac risks by getting a CT calcium score and my score was zero, meaning no calcifications in my arteries.

As far as a lifetime on it, who knows what the risk might be? There are no long term studies to determine safety. But my feeling is that I am willing to take the small risks for improved quality of life and maintaining my bones in a more natural way than any of the other meds. The other pharmaceutical options also pose risks so it's a tough choice we have to make. I would rather not take bisphosphonates but after my past experience of losing so much density during my natural trial (and error), I do not close doors. If it ends up that I need it, I would certainly consider it. My biggest regret is not going on hormones sooner as I would have preserved my bone rather than lost so much of it.

If you decide that you want to pursue it, you can use Alloy Health, an online MD based practice that provides a review of your history and prescriptions at a nominal cost (if you live in the US). Or you can have your gyn prescribe for menopausal symptoms vs for osteoporosis.

Good morning @teb. I’m glad to hear another viewpoint as I was wondering if I should stop eating my delicious morning breakfast of homemade granola (puffed kamut, almonds, walnuts, pecans, pumpkin seeds, sunflower seeds baked with a little honey/maple syrup) topped with blueberries, blackberries, bananas, 5 tbl. yogurt and skim milk. That equals about 460 mg of calcium! Then I drink at least one glass of skim milk (300g) a day, and if I don’t get a second glass or substitute that with hard cheese, I take 250mg-500mg of liquid calcium at night. I find I’m taking the supplement at night more often lately, perhaps I should stop and start counting the calcium I get from other sources like broccoli, arugula, clementines, etc. Thoughts? Do you keep a daily tally? What are your primary calcium sources?

@lynn59, it looks like you are working your diet very consciously!

I've been calculating my nutrition for several years now so at this point, I kind of have a feel for whether or not I've achieved my nutritional daily goals. I still like to calculate it sometimes to check in (hey, it's fun!) but I just don't need to as much as in the past. I use the website cronometer.com. It's really terrific as it has the nutritional content of whole foods as well as many of the packaged foods you might buy. In addition, if you have a particular daily meal or recipe that you repeat regularly, you can create a "recipe" for that and it will calculate your nutrition for that meal or recipe. Then you just have to click on that recipe item to add all of the ingredient components at one time. Your daily diary is retained long term so you can track your changes and see your progress if you care to.

I don't consume dairy (or gluten) due to autoimmune issues so it's a little more challenging getting my calcium requirements. I start every day with a heaping serving of sauteed collard greens along with 2 eggs, homemade nut and seed crackers, sauerkraut and some avocado. The collards alone give me a full serving of calcium and along with the crackers, etc, I get almost 400 mg. The rest of the day, I eat lots of dark leafy greens, broccoli or broccolini, canned salmon with bones or sardines (when I can stomach them), almonds, figs, oranges, carrots, etc. I take a spoonful of Eden black sesame paste like a supplement when I need to. Two tablespoons has 35% of your daily dietary calcium need (along with protein, iron and good fats). I often add a Tblsp of blackstrap molasses to a cocoa drink concoction I make. One Tblsp has about 145 mg of calcium along with iron. I drink nettles and peppermint teas daily which are also calcium and mineral rich. If I do need a calcium supplement, I try to take it in smaller doses throughout the day.

One area you might consider is replacing your skim milk with whole milk or better yet, yogurt, kefir or a well-aged gouda (has one of the highest amounts of vitamin k in cheese). There is mounting evidence that whole fat dairy offers benefits over skim, fermented full fat dairy being the best (but who knows, nutrition "evidence" is constantly evolving!).

A study published in the British Medical Journal determined that "Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of Metabolic Syndrome and most of its component factors, and with a lower incidence of hypertension and diabetes."
Quite compelling!
https://drc.bmj.com/content/8/1/e000826

Hi @teb …. What a delicious breakfast you prepare for yourself. I love that idea as an alternative to my regime, especially on weekends. I love sautéed greens and used to do spinach, dandelion and Swiss chard combined, but due to the high oxolates in spinach I’ve stopped making it. I’ll look for collard greens today and prepare a bunch. I don’t like sauerkraut or sardines unfortunately, and I’ve been having a hard time finding canned salmon with bones … they all seem to be canned without bones now. Thanks for the other tips too … I’ll look into all of them. Snacking on edamame or putting them in salads is another great option. I have also started eating 5 prunes a day, as there are several studies which link it to stronger bones due to their anti-inflammatory properties.

oh yes to prunes and edamame!

One tip on collards...most ppl strip the leaves from the stems thinking it's similar to kale. It's really not! The stems are delicious, a little sweet and a nice balance to the slightly bitter leaves. Collards have one of the highest calcium contents of leafy greens and are generally considered low in oxalates so are a really good option!

If you have a Trader Joes nearby, their canned salmon is excellent. It is sockeye and has all of the bones so high in calcium.

Good to know! I always trim my kale stems, but don’t with Swiss chard or dandelions:)