Does reducing dosage of steroids help recover from low bone density?

Posted by rogerscott8562 @rogerscott8562, Jan 13 11:48pm

Many years of steroids may have caused my low bone density. I am an 80 year old male in pretty good heath. The steroids are for treating lung diseases. What treatments work best? I increased my dosage of Calcium citrate with Vitamin D3 from 1 tablet to 3 tablets per day. I will start alendronate on Tuesday. My diagnosis was early this week. Weight training?

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@gently

you know rogerscott all these other remedies are important. And you could add vitamin K2. But 3% increase in bone density is a geater increase in prevention of fracture. I have the opinion that you won't get any % with the other important remedies. You need the steroids, so give yourself a chance with these great OP drugs that all these researchers have spent their lives making available so that you won't have to have a devastating fracture that could upend all your exercise ambitions. You'll still be able to take your vitamins, though.

All this without a medical degree and not even knowing your OP numbers might be a little much.

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So far, reducing steroids is OK. But, just started a few days ago.

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@gently

roger, when you first begin steroid use bone loss is caused by an increase in osteoclasts. With long term use steroids reduce the number and the life span of osteoblasts. Reducing the dosage of steroids, would lessen the effect, but may be detrimental to your breathing. Alendronate will address the osteoclasts; it doesn't build bone. It allows your body to preserve the bone you have. I don't know your numbers, but think you would be better served by a drug that addresses both aspects of bone quality building bone and reducing loss. Both Forteo and Tymlos are drugs you might ask your physician to consider.

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Here are my test results. Any ideas now?

BONE DENSITOMETRY (DEXA)

CLINICAL: Screening for osteoporosis. History of prior
fractures. History of long term steroid medication use for
treatment of asthma.

PROCEDURE: Bone densitometry, Standard.

BONE DENSITY:
-----------------------------------------------------------------
Region BMD T-score Z-score Classification
-----------------------------------------------------------------
AP Spine(L3, L4) 0.743 -3.5 -2.3 Osteoporosis
Femoral Neck (Left) 0.533 -2.9 -1.4 Osteoporosis
Total Hip (Left) 0.638 -2.6 -1.5 Osteoporosis
Femoral Neck (Right) 0.461 -3.4 -1.9 Osteoporosis
Total Hip (Right) 0.565 -3.1 -2.0 Osteoporosis
-----------------------------------------------------------------

10-year Fracture Risk:
-----------------------------------------------------------------
FRAX not reported because:
Some T-score for Spine Total or Hip Total or Femoral Neck at
or below -2.5
-----------------------------------------------------------------

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@gently

roger, when you first begin steroid use bone loss is caused by an increase in osteoclasts. With long term use steroids reduce the number and the life span of osteoblasts. Reducing the dosage of steroids, would lessen the effect, but may be detrimental to your breathing. Alendronate will address the osteoclasts; it doesn't build bone. It allows your body to preserve the bone you have. I don't know your numbers, but think you would be better served by a drug that addresses both aspects of bone quality building bone and reducing loss. Both Forteo and Tymlos are drugs you might ask your physician to consider.

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My test results are attached to another comment. Any change or addition to what you wrote?

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@rogerscott8562

Thanks for the education. I did not realize osteoclasts have a positive function. I need to talk with my doctor about my options. I first need find out my tolerance fore alendronate. I start tomorrow when I can access my doctor in case I have a bad reaction. I might go back to resistance machines. I have been off them for two years.
Here are my numbers. Let me know how bad they are:
BONE DENSITOMETRY (DEXA)

CLINICAL: Screening for osteoporosis. History of prior
fractures. History of long term steroid medication use for
treatment of asthma.

PROCEDURE: Bone densitometry, Standard.

BONE DENSITY:
-----------------------------------------------------------------
Region BMD T-score Z-score Classification
-----------------------------------------------------------------
AP Spine(L3, L4) 0.743 -3.5 -2.3 Osteoporosis
Femoral Neck (Left) 0.533 -2.9 -1.4 Osteoporosis
Total Hip (Left) 0.638 -2.6 -1.5 Osteoporosis
Femoral Neck (Right) 0.461 -3.4 -1.9 Osteoporosis
Total Hip (Right) 0.565 -3.1 -2.0 Osteoporosis
-----------------------------------------------------------------

10-year Fracture Risk:
-----------------------------------------------------------------
FRAX not reported because:
Some T-score for Spine Total or Hip Total or Femoral Neck at
or below -2.5
-----------------------------------------------------------------

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Roger, if you take alendronate before taking a drug that builds bone the effect of the anabolic drug will not be as effective.
It's L3, L4 that would be most concerning to me. Spinal fractures are the most frightening because that kind of fracture can't heal in its original configuration. The vertebral body loses height even with kyphoplasty --a procedure that attempts to restore the loss. The change in height alters the pressures and balance of your entire spine. Not to speak of the pain.
I wonder that your provider isn't suggesting a stronger osteoporosis medication.
Leg press resistance training is associated with increased vertebral pressures with prevalant injuries to the lower spine.
One trouble with osteoporosis is that your muscles can be strong enough for the weight, but the bones may not be.
You may have secured the decision to take alendronate and I wish you the best results. If you have second thoughts about taking a stronger medication, message your doctor. S/he'd be surprised and might recognize the wisdom.

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@gently

tetris, thanks. I think I got some of the information I 've been looking for from todays video about the relationship between CTX and P1NP. His example was that if your CTX is at 600 your P1NP should be above 50. That seems like too easy a mark to meet. I'd like to just rest contentedly with that information. Doesn't seem quite right.

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Based on skimming an article from NIH, this is relevant to me after 3 or 6 months?

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@gently

Roger, if you take alendronate before taking a drug that builds bone the effect of the anabolic drug will not be as effective.
It's L3, L4 that would be most concerning to me. Spinal fractures are the most frightening because that kind of fracture can't heal in its original configuration. The vertebral body loses height even with kyphoplasty --a procedure that attempts to restore the loss. The change in height alters the pressures and balance of your entire spine. Not to speak of the pain.
I wonder that your provider isn't suggesting a stronger osteoporosis medication.
Leg press resistance training is associated with increased vertebral pressures with prevalant injuries to the lower spine.
One trouble with osteoporosis is that your muscles can be strong enough for the weight, but the bones may not be.
You may have secured the decision to take alendronate and I wish you the best results. If you have second thoughts about taking a stronger medication, message your doctor. S/he'd be surprised and might recognize the wisdom.

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Are you suggesting a stronger medication might help?
I took my first pill of alendronate a few minutes ago. So far, no bad reaction.
If I understand my situation correctly, I have a dilemma. If I discontinue steroids, I risk getting pneumonia again. I have had pneumonia about six times, so it is a real risk. But steroids cause bone loss which can cause a fracture which can substantially reduce the quality and length of my health span.
After a couple months of this treatment, I plan to meet with my doctor to discuss a plan to maximize. Reading the expected lifetimes for people with osteoporosis is sobering. It is way lower than my expectation.

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@rogerscott8562

Are you suggesting a stronger medication might help?
I took my first pill of alendronate a few minutes ago. So far, no bad reaction.
If I understand my situation correctly, I have a dilemma. If I discontinue steroids, I risk getting pneumonia again. I have had pneumonia about six times, so it is a real risk. But steroids cause bone loss which can cause a fracture which can substantially reduce the quality and length of my health span.
After a couple months of this treatment, I plan to meet with my doctor to discuss a plan to maximize. Reading the expected lifetimes for people with osteoporosis is sobering. It is way lower than my expectation.

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Yes, a suggestion. A moderator here is worried that you think I'm a medical doctor in disguise.
Tickles me.
The testosterone , too-- just a suggestion. I hadn't realized that it can help with asthma as well as the bones.

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When someone's health span can be substantially cut, I understand some will become experts in one disease. Testosterone is a possibility. It could make it easier to gain muscle and help with bone density. Nice to know about helping with asthma which might have the effect of lowering reliance on steroids which apparently have several side effects.

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roger, good point. We expect our medical providers to be versed in everything medical; it's impossible. Plus, here are all these researchers making it is difficult to stay abreast of the new information even in a single dedicated field.
For quality of life, patients do well to understand their disease, to question and suggest-- interact with their physicians.
It's great how you carefully read all the links and see how they apply or don't apply to you situation.
You'll do well and it won't be just luck.

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