Treating Osteoporosis: What works for you?

Maybe it is just the ppis. I should talk to my doctors. Thanks!!

I didn't think famotidine made osteo worse, thought it was just the PPI's which my stomach doctor took me off of because of my osteoporosis.

Good morning @toni7, that is very good news. I hope the appointment goes well. When you have scheduled visits with clinicians, do you prepare a list of your issues and the questions you have about your condition? I am doing that this morning to prepare for a pre-surgery visit to my surgeon tomorrow. Knowledge is power and this is just one way to make sure you are getting helpful information during your visit.

Good luck and if sharing is OK with you, I will be happy to see the report of your visit.
What day is your appointment?

May you be content and at ease.
Chris

On the effect of body size on DEXA: (caveat, if DEXA shows severe osteoporosis and you are small, you still have concerning osteoporosis and fracture risk)

Source: https://www.inspire.com/windblown/journal/forteo-results/reply/1478797/......... from a poster called "endodoc" who is a physician, presumably an endocrinologist:

"Most patients and most otherwise good physicians who never specifically
studied bone metabolism are unaware of the fact that DXA machines do not actually measure BMD. I realize that sounds bizarre, but it is true. If you look at the units for your BMD values on DXA, they are grams per square centimeter (g/cm2). There is no universe where mass/area equals density. D=M/V, in other words, density equals mass over volume. The DXA measures your BMC (bone mineral content), based on the level of x-rays that reach the detector. More mineral in the path of the beam, less x-rays make it to the detector = higher BMC. Less mineral in the path of the beam, more x-rays make it to the detector = lower BMC.

If DXA machines divided the BMC they actually measure by the volume of the bone scanned, the units would be g/cm3, it would actually be measuring density, and we wouldn't be having this discussion. However, they divide the BMC by the area of the ROI (region of Interest) that the DXA and/or DXA tech puts over the image of your bone; hence, the units are g/cm2. If you've ever seen your hip scan, you will see a rectangle that represents the ROI for the femoral neck sub-region. You will see a smaller square box, either close to the rectangle or touching/partially within the rectangle - that's the ROI for the Ward's triangle sub-region.

The problem with DXA being an areal measurement as opposed to a true volumetric measurement is that, as a result, it systematically over-estimates BMD on individuals whose bones are larger than average (think: those 5'10" gals with the the big wrists who played rugby in college), and systematically under-estimates BMD in individuals whose bones are more petite than average (think: those 5'2" gals with the the small wrists and ankles who did ballet in college).

Because of the confound of bone size on DXA, many smallish women have t-scores of < -2.0 when they are at their peak BMD at age 25. So if their T-score is -2.5 at the time they enter the menopause, it's likely (absent other risk factors, like bone toxic drugs or diseases) to represent an approximation of their peak bone mass. Most non-expert physicians, however, make the idiotic assumption that "everyone starts at average" (trust me, half are above and half are below, and with DXA it's only the big-boned folks who are above), so they interpret your baseline T-score of -2.5 at age 50 as if you've already lost 2.5 SD [standard deviations] of your bone mass. This is absurd."

ps this also explains why the heavier strontium makes DEXA look better than it is. Also please don't use this info as a reason to avoid meds if meds are needed!

On the effect of body size on DEXA:

Source: https://www.inspire.com/windblown/journal/forteo-results/reply/1478797/......... from a poster called "endodoc" who is a phyician, presumably an endocrinologist:

"Most patients and most otherwise good physicians who never specifically
studied bone metabolism are unaware of the fact that DXA machines do not actually measure BMD. I realize that sounds bizarre, but it is true. If you look at the units for your BMD values on DXA, they are grams per square centimeter (g/cm2). There is no universe where mass/area equals density. D=M/V, in other words, density equals mass over volume. The DXA measures your BMC (bone mineral content), based on the level of x-rays that reach the detector. More mineral in the path of the beam, less x-rays make it to the detector = higher BMC. Less mineral in the path of the beam, more x-rays make it to the detector = lower BMC.

If DXA machines divided the BMC they actually measure by the volume of the bone scanned, the units would be g/cm3, it would actually be measuring density, and we wouldn't be having this discussion. However, they divide the BMC by the area of the ROI (region of Interest) that the DXA and/or DXA tech puts over the image of your bone; hence, the units are g/cm2. If you've ever seen your hip scan, you will see a rectangle that represents the ROI for the femoral neck sub-region. You will see a smaller square box, either close to the rectangle or touching/partially within the rectangle - that's the ROI for the Ward's triangle sub-region.

The problem with DXA being an areal measurement as opposed to a true volumetric measurement is that, as a result, it systematically over-estimates BMD on individuals whose bones are larger than average (think: those 5'10" gals with the the big wrists who played rugby in college), and systematically under-estimates BMD in individuals whose bones are more petite than average (think: those 5'2" gals with the the small wrists and ankles who did ballet in college).

Because of the confound of bone size on DXA, many smallish women have t-scores of < -2.0 when they are at their peak BMD at age 25. So if their T-score is -2.5 at the time they enter the menopause, it's likely (absent other risk factors, like bone toxic drugs or diseases) to represent an approximation of their peak bone mass. Most non-expert physicians, however, make the idiotic assumption that "everyone starts at average" (trust me, half are above and half are below, and with DXA it's only the big-boned folks who are above), so they interpret your baseline T-score of -2.5 at age 50 as if you've already lost 2.5 SD [standard deviations] of your bone mass. This is absurd."

ps this also explains why the heavier strontium makes DEXA look better than it is

Calcium citrate is recommended.

Omeprazole is really intended for short term use but docs never seem to prescribe it that way. I have personally taken my mother off three times when I see it unexpectedly in her med list.

I would think baking soda would have the same issue of triggering an increase in acid production. Your body wants to have acid for digestion. I think using baking soda or pepcid/zantac would be fine is uses as needed but not all the time. As I said, I don't eat after 5 and that helps some.

Which is the preferred supplement for osteoporosis? Calcium Citrate or Calcium Carbonate?

Does your doctor have any helpful ideas for the T-12 pain? Is it something that will ease with healing?

Hmmm, thanks.

I hope that I didn't give bad advice. But here's an article from Mayo Clinic that gives much more information for anyone contemplating trying baking soda in lieu of prescription and OTC acid blockers. And, as always, its best to check with your doctor.

Sodium Bicarbonate (Oral Route, Intravenous Route, Subcutaneous Route)
https://www.mayoclinic.org/drugs-supplements/sodium-bicarbonate-oral-route-intravenous-route-subcutaneous-route/side-effects/drg-20065950?p=1

How tall are you? There is evidence that shorter women will pretty much always show a low Dexa result and that the baseline for shorter women should be adjusted down from the "standard" one-size-fits-all charts.