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Art S
08-24-2003, 07:28 PM
"Dot S" <quailwomn@webtv.net> wrote in message
news:6466-3F48FCF9-231@storefull-2135.public.lawson.webtv.net...
>
> Hello. I was SO glad to find this group. I am a 58-year-old caucasian
> female with very small bones. I have never taken hormones. I was
> recently diagnosed with osteopenia, which was probably caused by my
> sedentary lifestyle, due to fibromyalgia and chronic depression.
>
> My T-scores:
>
> Spine -.863
> Left Hip -.899
> Right Hip -1.176
> Left Femur -1.593
> Right Femur -1.559
>
> The nurse gave me the results of the test over the phone, and told me
> that the doc said I "could" take Fosomax, and that I should repeat the
> scan in two years. I can't take Fosomax because of swallowing issues,
> but should they be more concerned? Should I repeat the scan in a year?
> The nurse didn't even suggest taking calcium, just gave me the facts. I
> have lost 3/4" in height.
>

Ouch! First, you don't say what your doctor's expertise is. If you've lost
3/4" in height, there is an excellent chance that you've had compression
fractures of the spine, which make the bone density of the spine appear
higher than it really is. See
1) http://courses.washington.edu/bonephys/mis/mist1.html (sorry
about the format).

2) http://courses.washington.edu/bonephys/opclin.html#vfx

So the first recommendation is to track down a doctor who treats a
substantial number of people with Osteoporosis. The most likely
specialties are Endocrinology and Rheumatology, with the Endocrinologist
being the most likely to have the additional expertise. Either bring a copy
of your DEXA, or have it sent to the doctor before your visit. (Note: it
can take a few months for a new patient to get an appointment with either
specialist - make that appointment NOW!). Mention the concern that
you may have had some compression fractures so that they actually look
at the image with that in mind.

Second recommendation: Until compression fractures have been ruled
out, be careful about lifting heavy objects. When you see the specialist,
try to get an idea of what you can lift safely (most give very general
advice, so this may prove difficult.)

Suggestion: You don't say what your swallowing issues are. Can you
take Actonel instead? Alternatively, see if you qualify for Forteo (which
is injected).

Other websites to look at:

1) http://uwcme.org/courses/bonephys/index.html
2) http://courses.washington.edu/bonephys/
3) http://www.geri.duke.edu/pepper/osteocurriculum/index.html
4) http://www.nof.org/
5) http://www.nursece.com/onlinecourses/9006P2.html
6) http://www.osteo.org/


> I ordered a "Pilates for Osteoporosis" video. Are these very mild
> exercises really able to build bone mass?

The general rule of thumb is that your body will store all of the fat it
can, to protect it from food shortages in the future, while trying to
avoid building lean mass (bone and muscle) as much as possible because
they take resources to support.

Your bones get stronger when placed under stress: if you lift a heavier
weight than they are used to (have adapted to) of have a heavier impact
(from walking, jogging, running, jumping) than they are used to, they
will compress microscopically. When they do so, they will change
their electric charge, and attract calcium ions.

Depending on what your bones have adapted to, and how intensly you
exercise, pilates may be enough to stress your bones.

> They concentrate on the hip
> and spine - what about arms, wrists, ankles, etc?

If you don't stress the bone, it probably won't increase in density.

> The video doesn't say
> how often to do these exercises - can I assume three times a week?
>

Depends on your condition and how intensly you exercise. I would
start three times a week. If you aren't using heavy weights (and you
probably shouldn't be, for the moment) then when you are used to three
times a week, expirement with four and then five times a week.

> I am highly motivated to get serious about my health, and plan to begin
> a walking program, exercise, and making some radical diet changes. I
> will have to start very slowly with the walking because I have panic
> disorder and anything that makes me feel short of breath scares me and I
> quit. Everything seems so complicated! My diet is really horrible, and
> I know better. I need to lose about 50 pounds. How can I do this
> without worsening my osteopenia? BTW, I am a vegetarian, and don't do
> dairy, but am going to begin eating salmon twice a week.
>

Rule of thumbs: to lose weight, eat fewer calories than you expend. To
do so safely, make sure you are getting sufficient protein, essential fats,
minerals, etc. Track what you eat and what it is composed of, and see
what you can cut out. Usually during the first go-round it is fairly easy:
reduce processed sugars and fats (cookies, sodas, cakes, etc.) You
can use www.fitday.com to track your diet and exercise.

> I am confused about lifting. I understand that we aren't supposed to
> lift anything heavy. Does that apply to me, or is my condition that
> serious yet? I care for my 18-month-old grandson during the week, and I
> lift him regularly - he weighs about 30 pounds. Is this OK?

Sorry - nobody here will know for sure. See a knowledgable specialist.

> I have
> learned not to try to lean forward and grab him out of his highchair,
> because that causes lower back pain right away.

That is _probably_ due to weak back muscles rather than Osteoporosis
or Osteopenia. Exercising should help. As soon as the doctor gives
his/her approval, I would start using weights, though. Take a look at
http://www.orthoassociates.com/spine_recovery_protocol.htm

> I do carry him down a
> flight of stairs after his naps, holding onto the railing with my right
> hand, and with him on my left arm. If lifting is bad, how do the weight
> lifting exercises work? Can anyone recommend a video? I am not able to
> get to a gym, and I have never had any luck exercising out of a book. I
> need to know exactly what to do, how many repetitions, etc, and how
> often.
>

The first key is to not overdo it. Start slow, and build up gradually.

I haven't seen the video, and can't judge how good it is, but take a
look at http://www.bonesandbalance.com/index.htm

For bodyweight exercises, take a look at
1) http://b_movie.tripod.com/in_shape.htm


If your doctor approves using weights and you are willing to buy them
(try garage sales and used sporting goods places, like "Play it again Sports")
take a look at:
1) http://www.stumptuous.com/weights.html and
2) http://www.exrx.net/ (note: exrx.net has some good clips and information,
but it also has a tendency to use poor form in some of the more difficult
exercises like squats and deadlifts.)

> I am seeking a calcium/magnesium citrate supplement, but can't find one
> that doesn't contain Vitamin D, which I already get in a powdered
> vitamin/mineral supplement that I don't want to stop taking. Does
> anyone know of a brand I can take? They would have to be chewable or
> liquid.
>
> My mother died of osteoporosis (her entire spine collapsed), so I want
> to treat this aggressively (by natural means, as much as possible).
> This is a real wakeup call for me - I have been ignoring my health for
> way too long. I'm sure I'll have many more questions. I will greatly
> appreciate any help you can give.
>
> Dot

Good luck.

Let us know how it goes.

Art

Art S
08-27-2003, 01:28 AM
"Dot S" <quailwomn@webtv.net> wrote in message
news:4871-3F4AFD2B-507@storefull-2131.public.lawson.webtv.net...
>
> Art wrote:
>
>
> >If you've lost 3/4" in height, there is an
> >excellent chance that you've had
> >compression fractures of the spine,
> >which make the bone density of the
> >spine appear higher than it really is.
>
> "Ouch!" is right. That's a scary thought. What kind of test would I
> need for those fractures to show up - a regular x-ray? Wouldn't I be
> having a lot of pain? I don't have any "rounding" of my back. If I did
> have any compression fractures, what would change by my knowing about
> it?
>

A knowledgable doctor can read it on the DEXA.

What would it change? It would mean that you should act as though
you have severe Osteoporosis, rather than minor Osteopenia.

> >So the first recommendation is to track
> >down a doctor who treats a substantial
> >number of people with Osteoporosis.
>
> No endocrinologists around. There are rheumatologists. I will look
> into that.
>

If you don't have any on your insurance plan, try to negotiate with one
who isn't on the plan for a discounted rate. It looks like you need someone
more knowledgeable than your GP.


> >Second recommendation: Until
> >compression fractures have been ruled
> >out, be careful about lifting heavy
> >objects.
>
> Uh-oh. I don't see how I can get out of lifting my grandson, although
> it doesn't seem to cause me any strain. I've been lifting him since he
> was a small baby (kind of like the farmer who lifts the calf over the
> fence every day and ends up lifting a cow : ))
>

Your life, your call.

A question for you, though: if you have compression fractures, what
caused them?

> >Suggestion: You don't say what your
> >swallowing issues are. Can you
> >take Actonel instead? Alternatively, see
> >if you qualify for Forteo (which is
> >injected).
>
> My swallowing issues are such that I am not able to swallow any kind of
> pill at all. Do you think (baring possible compression fractures), that
> my condition is really bad enough to require medication?
>

If you have compression fractures, then I think it is highly likely. (That
is why you need a knowledgeable doctor. Nobody in this news group
knows enough [both about you and your situation and Osteoporosis in
general] to be able to make a diagnosis).

> >Your bones get stronger when placed
> >under stress: if you lift a heavier weight
> >than they are used to (have adapted to)
> >of have a heavier impact (from walking,
> >jogging, running, jumping) than they are
> >used to, they will compress
> >microscopically. When they do so, they
> >will change their electric charge, and
> >attract calcium ions.
>
> Very good and simple explanation that even I can understand. I wasn't
> really sure how that worked.
>
> >If you aren't using heavy weights (and
> >you probably shouldn't be, for the
> >moment) then when you are used to
> >three times a week, expirement with four
> >and then five times a week.
>
> Weights? This pilates video only consists of mild stretching exercises,
> but claims to build bone.
>

Stretching, in and of itself, won't increase bone density.

> >Rule of thumbs: to lose weight, eat fewer
> >calories than you expend.
> >You can use www.fitday.com to track
> >your diet and exercise.
>
> I mostly need to cut out chocolate and replace with fruits and veggies -
> and get up off the couch. : )
>

As long as you do it. ;^)

> I had been planning to go the CRON route, and was still doing research,
> until this diagnosis. CRON stands for Calorie Restriction with Optimum
> Nutrition, and is the only proven way to extend lifespan. But that
> would require reaching quite a low BMI (I was going to aim for 17.5 or
> 18, which was normal for me until about 10 or 15 years ago). That
> doesn't seem like a very good idea now, so I won't be trying to lose as
> much weight as I had thought.
>

BMI only works for the "standard" body. If you get to the point where
you are building muscle, BMI is less meaningful. For people with low
body fat, it is outright wrong, because it assumes that most of your mass
is fat. If you get to that point, you will need to use calipers, and go off of
% body fat, and not BMI.

> Here is a database where you can look up the nutritional content of any
> food: http://yarrow.best.vwh.net/Usda_data/foods_db.html
>

If it does what you want, fine. www.fitday.com lets you track over time,
not just look up the contents of a food.

> Thanks for all the great information. It will take me a while to
> assimilate all of it, I'm sure. Whew! Got a lot of reading ahead of
> me!
>
> Dot
>

Enjoy.

Art