Although we want to think that osteoporosis medications increase our bone density, it's very common for the bone density tests to stay the same on bisphosphonates such as Fosamax.
On an anabolic agent, like teriparatide (Forteo), bone density should almost always increase unless there is an underlying medical condition causing the bone loss (secondary osteoporosis).
For people on medicine for osteoporosis, the most common cause of continued bone loss is vitamin D deficiency. In children, vitamin D deficiency is called rickets, but it is called osteomalacia in adults. Unfortunately, if you have vitamin D deficiency, taking the 1000 IU vitamin D is not enough to overcome the deficiency in a timely manner.
For example, patients in our clinic with ricketts will get a 50,000 IU dose for 30 days and recheck the blood level. However, it's important to check the level before and during treatment. The National Osteoporosis Foundation recently increased their recommended daily intake of Vitamin D to 800-1000 IU for patients 50 and over. That includes all sources, so if you have vitamin D intake from foods such as milk and cheese, these count towards the total.
It's important to note that that is the recommended total amount needed to prevent deficiency in healthy adults. If you already have deficiency, you will need a higher dose.
Make sure that your physician checks your vitamin D level before you are started on any kind of osteoporosis medication. If you don't have adequate vitamin D, your body can make enough new bone to overcome osteoporosis. Although many labs use 30ng/mL as the lower limit of normal for a vitamin D level, it really should be 40 or more.
About 90 percent of the patients we see (most who have fractures) have osteomalacia (rickets in adults). Also, if you have continued decrease on your Dexa despite religiously taking your medications, you should have a comprehensive metabolic workup for secondary causes--that is, something else is usually going on and several blood and urine tests are usually needed to find out why.
Always consult your physician. I recommend finding a qualified physician in your area who has an interest in osteoporosis. Preferably they will be involved with the NOF or at least aware of its recommendations. You need the best team on your side to beat this disease.
I am often asked by patients "My doctor told me I had a fracture, but that it will probably get better." Sometimes the doctor will tell them that "there is nothing we can do for it." While it's true that some fractures will get better with conservative therapy, many do not. In my opinion, it is important to take into account the amount of pain and suffering the patient has before decided if and when to fix the fracture.
As far as there being "nothing we can do about it", that's hogwash--as my patients know. In fact, if you have pain from a vertebral compression fracture, we can take that pain away in nearly 100% of the cases. There are two reasons doctors would say there is nothing can be done:
1. They don't know about the procedure.
2. They don't have experience with the procedure.
First of all, there is a huge amount of new information bombarding everyone, including doctors, everyday. Although vertebroplasty and kyphoplasty have been around for several years, most doctors haven't had direct experience with the procedure.
There are other doctors who know about vertebroplasty and kyphoplasty for compression fractures, but who have limited experience with it. They trained in an era when there literally was nothing that could be done for vertebral compression fractures (VCF). They have practiced for years when there was no effective therapy. Many are experienced spine surgeons who see how poorly these patients do at surgery, but haven’t had experience with vertebroplasty and kyphoplasty. Why is this? Until recently, the only treatment for vertebral compression fracture (VCF) was bed rest and oral pain medications, and those don't work for all patients. But as we will see in the next post, even these conservative therapies can be dangerous for the patient.
Thus, there are effective treatments for VCF, but most doctors haven't yet seen how effective the treatment is first hand. If you or a loved one are suffering from the pain of a VCF, give us a call. We would love help or refer you to a doctor in your area who can.
Bone pain generally results in aching as well as pain and muscle spasm. For instance, in the case of arthritis, sensory fibers of the joint may respond to sympathetic activity due to inflammation. Most people know someone with arthritis. Sometimes the pain of arthritis is due to joint inflammation, but even this inflammatory response can cause bone pain.
Most body tissues, including bones, produce a number of chemicals and hormones that cause pain. Some examples are substance P, histamine and one class chemicals called prostaglandins. These are all associated with pain. Prostaglandins also play an important role in pain caused by bone metastases.
One of the most common reasons for bone pain is fracture due to trauma or osteoporosis. When normal bones are subjected to abnormal mechanical forces, a fracture can occur. Unfortunately in patients with osteoporosis, even normal mechanical stress can cause a fracture. This can result in disruption of the cortical bone and stimulation of the nociceptive (pain) nerve endings.
Although most people think of bone as a hard, unchanging tissue (like skeletons), our bones are living, active, changing organisms just like other organs. One reason fracture and other causes of bone pain hurt so much it of the exquisite nerve supply. Most of the nerves that cause pain appear to serve the periosteum.
The periosteum is the living, outer lining of bone that serves as a type of covering as well as a a type of anchor site for tendons and ligaments to attach to bone. When you pull a muscle or strain a ligament, much of the pain is associated with the stress on the periosteum and stimulation of the pain fibers there. This also is a factor in many forms of arthritis and the periosteum lines the bone up to the level of the joint.
As such, inflammation, fracture and even other pathological processes to which bone is subjected can result pressure changes which, in turn, results in bone pain. For example, during a bone marrow biopsy, a needle is placed into the marrow cavity and a sample obtained. This causes negative pressure (vacuum) that stimulates the pain fibers. In fact, this procedure is one of the most painful 'routine' medical procedures that we do. It's no surprise, therefore, that people with metastatic cancer or other bone pathology have so much pain.
