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    #1

    Osteoporosis

    I am a healthy 54 year old T6 complete para. I recently had a full body dexascan bone mineral density test and my T-score at the hip is -2.6, which is past osteopenia and into osteoporosis. I already take vitamin D and eat a lot of dairy products. I'm pretty active with work, some sports, and general activities.
    How scared should I be and what can be done? My doctor is useless on issues like this; he sees some old ladies with it but my situation is different. Do bisphosphonates work for people with SCI? Have any studies been done on that? Is there anything else?
    Tags: None
    #2
    There's a good thread in the Care section:

    https://www.carecure.net/forum/showt...t=osteoporosis

    I'd posted a review article about treatment options including biphosphonates and Nurse KLD had some suggestions for Calcium and Vit D supplements.

    http://omicsonline.org/spinal-cord-i...mr.1000127.pdf

    Hope this helps. I've been encouraging my husband to get a Bone Density test so he could explore the possibility of joining a Project Walk program. He takes a Calcium/Magnezium/Zinc combo pill plus 2000 IU of Vit D daily and we hope for the best.
    Last edited by 2drwhofans; 28 Mar 2015, 7:54 PM.

    Comment

      #3
      Have you had your testosterone checked? Low T can also contribute to osteoporosis, and low T is common in those with SCI.

      Comment

        #4
        I have used the tool below to estimate the need for treatment for osteoporosis. I used the tool with a very young SCI patient about a year ago to determine whether to treat for osteoporosis after he had a DEXA SCAN.

        http://www.shef.ac.uk/FRAX/tool.jsp

        pbr
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment

          #5
          I started down this road about two years ago with a scan. With the results, I was put on Fosomax. My body responded by producing kidney and/or bladder stones by the boatload. Taking me off the Fosomax pretty much stopped the stones. My next scan showed little difference in my density scores. Next came Androgel, an expensive testosterone supplement. This raised my PSA enough that I had a prostate biopsy. In the meantime I was taken off Androgel and after looking at Fortea [and I thought Androgel was expensive], I ended up back on Fosomax. I am now scheduled for another biopsy as my Gleason score from the first biopsy indicated close monitoring. I sometimes wonder if I should ever have had that first scan.
          Tom

          "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

          Comment

            #6
            The tool indicates I have a 23% 10 year risk of major fracture and 6.5% risk of hip fracture. This puts me well into the "treat" section of the graph but what does treat mean?
            I have not had testorone checked.

            Comment

              #7
              There is little evidence that anything can be done to treat osteoporosis in SCIs. If you can tolerate bisphosphonates they might be worth a try with monitoring. If you do not find any improvement in a year I would quit. There is some indication that FES might help but the limited research renders this questionable. Healthy bones depend on muscle-bone tension. Standing does not help. Here is an article suggesting that alendronate may help if stated soon after injury. In the end, the best thing we can do is to be careful. I fractured a femur just by rolling on my side with my foot caught in the bed covers.


              http://press.endocrine.org/doi/abs/10.1210/jc.2006-2013
              You will find a guide to preserving shoulder function @
              http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

              See my personal webpage @
              http://cccforum55.freehostia.com/

              Comment

                #8
                The only time I order DEXA scans and treat for osteoporosis in SCI patients is if they are choosing to use a standing frame. I get calcium and Vit D levels on all my patients whether they choose to use a standing frame or not. There are some research studies showing that treatment vitamin d deficiency can help reduce incidence of falls and prevent fractures. There is no good research to treat for osteo in SCI unless you are standing. Sorry I didn't clarify that earlier.

                pbr
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment

                  #9
                  Originally posted by SCI-Nurse View Post
                  The only time I order DEXA scans and treat for osteoporosis in SCI patients is if they are choosing to use a standing frame. I get calcium and Vit D levels on all my patients whether they choose to use a standing frame or not. There are some research studies showing that treatment vitamin d deficiency can help reduce incidence of falls and prevent fractures. There is no good research to treat for osteo in SCI unless you are standing. Sorry I didn't clarify that earlier.

                  pbr
                  Interesting. I try to use a standing frame every day because it helps relieve spasticity and pain. I just had a test and the results show that I've lost 50% of my bone density on my left hip (in comparison to 2 years ago) and only 2% on my right. Strangely my spine has a slight increase in density. I've been taking vitamin D. The results say that significant treatment is needed and I should consult with an endocrinologist. I have taken bio phosphates in the past – but my body did not respond well to them. I had a femur fracture about five years ago and stopped taking Boniva and before that it was Fosamax.

                  So this really nothing that we can do? huh?

                  Should I be concerned about using my standing frame?

                  Comment

                    #10
                    Electro stim and standing everyday, long time perfect nutrtion best chance. Full body vibration too

                    Comment

                      #11
                      Originally posted by SCIfor55yrs. View Post
                      There is little evidence that anything can be done to treat osteoporosis in SCIs. If you can tolerate bisphosphonates they might be worth a try with monitoring. If you do not find any improvement in a year I would quit. There is some indication that FES might help but the limited research renders this questionable. Healthy bones depend on muscle-bone tension. Standing does not help. Here is an article suggesting that alendronate may help if stated soon after injury. In the end, the best thing we can do is to be careful. I fractured a femur just by rolling on my side with my foot caught in the bed covers.


                      http://press.endocrine.org/doi/abs/10.1210/jc.2006-2013
                      Wow that's retarted, how did you know you fractured it?

                      Comment

                        #12
                        Chaz, your picture is classic for what is found in SCI. Passive standing does not appear to prevent or improve osteoporosis in SCI, and neither do biphosphanates from most studies. There is some promising research on FES combined with the drugs, and with standing on a vibrating plate of the right amplitude and frequency.

                        You should discuss your continued use of passive standing with your SCI physician to determine if it is still safe for you to do so without risking breaking a leg in the process.

                        Diagnosing a fracture after SCI can be difficult. Sometimes you hear it snap (I have been in the room with a client when this happened and we knew what it was right away). The leg may be swollen, and AD can occur after several hours. Other rule-out diagnoses must be eliminated including DVT and HO, and an Xray is the only real way to determine there is a fracture or not.


                        (KLD)
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment

                          #13
                          Should I even be taking biphosphates if I only go to physiotherapy twice a week? Basically stand in a lokomat for 30 minutes and FES bike once a week for 30 minutes.

                          Comment

                            #14
                            Rather than discussing osteoporosis with your primary care physcian, I recommend consulting an endocrinologist. I see one at UCSF.

                            All the best,
                            GJ

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